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Nov 03, 2014

Ebola: US, UK demand AUSMAT teams

Ebola: US, UK demand AUSMAT teamsTHE US and Britain have made specific appeals for Australia to send personnel to fight the Ebola epidemic in West Africa, despite the government’s insistence that it won’t send Australians into harm’s way.Senior foreign affairs official Blair Exell revealed the requests from Australia’s two closest allies at a Senate estimates committee hearing today, adding they were still being dealt with.The departmental first assistant secretary said Britain had sought Australian personnel for its Ebola effort in Sierra Leone in a letter to Foreign Affairs Minister Julie Bishop at the end of September.The US made an initial request for a liaison officer about the same time, but has since expanded its request to include an unspecified number of support personnel and a bigger contribution of funds via the UN, he said.The revelation comes as the government is under pressure to allay doubts about its preparedness to mount a rapid medical response to an outbreak of Ebola in the Asia-Pacific region.So far the government has fended off pressure from aid groups to fight Ebola in Africa, saying Australia could not evacuate people from Africa and it would instead maintain a regional focus on the disease.But Australia’s chief medical officer, Professor Chris Baggoley, yesterday cast doubt on the preparedness of a regional response, saying no Australian medical assistance team had been selected and given specialist training to deal with Ebola or the use of elaborate personal protective equipment to avoid infection.“We’ve not trained the AUSMAT team specifically in personal protective gear,” Professor Baggoley told a Senate estimates committee on Wednesday.To prepare AUSMAT health workers and logistic support staff for regional deployment would take up to two weeks, he said.Health Minister Peter Dutton said the National Critical Care and Trauma Response Centre in Darwin had trained clinical staff in Ebola-specific personal protective equipment who could be deployed at short notice.“On standby are infectious diseases and emergency specialist doctors and nurses who could be deployed from Darwin. They are vaccinated and heat-acclimatised for a four-week deployment.”Labor’s deputy leader Tanya Plibersek said today the best way of protecting Australians against Ebola would be to join the fight against the epidemic at its source in West Africa.“I think it’s obvious that if we don’t contain Ebola in West Africa this becomes a greater risk, not just to the African continent but to the world more generally.” Greens senator Richard Di Natale expressed concern about the preparedness to deal with a regional emergency. “We had the prime minister go to PNG and state… we’re ready to help, should there be an outbreak on our doorstep,” Dr Di Natale said, adding such a mission would require “very specific skills and expertise”.

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Nov 03, 2014

Australia’s Ebola ban ‘discriminatory’

WEST African leaders are dismayed at Australia’s decision to close its doors to people from Ebola-hit nations at a time when rotations of international medical help are needed more than ever before.Australia is the first developed country to adopt such a ban, with the government announcing yesterday that it had stopped processing visa applications from people in Sierra Leone, Liberia and Guinea.Liberia's president Ellen Johnson Sirleaf said the travel ban would hurt Ebola relief efforts."Any time there's stigmatisation, there's quarantine, there's exclusion of people, many of whom are just normal, then those of us who are fighting this epidemic, when we face that, we get very sad," she told a news conference.Australia’s decision came after the US military imposed mandatory 21-day quarantine on soldiers returning from Ebola relief work. Australian states are also reviewing quarantine measures. The World Health Organisation fears travel bans and tough quarantine measures will deter doctors and nurses from joining the battle against the epidemic at its source. World Bank chief Jim Yong Kim said yesterday the three worst-hit countries needed 5000 overseas health workers at any one time."Those health workers cannot work continuously: there needs to be a rotation. So we will need many thousands of health workers over the next months to a year in order to bring this epidemic under control," he said at an African Union meeting in Ethiopia on Tuesday."Right now, I am very much worried where we will find those health workers."In Australia, AMA president Associate Professor Brian Owler said adopting stricter quarantine of personnel would be a significant deterrent.“It is going to discourage people from going and doing this work,” Professor Owler told ABC Radio. “They'll obviously have to give up weeks before they go and are deployed in terms of training, but also they'll be over there already for most cases about four weeks, so adding another three weeks of isolation overseas – presumably in West Africa – is going to mean more disruption. “I think it would actually be much better and safer for them to be at home, here, provided when they travel they obviously show no sign [or] symptoms of the disease, and then, in that case, they'd be quite safe.”Anthony Banbury, head of the UN Mission for Ebola Emergency Response, said the need for skilled medical personnel was critical.“What we need the most are foreign medical teams, trained personnel who cannot only work in Ebola treatment units, but who can manage them, the complex systems that need to be followed in a very strict way to ensure good infection control, treatment of the people,” Mr Banbury said. “We need them and we need them fast.” Meanwhile, Ugandan government spokesman Ofwono Opondo said: "Western countries are creating mass panic which is unhelpful in containing a contagious disease like Ebola."

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Nov 03, 2014

Rural classification system scrapping applauded

GPs have hailed the federal government’s move to scrap its rural classification system and adopt a fairer model of cash incentives for doctors in the bush.Assistant Health Minister Fiona Nash announced the long-anticipated reform at the Rural Doctors Association of Australia annual conference in Sydney today.The pledge comes after a long-running campaign by rural doctors to abolish Australian Standard Geographical Classification (ASGC), under which some regional centres drew better incentives for doctors than smaller rural outposts. RDAA president Dr Ian Kamerman said the rural classification system was responsible for some “great inequities in the ways ‘rurality’ has been identified, resulting in a maldistribution of doctors”. The new modified “Monash model” is evidenced-based and would be fairer to many small rural towns, Dr Kamerman said.“Under the new system, towns like Charters Towers and Cairns, or Gundagai and Wagga Wagga, will no longer be classified as equally rural, but rather will be given a rating that more accurately reflects the circumstances in these communities,” he said.The AMA greeted the announcement as a “major breakthrough”.Senator Nash also revealed changes to the District of Workforce (DWS) program, which Dr Kamerman said were “well overdue”. The government will use the latest population data and medical services data to more accurately determine which town is the most under-serviced, she said.“The new updated data will more properly reflect the true situation in areas when determining their DWS status,” Dr Kamerman said.“There will also be a change to the timing arrangements from a three-month to a 12-month interval, with some flexibility built in. This will give a lot more certainty around the employment factors affected by DWS status.”A committee will be established to work on details of the policy changes, the minister said. The RACGP’s National Rural Faculty hopes to be consulted as part of the committee to achieve a better needs-based system. RACGP NRF Chair, Dr Ayman Shenouda said: “Refining the DWS system by aligning it to an improved rural classification system will help provide more equitable outcomes and improved service continuity for smaller rural and remote communities.” The General Practice Rural Incentives Program (GPRIP) will be one of the first programs to be affected by the reforms. The panel will report back to the government on how the GPRIP should be redesigned to ensure incentive payments are targeted at getting doctors to areas of greatest need, Senator Nash said.

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Nov 03, 2014

Isolation no protection from Ebola: WA scientist

AUSTRALIA cannot be protected from Ebola by isolating itself, a West Australian scientist has warned ahead of his journey to West Africa to combat the outbreak of the virus.Doctor Tim Inglis, a medical microbiologist at the University of WA, says the debate about how to respond to the virus is being undermined by media hype and political panic."When science is lacking, the default response to infectious disease is often fear," Dr Inglis wrote in an article published in Nature.The federal government has so far refused to send help, citing the lack of evacuation processes to ensure the safe return of infected Australians.But Dr Inglis says if Ebola is brought home by health workers, it can be managed and is an acceptable price to pay for combating the disease at its source."The real issue is that the threat to Australia, the United States and other developed countries will be much higher in six months. The best defence is to act now and in Africa."Dr Inglis and his team will test their mobile laboratory in northern WA before travelling to the fringes of the worst-affected region of West Africa by the end of the year to assist efforts to diagnose the disease.He said testing at the edge of the outbreak zone would take diagnosis to where patients were likely to become infected next, rather than sending people or blood samples to where the disease was concentrated.Dr Jennifer Todd (PhD), a senior lecturer at the University of Wollongong, said scientists and healthcare workers should be praised for going into the zone, rather than being criticised."These people are quite aware of the risks they are taking and the potential for infection, however they go hoping to stop the slow march in advancing cases," she said.Associate Professor Sanjaya Senanayake, an infectious diseases physician at the Australian National University Medical School, says Ebola is not easy to contract.A study examining household contacts of Ebola patients during an earlier outbreak found that only about one in six became unwell, which was low compared to an infection like measles, she said.But Professor Nikolai Petrovsky, the director of endocrinology at the Flinders University School of Medicine, is less convinced that sending scientists to the frontline will help.Professor Petrovsky said efforts should be directed at developing successful vaccines."If current public health efforts to quarantine and prevent further transmission fail over the next few months, then only an effective prophylactic vaccine is going to prevent a major humanitarian crisis evolving in west Africa over the next year," he said.Unlike influenza, Ebola was a relatively stable genome that was not evolving rapidly or becoming more transmissible, although that was still possible in the future, he said.US President Barack Obama today praised “heroic” US health workers battling Ebola in Africa, saying they deserved to be treated with dignity and respect and applauded for their service.

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Nov 03, 2014

GPs’ ASGC-RA overhaul demand

GP LEADERS have called on the government to overhaul the classification system used to determine rural health workforce assistance and incentive payments to better address the needs of rural and remote communities.Following a meeting earlier this month, GP umbrella body United General Practice Australia (UGPA) has called for the controversial Australian Standard Geographical Classification – Remoteness Areas (ASGC-RA) system to be restructured to reduce perceived maldistribution of funding and incentives.The group called for a review of the system to be expedited so that long-awaited improvements could be made.Since the system’s introduction in 2010, the RDAA has received feedback from communities negatively affected by the model, arguing it has unfairly equated larger more attractive regional centres with remote towns.As a result, many small towns in need of GPs say they have found it difficult to compete for doctors.In a statement, UGPA said the ASGC-RA had resulted in inefficient use of incentive funding, and called for a new model devised by researchers at Monash University to be adopted in its place.RDAA president Dr Ian Kamerman said the Monash Model would more appropriately factor in population levels and other parameters.

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Oct 19, 2014

AMA calls for emergency meeting on Ebola

THE AMA has urged Prime Minister Tony Abbott to convene an emergency meeting of public health experts to review Australia’s preparedness for dealing with Ebola after a second US nurse tested positive for the virus.“Just because we haven’t had a case yet doesn’t mean we won’t get one,” AMA president Associate Professor Brian Owler said. “If the situation in west Africa gets further out of control, the chances of it coming to Australia escalate.” Confirmation that a second nurse at the Texas Health Presbyterian Hospital in Dallas is infected with Ebola has shaken confidence that western health systems can deflect the disease, prompting President Barack Obama to call a crisis meeting in Washington. Associate Professor Owler told MO: “The events overnight really do give pause for concern and it is time for us to reconsider everything we are doing in this country at a GP level and at a hospital level to make sure we are on track. “We need to elevate this issue to the same level of concern in Australia. “The prime minister and the health minister really need to convene a group of public health and infectious disease experts to look at how we deal with things here, and also our response to healthcare workers returning from west Africa."In the latest US case, nurse Amber Vinson, 29, was diagnosed with Ebola on Tuesday after reporting a fever. Professor Peter Collignon, an infectious disease expert at Australian National University, says all Australian hospitals and clinics need to be prepared, aside from the state-designated hospitals for Ebola control. “There is no way [an Ebola patient] is just going to turn up to a designated hospital in Sydney from rural NSW because they are sick. The reality is you have got to get them there, and everyone along the line has to protect themselves,” Professor Collignon said.“We have to have the ability to keep [health practitioners] safe for a period of time with an infected person, which might mean several hours.”Professor Collingon said current thinking was that an Ebola case presenting with fever but no vomiting or bleeding was of “minimal risk” to others. “The available evidence from 1975 on Ebola is the people who get it are the ones who come in contact with a lot of bodily secretions, and if you get enough resources into those areas – gloves, gowns, protective equipment – you can stop it.“Nigeria had 20 cases but stopped the disease,” he said. “Of course, that doesn’t mean you can stop an individual nurse from getting it.”

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Oct 19, 2014

Health authorities meet on Ebola controls

AUSTRALIAN authorities will look at stepping up infection-control training for doctors and nurses and tougher quarantine measures to stave off the threat of Ebola.The nation’s chief medical officers are meeting today to conduct a sweeping review of the hospital system’s preparedness for a possible Ebola case presenting in Australia, after nurses in the US and Spain contracted the virus from patients.“There are lessons to be learned out of Texas and indeed Spain, and we need to look at the training that’s provided to the nurses and to the doctors that are using the personal protective equipment,” Health Minister Peter Dutton said.The review comes after two nurses were infected at a Dallas hospital despite wearing protective equipment as they cared for a Liberian Ebola patient who had walked in off the street. Highlighting the system’s failure, one of the nurses had taken a domestic flight the day before her diagnosis.The AMA has demanded a complete review of Australian preparations, from the level of GPs’ surgeries to emergency rooms and isolation facilities at designated Ebola hospitals in major cities.AMA president Associate Professor Brian Owler said training should not be restricted to drills for healthcare workers in putting on and taking off cumbersome protective equipment. “Cleaners in the hospital need to know the right procedures. How [do they] respond in terms of waste management? What’s the response at the front door of the emergency department? How is the rest of the hospital handled if there’s a case isolated?”Stepped-up immigration and quarantine controls will also be on the meeting’s agenda after the World Health Organization forecast that new Ebola cases would reach 10,000 a week in two months without urgent action to contain the epidemic in West Africa.Queensland’s Health Minister Lawrence Springborg has demanded mandatory reporting and tracking of travellers from the Ebola zone during a 21-day incubation period. The National Security Council has considered mandatory isolation for travellers from Ebola hot spots, and Immigration Minister Scott Morrison has said controls could be tightened swiftly.Mr Dutton revealed today the government has a strategy to send medical personnel to battle any outbreak of Ebola in the Asia-Pacific.“They have the ability to respond rapidly out of Darwin, we have the expertise within our medical workforce here.”But the government continues to reject pleas to deploy a medical taskforce and troops to Africa, saying it would be irresponsible to send them into harm’s way without the means to evacuate them in an emergency.“We are quite rightly and understandably focused on being prepared here at home and in our region,” Prime Minister Tony Abbott said.

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Oct 19, 2014

Toxic’ energy drinks leading to problems in kids

THE health impact of energy drink consumption in children and teens is slipping under the radar, experts warn in calling for stricter regulation of the products.The consumption of energy drinks, particularly mixed with alcohol, is rising and doctors need to be vigilant to recognise presentations of caffeine intoxication, withdrawal and dependence, according to WHO researchers who conducted a literature review.An Australian sleep physician agrees, calling the popular beverage “a toxic substance dressed up as a drink”.The primary concern with energy drinks is their high caffeine content and its faster uptake by the body compared to coffee – which is often hot and consumed more slowly, said the WHO researchers. The authors warned that energy drink consumption was "very high" among adolescents and increasing among children. Seventy-one per cent of young adults who consume energy drinks mix them with alcohol. The "wide-awake drunkenness" that comes from the high amounts of caffeine drunk in tandem with alcohol can mean that individuals are staying awake longer and are more likely to experience adverse consequences to do with sexual assault, being injured, or riding with an intoxicated driver. While Australian food standards limit the amount of caffeine in energy drinks to 80mg/250ml, Dr Seton pointed out that two energy drinks may be the equivalent of 6–7 cups of coffee depending on the size of the cans.But these limits are not enough, according to Dr Seton, a specialist at the Children's Hospital in Westmead, NSW. He thinks that energy drinks need to be restricted in under-18s in a similar way to tobacco and alcohol products. "Any drug that's got potential side effects should be regulated, as drugs are," he told MO."This stuff has just slipped under the radar, because it's not regarded as a drug in the usual drug sense." Asking children or teens what time they go to sleep, what time they wake up, how much they sleep in on the weekend and how many energy drinks they consume could hold valuable information for a GP faced with kids who may appear depressed or anxious, said Dr Seton."It can be more of a red flag," he said. "How much they sleep in on the weekend is a big indicator of sleep deprivation."Meanwhile, Australian public servants have demanded isolation units be set up in Canberra to quarantine officials returning from Ebola-hit regions of Africa, after learning a Department of Foreign Affairs doctor had visited Australian diplomatic posts there.The RACGP expressed confidence yesterday in the federal government’s guidelines for dealing with possible Ebola cases.The Department of Health says people with a history of travel to affected countries in West Africa and fever symptoms should present to public hospital emergency departments.Those with no symptoms "should see your doctor to discuss whether it might be necessary for you to monitor your health, particularly if you think you may have had direct contact with someone who may have had Ebola”, the department advises.

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Jul 24, 2014



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Jul 22, 2014

HIV diagnosis in Australia at 20-year high

THE number of new HIV diagnoses remains at a 20-year high amid concern about increasing levels of unprotected sex among gay men and a decrease in testing rates among this group, according to new surveillance data from the Kirby InstituteIn 2013, 1235 people were diagnosed with HIV, compared to 1253 in 2012. The figures, though stable over the last two years, are the highest since the mid-90s.

There are now an estimated 26,800 people living with HIV in Australia, of those the report suggests one in seven do not know they have the virus. A large number of people also continue to be diagnosed late.

Associate Professor David Wilson, head of the Surveillance and Evaluation Program for Public Health at the Kirby Institute, said around 30% of people are diagnosed well after they should have started treatment.

That indicates that the steady rise in new cases is likely due to an increase in incidence and not just a reflection of more people being tested, according to Professor Wilson.

“The biological markers for HIV in people getting diagnosed give us an indication of how long they’ve been infected and the bottom line is the levels have been stable over time. “The median CD4 cell count, a marker of immunological status, has also remained stable over time. That suggests the increase in new cases is not due to increased testing, it's likely due to underlying increase in incidence."

Dr Limin Mao, senior research fellow at the Centre for Social Research in Health at the University of New South Wales said the key behaviour driving HIV is unprotected sex among men who have sex with men (MSM).

“Over the last 10 years we can see that among MSM unprotected anal intercourse, particularly with casual partners, has continued to increase from around 30% in 2004 to now 38%.”

She added that among men under 25 years there was a small but significant decrease of 2–3% in testing rates.

The majority of people with HIV are MSM, accounting for 67% of all diagnoses, and around12% of people in the gay community have HIV.

While the majority of transmission in Indigenous populations is also through MSM, an increasing proportion is due to heterosexual contact or injecting drug use.

The report shows around 60% of people with HIV are on antiretroviral treatment, and in 60% of those the virus is suppressed.

“This is higher than almost anywhere else in the world and a great achievement. In comparison, in the US the proportion of people on antiretroviral therapy with suppressed virus is about 25%,” he said.

Executive director of the National Association of People With HIV Australia (NAPWHA), Jo Watson said the data showing the late diagnoses of HIV is particularly sobering.

“I think that continues to emphasise the need to keep our foot on the pedal in terms of testing rates and testing frequency being increased as well as the benefit of earlier treatment uptake being promoted.”

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Jul 22, 2014

HIV cases spike following rapid-test push

A PUSH to increase HIV screening in high-risk groups has resulted in a dramatic rise in new cases reported in New South Wales this year.An extra 8200 HIV tests were conducted in NSW in the first quarter of 2014 compared to the same period last year.

Just over 100 people were newly diagnosed with HIV, a 32% increase in notifications compared to the same time last year.

Of these 103 newly diagnosed people, 84% were men who have sex with men and over half were diagnosed within 12 months of when they were likely to have been infected with the virus – a higher proportion than in any of the previous five years.

According to NSW Health Minister Jillian Skinner, the spike in newly detected cases means that the NSW HIV strategy, implemented by the NSW Liberals and previous federal government in 2012, is on track to decrease the spread of HIV in the state.

“We know that by making testing more accessible and encouraging people in at-risk groups to be tested, the number of new diagnoses will increase before it starts to fall again,” she said.

In 2013, the NSW government funded the expansion of rapid HIV testing to 15 additional testing sites bringing the total to 19 sites, including community settings.

NSW Chief Health Officer, Dr Kerry Chant said that the NSW Quarter 1 2014 HIV Data Report indicates that the program is targeting the right settings to reach at-risk populations.

“There’s a lot more to be done but its pleasing to see that we’ve got these settings right. We’ve always expected to see an increase in HIV detections before we see a decline so I'm quite confident that the program is working," she told MO.

She added that up to 50% of HIV diagnoses are made in GP settings and that it remained important for GPs to include HIV screening of high-risk groups in routine practice.

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Jul 22, 2014

Bone marrow transplant clears HIV

TWO Sydney men who were HIV-positive appear to have cleared the virus after undergoing bone marrow transplants to treat HIV-related malignancies.More than three years on, the patients remain free of the virus, although they remain on antiretroviral therapy (ART) as a precaution.Dr Sam Milliken, director of St Vincent’s Haematology and Bone Marrow Transplantation said the patients, who had long-standing HIV infection, had undergone the transplants to treat their cancer and the impact on their HIV status was unexpected. One patient was being treated for lymphoma and the other for secondary acute leukaemia that had arisen from an initial lymphoma diagnosis.The transplants were performed in 2010 and 2011. Around the same time case reports about Timothy Ray Brown, an American who had two bone marrow transplants in Berlin in 2007 and 2008 and became the first person to ever be cured of the virus, had just been published. In his case, the second donor carried both copies of a gene that affords protection against HIV — CCR5-delta32 mutation — which is found in less than 1% of the population. Mr Brown became known as ‘the Berlin patient’. He is no longer on ART and remains clear of the virus.“When we saw the reports, we went back and looked very carefully at our patients. It was then that we discovered that one of the donor transplants carried one copy of CCR5,” said Dr Milliken.However, the second bone marrow donor did not carry any copies of CCR5. Both patients cleared their original malignancies following transplantation but one patient has now developed cancer of the tongue as well as anal cancer.Senior author of the case reports and Kirby Institute director, Scientia Professor David Cooper, said a number of assays have not been able to detect HIV or antibodies to the virus in either patient since the transplant.In Boston, two patients underwent similar bone marrow transplants in 2012 but the transplanted cells did not contain the CCR5 gene mutation. In both cases the virus returned after ART was stopped. While the Sydney results are significant, the researchers stressed that bone marrow transplantation is a difficult and costly procedure that can result in death in 10% or more cases.“You take that risk in someone with lymphoma or leukaemia because they will die without it. For someone with HIV alone, we would certainly not transplant them when they’ve got an almost normal life span with standard ART,” Professor Cooper said.He said research will now focus on understanding how bone marrow transplantation can yield an anti-HIV effect.“If we could reproduce that effect by a simple immune therapy that wasn’t as dangerous as bone marrow transplanting, then we might be able to envisage a long-term cure of HIV.”In 2013, 1235 people were diagnosed with HIV, compared to 1253 in 2012. The figures, though stable over the last two years, are the highest since the mid-’90s.

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Jul 18, 2014

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Jul 18, 2014

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Jul 18, 2014

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Jul 17, 2014

Plan for primary care rapid HIV test

GPs could soon be offering point-of-care HIV tests if the Federal Government accepts a call from sexual health experts.

A review of Australia’s policy on HIV testing, backed by the RACGP, supports the use of tests capable of indicating a person’s infection status “in the clinic within 20 minutes”.

The introduction of a mouth-swab or other rapid-result test would follow similar moves in the US and UK in response to concern over shifting patterns of HIV transmission and late diagnosis.

The Australasian Society for HIV Medicine (ASHM) is writing the revised policy, with stakeholder input, and it is undergoing a final round of consultation this month ahead of its submission to an Australian Health Ministers’ Advisory Committee.

The draft recommends the TGA oversee the selection of a rapid HIV test suited to primary care, as well as training, and guidelines confining the test’s use to “appropriate settings” in areas with high HIV prevalence.

MO understands that one company has sought approval for a test for use in primary care.

The ASHM advice follows concerns up to 20% of HIV-positive Australians do not know they are infected, as well as the rising rates of transmission among heterosexuals and men who have same-sex contact but do not identify as gay.

ASHM chief executive Levinia Crooks said the preferred model would allow a GP to “offer a screen for HIV” to walk-in patients.

“For someone who has found out recently that someone they had quite a lot of sex with some time ago has been infected for quite a while… you could do a test on that person and say everything is fine, in the clinic, within 20 minutes,” Ms Crooks said. “That is a really changed dynamic.”

Positive results would be laboratory confirmed.

RACGP spokesperson Dr Ronald McCoy said the move would boost detection among those people who “come to a sexual health centre probably just once” while the bulk of HIV testing would continue to be done conventionally.

“We’re supportive of having the various options, and our interest is ensuring that there is no compromise in terms of standards around HIV testing,” he said.

GP and sexual health specialist Dr Catriona Ooi said point-of-care HIV testing would “give patients more options” and lead to more diagnoses of HIV.

“You wouldn’t use it in the general population… only in certain populations where the risk of a false positive was not too high.

“Pre- and post-test discussion would still need to be done… and you do need to be able to manage a person who has had a positive result that was not expecting [it].”

There are currently at least two rapid TGA-approved HIV tests, but not for primary care use

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Jul 17, 2014

HIV diagnosis in Australia at 20-year high

THE number of new HIV diagnoses remains at a 20-year high amid concern about increasing levels of unprotected sex among gay men and a decrease in testing rates among this group, according to new surveillance data from the Kirby InstituteIn 2013, 1235 people were diagnosed with HIV, compared to 1253 in 2012. The figures, though stable over the last two years, are the highest since the mid-90s.

There are now an estimated 26,800 people living with HIV in Australia, of those the report suggests one in seven do not know they have the virus. A large number of people also continue to be diagnosed late.

Associate Professor David Wilson, head of the Surveillance and Evaluation Program for Public Health at the Kirby Institute, said around 30% of people are diagnosed well after they should have started treatment.

That indicates that the steady rise in new cases is likely due to an increase in incidence and not just a reflection of more people being tested, according to Professor Wilson.

“The biological markers for HIV in people getting diagnosed give us an indication of how long they’ve been infected and the bottom line is the levels have been stable over time. “The median CD4 cell count, a marker of immunological status, has also remained stable over time. That suggests the increase in new cases is not due to increased testing, it's likely due to underlying increase in incidence."

Dr Limin Mao, senior research fellow at the Centre for Social Research in Health at the University of New South Wales said the key behaviour driving HIV is unprotected sex among men who have sex with men (MSM).

“Over the last 10 years we can see that among MSM unprotected anal intercourse, particularly with casual partners, has continued to increase from around 30% in 2004 to now 38%.”

She added that among men under 25 years there was a small but significant decrease of 2–3% in testing rates.

Continue reading "HIV diagnosis in Australia at 20-year high"

Jul 17, 2014

Warning on risks of HIV home testing

THE RACGP has strongly urged the government to immediately reverse the decision to permit the TGA registration and sale of HIV home test kits.It has called on the government to instead focus on reducing barriers to accessing primary healthcare, and increase point-of-care testing capabilities.

"There are real dangers associated with patients receiving a positive result at home without appropriate support and information from a medical professional. Single rapid tests, such as these at-home tests, are keyed for high sensitivity and have the potential to lead to a false positive rate of around 1–2%. Unnecessary distress as a consequence of inaccurate results without adequate follow-up and ongoing support from a medical practitioner poses a huge risk to patients," the college said.

If the decision is not abandoned, it has demanded the TGA ensure suppliers provide comprehensive accompanying information outlining the possibility of a false positive and a strong recommendation for immediate follow-up with a GP.

The president of the Royal College of Pathologists of Australasia (RCPA), Associate Professor Peter Stewart, said the oral swab home tests were known to produce a concerning number of false negatives because saliva carries fewer antibodies than blood.

Professor Stewart said the RCPA continues to be concerned about the inability of HIV self-tests and point-of-care tests to detect some cases, especially early infection.

RCPA vice-president Dr Michael Harrison said home tests will miss about a third of cases.

“There are also people who have early infection and both point-of-care testing and home testing are not sensitive enough to detect these cases.

"Some people with early infection have very high levels of the virus in their blood and semen and are very infectious, so home testing [because it is saliva based] risks missing some of the people you really want to protect if you want to break the infection cycle,” he told MO.

He added that while people should be warned not to rely completely on self-testing, if the tests pick up the virus in enough people who would not otherwise have been tested, the public health benefits would be significant.

Researchers from the Kirby Institute at the University of NSW, which manages national HIV surveillance, have undertaken considerable research on home testing and said the benefits outweigh the risks.

According to the researchers, if 40% or more of high-risk men tested more frequently because they had access to home tests, then any additional loss in test sensitivity would be offset at the population level by additional infections detected.

Levinia Crooks, CEO of the Australasian Society for HIV Medicine, said it has been supportive of home testing for some time but cautioned that TGA approval of a device is still a long way off.

“This announcement has removed a legal barrier. It has not presented a test onto the market. It opens up a mechanism for having a test rigorously evaluated for personal use and development of policy to support that,” she said.

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Jul 17, 2014

First rapid HIV test approved

SEXUAL health experts in Australia will be able to diagnose HIV as early as 12 days after infection, following TGA approval of the first rapid HIV test.The pinprick screening test provides results within 30 minutes and is initially available for use only by accredited professionals.All positive tests must then be confirmed by a TGA-authorised laboratory test.Manufacturer Alere said the Determine HIV-1/2 Ag/Ab Combo was the first rapid point-of-care test that detected both HIV-1/2 antibodies and the HIV-1 antigen, which can appear just 12–26 days after infection, compared to the appearance of HIV-1/2 antibodies between 20 and 45 days after infection.In Australia between 1985 and 2011, there were 31,645 reported HIV infections, 10,797 cases of AIDS and 6843 deaths.An estimated 24,731 people were living with diagnosed HIV infection in Australia at the end of 2011. New HIV diagnoses increased by 8.2% last year from 1051 cases in 2010 to 1137 cases, part of a 50% increase over the last 10 years.Health Minister Tanya Plibersek said that while the increased rate of new HIV infections was low by international standards, any increase was of concern."It is expected that this simple first-line screening will encourage vulnerable people to be tested more regularly and to undertake further assessment if there is a positive result, enabling treatment to commence if there is a confirmed positive diagnosis," she said.Parliamentary Secretary Catherine King, who is responsible for the TGA, said the test would not be available for self-testing at home.“The company [Alere], as part of the marketing approval, must ensure the product is only supplied to organisations that have been appropriately trained and that participate in a quality assurance program in accordance with the National HIV Testing Policy," she said.Rob Lake, executive director of the Australian Federation of AIDS Organisations, said the move was a significant step towards achieving the target of the Melbourne Declaration, a multidisciplinary campaign to halve sexual transmission of HIV in Australia by 2015.“Making HIV testing simpler and more accessible for gay men, the most affected community in Australia, will help make the testing experience easier and encourage them to test more often,” he said.“We want to get on top of late diagnoses, and we are looking for people who have stopped or who are not testing enough.”Several other HIV tests are currently waiting approval by the TGA.It is not yet clear when or if rapid tests will be available for widespread use by GPs.

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Jul 16, 2014

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Jul 16, 2014

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Medical Jobs Australia recruitment agency assist doctors, GP's, medical practitioners, nurse practitioners and registered nurses find that special job and area to live that best suits them.

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Jul 13, 2014

New RACGP president elected

WEST Australian GP Associate Professor Frank Jones has been elected the new president of the RACGP, the college announced today.Professor Jones says a top priority for his leadership will be to speak out on behalf of GPs concerned by the proposed co-payment for GP services and the threat to universal healthcare in Australia.

“The general practice community looks to the RACGP for leadership on this issue and we have a responsibility to represent the concerns of our members and the profession at large," he said.

Professor Jones will take over from current RACGP president Dr Liz Marles, whose two-year term comes to an end in October.

He is committed to raising the profile of GPs’ role within the Australian healthcare system.

Professor Jones has vowed to continue the RACGP’s efforts to address the concerns of the profession and the public about the co-payment outlined in the recent federal budget.

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Jul 13, 2014

Viruses use 'fake' proteins to hide in our cells

Some viruses can hide in our bodies for decades and make 'fake' human proteins that trick our immune cells into believing nothing is wrong.Now researchers at the Imaging Centre of Excellenceat Monash and Melbourne Universities have determined the basic structure of one of the two known families of these deceptive proteins.

Using synchrotron light on a common virus that lives in people happily and for the most part harmlessly, they have worked out the structure of the fake proteins. The research, published online by the Journal of Biological Chemistry, is an important first step towards producing better vaccines and drugs to fight viral disease.

The research team focused on the structure of m04 immunoevasin from mouse cytomegalovirus, a member of the m02 protein family. Cytomegaloviruses belong to the herpes virus family, which can cause glandular fever, chicken pox and cold sores. About half the population become infected with the virus, develop flu-like illness and then carry the virus for life. But the virus can be dangerous to pregnant women and people whose immune system becomes suppressed.

Monash University's Dr Richard Berry, a senior author of the paper, said the discovery was important for understanding how this family of viruses can hide from our immune systems.

"Our work highlights how these viruses mimic the immune system in order to evade it," Dr Berry said.

Immune T-cells patrol our bodies checking on the health of cells. One of the things they look for is a complex of proteins on the surface of cells. This major histocompatibility complex (MHC) presents a snapshot of what's inside the cell. If bits of viral protein are detected by the T cells, they flag the infected cell for destruction.

Viruses fight back by disrupting the production of the MHC protein complex, thus reducing the numbers on the outer membrane.

But then, the next stage of what could be described as an evolutionary arms race kicks in. If there are too few MHC proteins on the outer membrane of a cell, then a different type of immune cell, termed the natural killer cell, will kill the cell just to be safe.

Cytomegaloviruses have responded to this by making large families of fake cellular proteins that interfere with natural killer cell recognition. It is the basic structure of one of these families the researchers have revealed for the first time.

Professor Jamie Rossjohn, the other senior author and a Chief Investigator of the Imaging Centre, leads the research group.

"It's been a race against our international competitors which we won with the help of the Australian Synchrotron. We were only able to produce very small protein crystals from which to solve the structures - too small to allow us to gain meaningful data with anything other than synchrotron X-rays," Professor Ross john said.

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Jul 13, 2014

How exactly do pain relief drugs work on the body?

Scientists have opened the door to a new world of pain treatments with their discovery of the exact way that pain relief drugs, such as anaesthetics, work on the body.Dr Ben Corry and Lewis Martin, from the Australian National University's Research School of Biology developed a detailed computer model that revealed for the first time how benzocaine, a local anaesthetic, and phenytoin, an anti-epilepsy drug, enter into nerve cells and prevent the pain signals being transmitted to the brain."By understanding how the current range of drugs work we can best design the next generation, to better treat conditions such as chronic pain, epilepsy and cardiac arrhythmia," said Dr Corry.The precise knowledge of how the drug molecules attach to proteins in the nerve cell give a springboard for redesigning drugs without the side-effects that current drugs bring with them.Their work is published in the latest edition of PLOS Computational Biology.Local anaesthetics were first inspired by cocaine and have been in use for more than 100 years, but the exact mechanism has not been understood until now.Mapping the drug's route to the nerve cellThe pair used more than three million CPU hours on the National Computational Infrastructure's supercomputer to simulate the drug's route into the nerve cell.Pain signals are transmitted to the brain when proteins that act as tiny gateways in nerve cell walls open, allowing sodium and potassium ions to pass through. The simulation shows that the drug's final binding site is inside the sodium gateway protein, which blocks it and prevents the signal from being transmitted.Drugs that block sodium channels are also used to treat nerve-signal disorders such as epilepsy or heart arrhythmia. However, the current drugs target sodium channels indiscriminately throughout the body, which can lead to side effects.Dr Corry says pharmaceutical companies are especially interested developing new drugs designed to selectively target the subtly-differing proteins in specific locations of the body, such as the heart or brain."Knowledge of the fine molecular detail of the drug opens up possibilities to conceive new drugs," said Dr Corry."Chronic pain is a big market, and an avenue I'd also like to pursue is developing antibiotics based on this approach."

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Jul 13, 2014

Digital donor record aims to enhance the organ donation process

Assistant Minister for Health Fiona Nash has announced a new national clinical information system to streamline organ and tissue donation processes across Australian hospital networks.

She said the DonateLife Electronic Donor Record (EDR) was an important step forward to improve information gathering and sharing between hospitals.

"The system will expedite the process of the allocation and assessment of the viability and suitability for organ and tissue acceptance," Nash said.

The EDR is a clinical information system used by donation specialists and replaces a manual paper-based record system. It provides real-time access to essential information about organ donors from the donor referral, organ offer, donor management and organ retrieval processes.

The Organ and Tissue Authority (OTA) commissioned the development of the EDR in close consultation with the donation and transplantation sector. The EDR went live nationally from July 1 this year.

From a clinical perspective, the EDR makes comprehensive donor referral data, medico-social history and family consent information readily available for consideration by transplant units and donation coordination specialists in a consistent format.

"The EDR replaces a 28-page paper-based form known as the Confidential Donor Referral Form. Donor coordinators would then spend many hours making phones calls and coordinating information with transplant units to identify a suitable recipient," Nash said.

"The roll-out of the system will ultimately benefit Australians awaiting a transplant, donor families and donation and transplantation specialists," Nash said.

"Time and access to consistent information are crucial factors in facilitating the organ donation and transplant process."

In 2013, 1,122 Australian transplant recipients benefited from the generosity of 391 deceased organ donors and their families who supported their decision to become organ donors. In addition, in 2013 over 5,000 Australians received corneal or tissue transplants from tissue donors.

The EDR is a clinical platform for donation specialists. It is a separate system to the Australian Organ Donor Register – the national database of people who register their intentions to be organ and tissue donors. To register your decision about becoming an organ and tissue donor, visit the DonateLife website.

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Jul 13, 2014

Report 'clearly quantifies' impact of GP co-payments

The elderly, those with chronic conditions and young families will be hit hardest by the proposed GP co-payment, according to a new study.Conducted by the University of Sydney, findings from the Byte from BEACH research suggest a young family, that is one with two children under 16 and two adults between 25-44 years of age, would be paying as much as $184 more per year to access basic medical care.Twenty five per cent of all Type 2 Diabetes patients would pay an additional $150 per year.The report's co-author Dr Clare Bayram said the introduction of co-payments wouldn't be shared equally within the community."The proposed co-payments regime is likely to deter the most vulnerable in the community from seeking care due to higher costs that they would face," Dr Bayram said.The Australian Medical Association's (AMA) President A/Prof Brian Owler said the report is the first to clearly quantify the likely impact of the government's Budget measures for health."This is the sort of research that the government should have conducted before the Budget," A/Prof Owler said.Alternative co-payment model 'may be appropriate'However in light of the heavy backlash from both health groups and the public, A/Prof Owler said the AMA is encouraged that the government is showing signs of having another look at some aspects of the current co-payment model, following talks held with Tony Abbot and Federal Health Minister Peter Dutton at the end of last month (June)."The AMA knows that a modest co-payment would improve our Medicare system and that is why I am perfectly happy to work with the AMA to ensure that Australia has the best possible Medicare system," Abbott told parliament recently."The Prime Minister and the Health Minister have acknowledged that there may be issues for residents of aged care facilities," A/Prof Owler said."Following my recent meeting with the Prime Minister, the AMA is working on some alternatives that protect the most vulnerable."The AMA acknowledges that GP services are undervalued, and that a form of co-payment may be appropriate."We have accepted the government's invitation to provide alternative models that promote health policies such as chronic disease management and preventive health care, and which value general practice, radiology, and pathology services."

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Jul 06, 2014

Abbott backtracks on co-payment plan

PRIME Minister Tony Abbott has signalled for the first time that he is prepared to soften the impact of proposed $7 co-payments for GP services.Doctors’ groups have been in intensive talks with senior politicians on both sides of politics, picking over a list of health budget measures that have alarmed many practitioners and face a hostile reception in the Senate.

AMA President Brian Owler emerged from talks with the prime minister and Health Minister Peter Dutton on Wednesday, describing the discussions as “very constructive”.

The AMA agreed that “a form of co-payment would be an acceptable model”, but it could not accept the proposal for $5 cut in the Medicare rebate to doctors and the impact on most vulnerable patients, he said.

Associate Professor Owler said the peak doctors’ group acknowledged there were many non-concessional patients who could afford to contribute to their healthcare.

“What we’d like to see is a model that actually promotes this,” he said.

“So, while it’s too early to outline numbers or exactly how it’s going to be instituted, I think the message that was clear today was a commitment on behalf of the prime minister and the minister to look at alternative models, something that we haven’t heard before or since the budget was announced.

“The prime minister and minister made it fairly clear in the meeting that they were willing to look at alternative models and consider those on their merits,” he said.

Professor Owler said the AMA would come back to the government with proposals to better reflect the “value” of GPs’ work and retain the ability to bulk-bill needy patients.

He declined to name what patient groups could be spared a co-payment burden, but said there was “at least a willingness” to acknowledge there were people for whom the fee would be an issue.

Asked in parliament if he had changed his mind on the co-payment, Mr Abbott said: “We are a consultative and a collegial government.”

Mr Abbott said he had made it clear to the AMA that the government was committed to a “modest price signal” for health services.

“The AMA knows that a modest co-payment would improve our Medicare system and that is why I am perfectly happy to work with the AMA to ensure that Australia has the best possible Medicare system,” he said.

Meanwhile, the swathe of health budget measures will come under the scrutiny of a new Senate committee approved by the upper house on Wednesday.

The Select Committee on Health will inquire into the impact on affordable healthcare and the sustainability of Medicare, reduced Commonwealth funding for hospitals and state and territory health systems, and health workforce planning, among other items.

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Jul 06, 2014

Medicare policy on nurse rebates still confusing

DOCTORS are demanding Medicare rewrite its policy on rebates for health assessments after a week of confusion that saw nurses sacked and practices’ business plans upended.AMA president Associate Professor Brian Owler said today the latest advice from the Department of Health had "added more confusion rather than clarification" on the question of whether GPs can include nurses’ time in choosing the correct item number for timed health assessments.

GPs must be advised immediately and in plain English that they can continue including the nurse’s time, he said. “The department advice says only that ‘a practice nurse may assist a GP with performing the health assessments’,” Professor Owler said.

“The AMA calls on the government to provide certainty to GPs about the processing of health assessment items.

The AMA also suggested amending the advice issued on Wednesday so it reads: “The time spent by the GP and the practice nurse is one consideration but not the only consideration.”

A series of bungles by Medicare, starting with a supposed policy “correction” on an obscure web page on Monday that specifically said nurses’ time could not be included in MBS item 701–707 health assessments has left many doctors and practice managers rattled.

“The consequences in terms of anxiety for general practice have been huge,” said RACGP president Dr Liz Marles.

“It is destabilising and demoralising,” she said. “The transparency is not there. It wouldn’t be tolerated in any other industry.”

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Jul 06, 2014

New Queensland surgeon scandal

TWO hospital chiefs have been sacked over a series of surgical errors by an overseas-trained doctor in Queensland.It's been revealed a South American surgeon, who completed his undergraduate medical training in Spain, removed the wrong kidney from a patient earlier this year.

It's also alleged he nicked the artery of another patient, who later returned to hospital suffering extensive blood loss.

The case has echoes of the notorious Jayant Patel controversy, which turned the spotlight on the credentials of overseas-trained doctors working in the Queensland health system.

The Central Queensland Hospital and Health Service Board has sacked Rockhampton Hospital's director of surgery, along with the acting executive director of medical services.

Board chairman Charles Ware told Fairfax radio there is a systemic issue at the hospital.

A broad-ranging review of patient safety systems had been ordered and another review will look at the incidents involving the surgeon.

"These reviews must be thorough and robust, and I assure Central Queenslanders they will lead to decisive action that will ensure the safety of our patients," Mr Ware said in a statement.

Queensland Health Minister Lawrence Springborg told parliament four surgical procedures carried out by the doctor are being investigated.

The surgeon had trained in Spain before coming to Australia, where he completed two years of training and became accredited to operate here in 2011.

He has worked in the public health system and in private practice in Australia.

"The Central Queensland Hospital and Health Service Board is confronting issues that arise from an unacceptable and worrying case of failed renal surgery earlier this year," Mr Springborg told parliament.

"An independent inquiry will look at four cases involving the same surgeon stretching back to 2011."

The Health Quality and Complaints Commission has also been asked to investigate the matter and whether there are systemic problems.

Before the minister addressed parliament, Mr Ware told Fairfax there appeared to be six incidents of concern involving the doctor.

"There are only two that have immediate patient impacts," he said.

"One is the case we disclosed last week, where the wrong kidney was removed, and the second one... with a patient who was operated on and it would appear that an artery was nicked during surgery."

He said the second patient was recovering after being flown to Brisbane because Rockhampton Hospital lacked the facilities to care for him.

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Jul 06, 2014

Paracetamol has no effect on back pain: study

PARACETAMOL is no more effective than placebo in relieving acute lower back pain, according to Australian research that calls into question the universal endorsement of the drug for back pain.The double-blind trial was conducted at 235 primary care centres in Sydney between November 2011 and March 2013.

The researchers from the George Institute for Global Health at the University of Sydney randomly allocated 1652 patients with acute lower back pain to receive either regular doses of paracetamol three times a day for up to four weeks (equivalent to 3990mg per day), as-needed doses of paracetamol (taken when needed and up to 4000mg per day), or placebo.

Patients recorded medication and pain scores on a 0–10 scale in a daily diary.

The researchers found that the median time to recovery – defined as the first day of pain intensity of 0 or 1 maintained for seven days – was 17 days in both the groups taking paracetamol and 16 days in the placebo group.Paracetamol also had no effect on short-term pain levels, disability, function, quality of life or sleep quality in either the regular group or the as-needed group.

Associate Professor Christine Lin, of the George Institute, said that despite evidence for the efficacy of paracetamol in relieving other forms of pain, this was the first placebo-controlled trial looking specifically back pain.

“There has been no placebo-controlled trial, and we were very surprised about that, considering all clinical guidelines recommend paracetamol as first choice for back pain,” Professor Lin said.

“We were also surprised with the results, as we expected to see a difference, compared to placebo and also among patients who took paracetamol as required. What we were most surprised about was that for pain severity we did not see a difference at any time point.”

“Even the first two weeks when paracetamol would be expected to make the most difference there was no difference between the groups, which is different to other pain conditions.”

Professor Lin said that the research team did not know why there was a difference but hypothesised that the results indicate “that pain mechanisms are very complex and we need more research to understand the mechanisms of back pain”.

In terms of alternatives to paracetamol, Professor Lin said that while there is some evidence of a positive effect for anti-inflammatories for short-term relief of back pain compared to placebo, the effect is so small that consideration of the harms is also necessary and that first-line treatment should instead focus on lifestyle measures.

All patients in the paracetamol trial also received advice from GPs on the best way to manage back pain, including remaining active and reassurance that most back pain will resolve.

“We think that is why everyone made a better recovery, because they were receiving good advice. That is where the emphasis should be in terms of first-line treatment for patients.”

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