Overall I Think Transparency With Surgical Outcomes Achieved Has To Be A Very Good Thing, But There Are Exceptions!

This appeared last week:

Safety in numbers: why honesty matters in medicine

Everyone thinks more openness in medicine is a good idea. And our world leading IVF and joint replacement projects are great examples. But information sharing doesn’t always produce better outcomes for doctors and patients.

Steve Robson

21 June, 2025

If you have any interest in health you’ve probably heard the word “transparency”. It now is inescapable and has been called for in everything from the cost of specialist visits and private health insurance, to the cost of health technology, and in healthcare outcomes.

Australia has two world-leading examples of transparency in healthcare – and a notable failure.

If you’re a patient what, exactly, is transparency and how can it make the medical treatment you receive better?

Transparency is all about making the healthcare system understandable not only for patients but also for doctors, healthcare workers, governments, indeed the whole community. It can involve everything from the costs of care to the outcomes of operations. Transparency guides good decision-making in your healthcare.

When transparency is missing it can be catastrophic. One terrible example was with the outcomes of heart surgery for British children in the 1990s at a hospital in Bristol, where the death rates were probably double that for England as a whole. Had the public and administrators had transparency around the hospital’s results it is possible that the lives of 35 children could have been saved.

A celebrated example of surgical transparency is Australia’s National Joint Replacement Registry. Well over 100,000 hip, knee and other joints are replaced in Australia every year. Our results are world-leading and this is due, in no small part, to the registry.

Surgeons complete information sheets about every joint replacement they perform, which includes information not only about the artificial joint itself but the age and health of the patient undergoing the procedure. This information is fed into a complex computer system for analysis and the results are made public. The process allows a careful matching of patient characteristics and devices, along with surgeon and hospital, to review the outcomes of this surgery.

When hip and knee replacement surgery was still in its infancy, problems with implants were relatively common, leading to the need for patients to go back to the operating theatre to have their implants removed and replaced – a potentially traumatic and resource-intensive process.

“Revision rates following primary joint replacement were pretty high,” explains orthopaedic surgeon Professor Paul Smith, the current clinical director of the registry. “With that burgeoning epidemic of prosthesis loosening and wear, people were conscious that they really needed to understand better which prostheses were actually performing and which weren’t.”

The registry was the brainchild of the Australian Orthopaedic Association, the peak body for orthopaedic surgeons. The leadership of the profession recognised the need for all surgeons to have unbiased and real-world information about the implants being placed in Australians’ knees and hips to avoid adverse outcomes.

This level of transparency was unprecedented in Australian healthcare and was embraced widely.

“We have 100 per cent of all joint replacement reported in Australia,” says Professor Smith with pride. “So there’s 100 per cent of surgeons who undertake joint replacement, and also 100 per cent of the hospitals with replacement occurring in them all engaged in the process.”

There is no legal obligation to participate in the registry – it is powered by the goodwill and passion of surgeons to offer their patients the best possible results of what are very big operations. Australians should be grateful for such an aid to transparency.

While the outcomes for patients of every single hip or knee implant can be individually tracked, the opposite was true for gynaecological mesh implants. This lack of transparency was uncovered during a Senate inquiry and related class action against the manufacturers of pelvic mesh.

The final report of the Senate inquiry found that, in contrast to the joint replacement registry, there was “no clear indication of how many women have had transvaginal mesh implants in Australia or how many women have experienced complications as there is no single source of information”.

This made the task of helping women who had experienced adverse outcomes – some lifelong – of mesh implants very challenging. It led the inquiry to recommend the “establishment of a registry for all high-risk implantable devices”.

What is notable about the Joint Replacement Registry is that it is entirely an initiative of surgeons and was not imposed by the government. Experience in the British National Health Service, much of it in the aftermath of the Bristol cardiac surgery disaster, suggests that government attempts to enforce transparency measures can be ham-fisted.

In his landmark book The Naked Surgeon – the power and peril of transparency in medicine, British cardiac surgeon Samer Nashef delved into the pitfalls of poorly thought-through transparency measures.

“The government decided to find ways of reducing costs by having expensive hospitals learn from cheaper ones,” he explained. The exercise began with heart surgery. Unfortunately, the economic analysis uncovered an important but perhaps unexpected truth.

The reason that some hospitals were so “cost-effective” in treating complex heart problems was a simple one. “Many died on the operating table,” he wrote. “This is a very inexpensive pathway: it results in a short hospital stay, no intensive care bills, and no recovery costs.”

This is a significant lesson about transparency: include those providing care – and the patients receiving care – in planning any transparency measures. This is particularly true when either outcomes of procedures are considered or the costs of care are under the microscope.

Indeed, according to a review of transparency in the Journal of the American Medical Association, “public reporting of healthcare system performance is promoted as a means for enhancing the value of healthcare by improving quality and lowering costs … but little evidence of broad and sustained improvements”.

IVF treatment is another area where calls for transparency are being made. Yet Australia leads the world in this area with our newest large-scale transparency initiative – the Your IVF Success website.

While the Joint Replacement Registry aims to provide transparency for surgeons and hospitals, the IVF website is pitched squarely at patients – although the profession takes careful note of its findings.

“The Your IVF Success website was launched in 2021,” says Professor Georgina Chambers who runs the project. “It came about to improve transparency around assisting patients in getting independent information about IVF success rates.”

Long before the website was launched, Professor Chambers’ team collected information about IVF outcomes and provided a yearly academic report. “It’s the oldest IVF registry in the world and probably the most comprehensive,” says Professor Chambers.

The information in these reports was presented in a way that was difficult for patients to understand and was of little value in guiding choice. It was a very opaque transparency project.

IVF is performed at a similar rate as joint replacement, with well over 100,000 IVF procedures performed each year. As with the Joint Replacement Registry, the IVF website is not legislated and is run by the voluntary contributions of IVF doctors.

“Because it’s voluntary, I have to get consent from every single clinic to publish their results,” says Professor Chambers. “The way it works is that I give them their results – exactly what’s going to appear on their website for their clinic and benchmark it to the national average.”

Information from the IVF transparency website is only one factor in the way patients choose their doctors and clinics, Professor Chambers says.

“With public transparency … everybody interprets statistics so differently. They might think, oh yes, but that doesn’t relate to me or my doctors, or my friend got pregnant at that clinic so I want to go there.

“It’s just been overwhelmingly positively accepted by consumers. We get 40,000 people to the website every month. Now this just shows you the absolute hunger for information on the web because it affects just so many people.”

One of the important aspects of transparency on the IVF website is that it has strong input from consumers. “We have a consumer advisory group made up of seven people who have varying experiences of infertility, men and women who advise on everything on the website,” Professor Chambers says.

“It’s been absolutely made with consumer focus and was co-designed with them.”

The Your IVF Success website won the 2023 Research Australia Award for data innovation.

The Joint Replacement Registry now has a patient focus as well. “In the last decade it’s been recognised that one of the important outcome measures is not just how the device works, but what are the patient-related outcomes?” Professor Smith says.

“The registry started to collect patient-reported outcome measures in 2018 and this really provides another dimension.

The IVF website that began as a data project for doctors became more useful to patients. Picture: iStock

“While it was set up to ascertain device performance, it’s actually the patient we treat and we need to understand what patient outcomes are. The last decade has seen a growth in the importance of patient-reported outcome measures such as satisfaction, general health outcomes and outcomes related to the joint that’s operated on.”

Professor Chambers says that in its short history, her transparency website has supported ongoing improvements in IVF care. “The multiple birth weight has dropped to the lowest it’s ever been, so there is no indication that people are putting back more embryos to improve success rates,” she says.

“While it may not be due to your IVF Success website, every year – no matter how you cut the data – the success rate from IVF is increasing.”

Professor Smith acknowledges a similar effect of transparency from the Joint Replacement Registry on orthopaedic surgery. “It provides surgeons with a lot of information and an opportunity to look at where they can improve their practice,” he says.

“Surgeons do not want to be seen to be using devices which clearly have been identified as being poor. The registry has identified better-performing devices, and so surgeons will opt to use a better-performing device.”

Indeed, the Australian registry has identified devices that yield results so poor that it draws worldwide attention to them. “About 20 years ago the first one was identified and that resulted in that device being recalled worldwide,” says Professor Smith.

If Australia is to build further innovation in transparency, what are the keys to success?

“My advice would be that you’ve got to work with the industry as a collaboration,” says Professor Chambers. “You’ve got to abide by certain principles that respect patient and clinician autonomy. One of the key principles of transparency in an industry is that you don’t interfere, you don’t create any perverse incentives.”

This principle came out strongly in the NHS reforms. Dr Nashef has warned that ranking surgeons – without putting the work they do in broader context – puts patients at risk. To avoid looking bad in public “league tables”, surgeons may avoid operating on complex patients – often the ones who most need care.

“The greatest risk to the patient in the publication of league tables is that surgeons start to run away from high-risk surgery, and that is bad news indeed, especially if you are such a patient,” Dr Nashef writes.

What lessons can we learn from the successes – and failures – of transparency in the Australian healthcare system? The information provided must be put in context and be understandable by patients and it must not scare off doctors or hospitals from participating.

“You’ve got to get the senior thought leaders within the craft group behind the idea,” says Professor Smith. “It’s really got to be something that is led from the front. There has to be a champion group.”

Australia has some world-leading examples of transparency that are guiding patient choices and informing the best possible standards of healthcare. There is plenty of scope for more, but we must not make mistakes such as those of the NHS. Let the profession and patients, together, chart the pathway in transparency. That way all of us will benefit in the future.

Steve Robson is professor of obstetrics and gynaecology at the Australian National University and former president of the Australian Medical Association. He is a board member of the National Health and Medical Research Council and a co-author of research into outcomes of public and private maternity care.

Here is the link:

https://www.theaustralian.com.au/health/medical/safety-in-numbers-why-honesty-matters-in-medicine/news-story/29a1492f8950de50762016a174be977d

Making sure that surgical outcomes are reported fairly and reflect the difficulty and risk of surgical intervention need to be carefully designed to ensure the outcomes we seek are achieved. It is possible to put reporting systems together that are unfair and produce very poor overall outcomes and put patients at risk!

This is a situation where listening to as many experts as possible makes good sense, to get the system design correct and the answers found valid!

David.

This Is Not Good News by Any Stretch! Ukraine Needs To Be Freed Of This Jerk!

This appeared a few days ago:

Putin claims ‘whole of Ukraine is ours’ as forces near major city

The Russian president told attendees at a St. Petersburg conference that “wherever a Russian soldier steps foot, that’s ours”.

Ivan Nechepurenko

Updated Jun 22, 2025 – 10.17am, first published at Jun 21, 2025 – 5.29am

St. Petersburg, Russia | Russian President Vladimir Putin on Friday (Saturday AEST) doubled down on his justification for the war in Ukraine, claiming Russians and Ukrainians were one people and “in that sense, the whole of Ukraine is ours”.

Speaking at an annual economic conference in St. Petersburg, Russia, Putin did not rule out Russian forces taking control of the large Ukrainian city of Sumy. A Russian offensive in northern Ukraine has put its forces about 12 miles (20 kilometres) outside the city’s centre.

“We don’t have a goal to grab Sumy,” Putin said. “But I don’t exclude it in principle.”

“Wherever a Russian soldier steps foot, that’s ours,” he added.

Putin’s insistence on maintaining the offensive in Ukraine has come at a diplomatic cost. US President Donald Trump’s election last year gave Russia hope that it could restore economic and diplomatic ties with the United States while continuing to wage war in Ukraine, but Trump has become impatient with Russia’s insistence on continuing the war.

The Russian president made clear he had no intentions of soon ending the war. But it was less clear whether Putin, whose comments came in response to a question about his military’s ultimate goals in Ukraine, was suggesting that Russia would annex additional territory beyond the four Ukraine regions that it has already declared are officially part of Russia.

In peace talks, the Kremlin has insisted on formal recognition of sovereignty over those regions — one of several positions that are unacceptable to the Ukrainian government. But since those annexations, Russian forces have pushed into three additional regions.

On Friday, before Putin’s remarks, the Kremlin made its most direct statement yet acknowledging that improved relations with the US were tied to Russia’s willingness to the end the war.

“American diplomats believe that we need to directly tie the process of removing the irritants in bilateral relations with the settlement in Ukraine,” Dmitry Peskov, the Kremlin’s spokesperson, told reporters at the conference Friday.

Peskov reiterated the Kremlin’s position, which is that it wants to discuss relations with the United States separately from efforts to end the war in Ukraine.

The Kremlin has been hoping that a thaw with Washington would lead to the lifting of some economic sanctions, the return of some American companies, US investments in Russian natural resources and more leeway for Russia to assert its interests in former Soviet states.

Trump’s focus has shifted

At the same time, Putin has shown little interest in bending to US, European and Ukrainian demands to agree to a ceasefire in Ukraine, where his forces are on the offensive.

Trump had promised to end the war in Ukraine 24 hours after taking office, but efforts to mediate have been dogged by deep disagreements between the warring countries about what peace should look like.

After two direct meetings between Russian and Ukrainian representatives, the negotiations have led only to agreements to exchange prisoners of war and bodies of fallen soldiers.

Frustrated by the lack of progress, Trump has his diplomatic attention elsewhere, most recently the conflict between Iran and Israel, where he is considering whether to join the war on the side of Israel.

Meanwhile, Russian air assaults on Ukraine have intensified in recent weeks, dimming any hopes for a ceasefire. On Thursday night, Russia launched drone attacks on Odesa and Kharkiv, injuring 20 people and killing one person in Odesa, President Volodymyr Zelensky of Ukraine said on Facebook.

Peskov said Russia expected Russian and Ukrainian representatives to set a date for their third meeting next week, but that the Kremlin was determined to achieve its stated goals in Ukraine either diplomatically or militarily.

The talks between Russia and the United States on restoring bilateral ties have also been dragging. Despite multiple phone calls between Putin and Trump this year and at least four public meetings of Russian and American officials over the same period, nothing substantive has been achieved so far on that issue. The two countries’ diplomatic missions are still understaffed and some consulates are still shut.

There has also not been any tangible movement in terms of American companies returning to Russia or sanctions being lifted. The St. Petersburg conference, a yearly event promoted by the Kremlin as a magnet for Western businesses, has turned into a platform where Russian state companies showcase themselves. Again this year, no major American investors showed up and there was little sign of Western interest.

At the conference, Putin instructed government members that they cannot allow it to slip into “stagnation and even recession”.

“This cannot be allowed under any circumstances,” Putin said.

On Thursday, Russia’s economy minister said the country was on the verge of sliding into a recession, putting more pressure on its central bank to lower interest rates, which now are at 20 per cent.

This article originally appeared in The New York Times.

Here is the link:

https://www.afr.com/world/europe/whole-of-ukraine-is-ours-putin-muses-20250621-p5m96v

I really hope Putin’s advances can be reversed!

David.

It Looks Like We Are Heading For A Lot Of Instability In the Private Hospital Sector In NSW!

This appeared a few days ago:

Healthscope in limbo for up to a year as administrators extend auction

Max Mason Senior courts and crime reporter

Jun 20, 2025 – 8.00pm

The country’s second-largest private hospital operator could be left in limbo for a year after administrators of the collapsed Healthscope business won approval to extend negotiations with prospective buyers for months.

The company, handed to lenders by asset management giant Brookfield earlier this year, was placed into receivership last month as it buckled under $1.6 billion in debt owed to a syndicate of dozens of hedge funds and banks.

The administration process has created fears among state governments that the 37-hospital portfolio could be split up, with some of the weaker operations closing down, adding to the strain on public health systems.

KordaMentha, Healthscope’s administrators, have now sought an extension of time from the Federal Court so that McGrathNicol can undertake “an orderly and considered sale process designed to maximise value for Healthscope’s creditors and benefit key stakeholders”.

Healthscope, with 5000 beds and 19,000 staff, declined to comment.

“The sale process is complex because the Healthscope group operates its 37 hospitals through various arrangements, including several leases,” KordaMentha wrote in its submission to the court.

“The receivers may be required to negotiate new rental terms with these landlords to facilitate any sale of the business … Operating the Healthscope group business also requires engagement with state regulatory bodies in relation to hospital licenses, engagement with its heavily unionised workforce of nurses with 23 separate enterprise bargaining agreements, and continual engagement with major private hospital insurers.”

KordaMentha said the sale process had already attracted interest from several bidders, and it would be completed within the year. The Federal Court this week agreed to extend the timeline for a deal to June 30 next year.

Healthscope is now run by former Qantas executive Tino La Spina. Last month, The Australian Financial Review revealed he had told staff and doctors in a frank exchange that Bupa, a major British health insurer interested in the business, would buy Healthscope “over my dead body”.

Healthscope and Bupa clashed last year after the British fund resisted pressure from Brookfield to increase how much it paid for its members’ care. Bupa has appointed advisers to look at the assets, the Financial Review’s Street Talk column has previously reported.

Healthscope has received 10 indicative offers from private hospital operators, including Ramsay Health Care.

Health Minister Mark Butler has ruled out a government bailout of Healthscope despite the risk that some of its hospitals could stop admitting patients if a buyer for the whole business cannot be found.

The Albanese government has also flagged that it would be less receptive to offshore private equity ownership than the previous Coalition government, which approved the 2019 sale of Healthscope to Brookfield.

Brookfield took on large amounts of debt to acquire Healthscope following a bidding war for the operator at a time when hospital valuations had soared. As part of the buyout, it sold 22 properties for $2.5 billion before leasing them back at rents it now says were well above market rates.

Healthscope also faces the loss of one of its largest facilities, Sydney’s Northern Beaches Hospital, in an escalating dispute with the NSW government.

“The government must be able to act decisively to avoid a prolonged dispute for members of the Northern Beaches community, staff working at the hospital and for NSW taxpayers,” NSW Treasurer Daniel Mookhey said.

Here is the link:

https://www.afr.com/companies/healthcare-and-fitness/healthscope-in-limbo-for-up-to-a-year-as-administrators-extend-auction-20250620-p5m92l

It is difficult to see that we will see this issue fixed soon – given the long -standing issues this hospital has and the issues with operating a hospital of this complexity.

It would be good if the State-Government took it over for a few years, got it up to scratch and then put back in the private sector when stabilized! Or they could just add it to the public hospital sector – which might not be a bad idea.

David.

It Looks Like We Are In For A Few Pretty Unstable Weeks As The Iranian Situation Plays Out!

This appeared a few hours ago:

Analysis:

Trump was holding back on Iran. Then he took a phone call

The Islamic Republic has become a lot weaker recently, and the US president and Benjamin Netanyahu know it. Both gave victorious press conferences on Saturday.

Jessica Gardner United States correspondent

Updated Jun 22, 2025 – 2.41pm, first published at 2.34pm

Washington | Last Thursday, US President Donald Trump gave himself a two-week option on bombing Iran, but by Saturday evening (Sunday AEST), the job was done.

What changed in those 48 hours? Was Trump handed new intelligence? Did Iran rebuff his fortnight window to negotiate? Did he finally snap over the Trump Always Chickens Out label?

His reasons for drawing the US into another war in the Middle East are perhaps many. He certainly didn’t give a detailed explanation in his brief address to the nation, warning instead of more attacks if Iran didn’t “make peace”. But what is known is that he received a tense phone call beforehand from Benjamin Netanyahu.

US media reported that Trump, Vice President J.D. Vance and Defence Secretary Pete Hegseth spoke with Israel’s prime minister, along with Defence Minister Israel Katz and military chief Eyal Zamir.

Israel was incensed that Trump could waste the opportunity to move against Iran’s crown jewel nuclear sites by giving it more time.

At the behest of Israel, probably angering voters (and some Republicans) who supported his promise to end US entanglement far from home, and very likely sparking Iranian retaliations, Trump made his move.

Iran is a repressive regime that holds little regard for the hopes, dreams and freedom of its 92 million citizens. Its rulers have pledged to destroy Israel and have threatened “death to America”. All of this has been true for decades.

The difference now is that Iran has been significantly weakened. The most recent barrage from Israel, which caught it unaware, wiped out top-ranking military and science personnel. And the regional militias Iran funds in Lebanon, Gaza and Yemen have been cut down by Israel’s unflinching attacks over the past 18 months, which have also led to widespread civilian deaths.

Iran’s stocks are down, and Trump and Netanyahu know it. Both gave victorious press conferences on Saturday night.

Nuclear weapons intelligence

The other factor that has changed, but accounts vary, is how far away Iran was from possessing a nuclear weapon. “If not stopped, Iran could produce a nuclear weapon in a very short time,” Netanyahu said on June 13 after Israel’s first strikes. “It could be a year. It could be within a few months.”

Iran was “weeks away” from creating a nuclear weapon, Trump said on June 18, without offering any evidence.

In March, Trump’s national intelligence director, Tulsi Gabbard, told Congress that Iran’s stockpile of enriched uranium was “at its highest levels” and “unprecedented for a state without nuclear weapons”. But she also said US intelligence suggested Iran had not decided to build a nuclear bomb.

Trump, on June 21, said that she was “wrong”.

The International Atomic Energy Agency said in May that Iran had amassed enough uranium enriched to potentially make nine nuclear bombs if it undertook further enrichment. But the watchdog also noted its monitoring efforts had been hamstrung by Iran’s refusal to co-operate.

While Trump danced around the prospect of an attack in the past week, some pundits mused on the similarities with George W. Bush’s invasion of Iraq. That deadly military intervention was in response to incorrect intelligence that Iraq possessed weapons of mass destruction.

Iran has been conducting clandestine nuclear enrichment operations since the 1990s, which the regime has assured were for energy production, even if much of the globe did not trust it. The most troubling facility was Fordow, located deep in a mountainside reachable only by US-owned bunker-busting bombs, and the right fighter jets to carry them.

In his Saturday night address following the strikes, Trump said Fordow, and two other sites, Natanz and Isfahan, had been “obliterated”. That will make it challenging to ascertain exactly what was going on deep underground and cloud the basis for the operation.

What we know for sure is that this is not the end.

Trump did not shy away from that in his Saturday address. “Remember, there are many targets left,” he said. “Tonight’s was the most difficult of them all, by far, and perhaps the most lethal. But if peace does not come quickly, we’ll go after those other targets with precision, speed and skill.”

Trump may characterise these operations as a simple in-and-out, but by joining the Middle East’s latest conflict, he has lit a match in one of the globe’s most combustible regions.

After styling himself as a peacemaker who was more interested in ending wars than starting them, the unpredictable president has escalated one.

Here is the link:

https://www.afr.com/world/middle-east/trump-was-holding-back-on-iran-then-he-took-a-phone-call-20250622-p5m9b8

So here we are in the middle of another war in the Middle-East:

I fear no good can come from all this and it really is time for everyone to stand back and take a few deep breaths! The implications of all this could be pretty bad if we don't work to settle things down, and fast!

Peace has to be re-established ASAP.

Let us see how it plays out in the next few days:

David.

AusHealthIT Poll Number 799 – Results – 22 June 2025.

Here are the results of the recent poll.

Do You Think There Is A Significant Risk Of The Israel / Iran Conflict Getting Out Of Control And Resulting In A Major Conflict?

Yes                                                                     18 (67%)

No                                                                        9 (33%)

I Have No Idea                                                    0 (0%)

Total No. Of Votes: 27

Clearly an overall majority think the risk for major conflict is real as we now see happening!

Any insights on the poll are welcome, as a comment, as usual!

Not bad voter turnout – question must have been too easy. 

0 of 27 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many thanks to all those who voted! 

David.

A Update To Screening Approaches For Prostate Cancer. An Update After Almost A Decade.

This appeared last week:

16 June 2025

Prostate cancer screening gets revamp

By Laura Andronicos

But not everyone agrees with the recommendations, which would significantly change how GPs screen and treat patients.

---

The draft 2025 clinical guidelines for the early detection of prostate cancer have been released and some changes have sparked a strong response from the RACGP. 

The Prostate Cancer Foundation of Australia (PCFA) is replacing the current 2016 version and changing who is screened and when, who is offered active surveillance or definitive treatment, and removing biopsy as the primary test following an elevated PSA, among other things. 

“We need these new guidelines, because much has changed over the last decade in the diagnosis of prostate cancer,” said Dr Brett Montgomery, RACGP representative on the guidelines steering committee. 

He said many GPs found it challenging to counsel patients about early detection of prostate cancer, but the update will provide clear guidance about PSA testing and interpreting results, including flowcharts of action points that are easy to read and implement. 

The guideline includes new risk factors, with particular focus on recognising Aboriginal and Torres Strait Islander males as a priority population due to worse survival outcomes than the general Australian population. 

There were no specific recommendations for this population in the previous guideline, but now PSA testing is recommended every two years from the age of 40. The PCFA highlighted this as a world-first recommendation. 

Dr Montgomery told TMR that the recommendation to offer testing to males aged 50-69 is still what is best supported by evidence. However, the update offers support for starting screening earlier for people at increased risk. 

“They offer some cautious flexibility in the age of starting and stopping testing: allowing doctors to respect patient choice in testing from age 40 or beyond age 70 in people who are keen and relatively well, even though evidence of benefit in these age groups is much more slender,” he said. 

However, the RACGP expressed “major concerns” with the move, saying the disparity in mortality rates for Aboriginal and Torres Strait Islander people was likely due to access to and engagement with health systems. 

“The evidence cited in the draft guideline shows no significant difference in the age of diagnosis or spread of disease at diagnosis in Aboriginal and Torres Strait Islander men,” said Professor Mark Morgan, chair of the RACGP expert committee. 

“Therefore, while they are a priority population, the RACGP is concerned this approach may lead to more unintentional harms, such as false positive PSA tests and overdiagnosis.” 

For Aboriginal and Torres Strait Islander men aged 40-49, a PSA of 1.0μg/L or greater, or a PSA of 2.0μg/L or greater for men aged 50-69, would prompt a repeat test within three months. These age and PSA ranges also apply to other risk factors that were not identified in the 2016 guideline, such as black males of sub-Saharan ancestry, males with a BRCA2 gene mutation and a family history of prostate cancer. 

Family history specifically refers toas a brother diagnosed with prostate cancer, a father diagnosed with prostate cancer before the age of 65 and/or two or more second degree relatives who died of prostate cancer. The draft suggests that these risk factors can more than double the risk of an individual dying from prostate cancer. 

The RACGP recommended including men who take exogenous anabolic steroids as a risk factor, not because they’re at a higher risk of prostate cancer but because these medications may stimulate prostate cancer growth. 

There are also proposed changes to who should be offered active surveillance.  

The PCFA recommends reducing the PSA threshold from 20μg/L to 10μg/L and requiring a PSAD of 0.15μg/L/mL or less, an MRI PI-RADS of 3 or less and a clinical stage of T1-T2a. All criteria must be met to offer active surveillance.  

The previous guideline did not advise testing men over the age of 70, but the new guideline aims to reverse that, recommending testing based on clinical assessment rather than age alone.  

The RACGP asked for clarification, suggesting that clinical assessment should be clearly defined and include life expectancy, comorbidities, and patient values and preferences. 

It also recommended adding guidance for GPs on making a shared decision to discontinue testing in healthy men aged 70 and over with a PSA less than 1.5μg/L, as these individuals were unlikely to benefit from further screening. 

“A problem in the past has been that only a tiny proportion of participants have their life saved through early detection. And these benefits have needed to be weighed against the hazards of prostate screening, including overdiagnosis,” said Dr Montgomery. 

He said that for every 1000 people getting tested, they see around one life being saved after 11 years, two after 16 years, and perhaps four after 25 years and 14 after 40 years. These numbers were outlined in the RACGP submission, which cautioned potential overdiagnosis from the expansion of screening recommendations.  

The previous guideline had a lot of criteria for offering definitive treatment, but the update suggests that it only requires either pathological progression detected from a biopsy or based on patient preference.  

Under the new guidelines, biopsy will no longer be considered the primary testing approach after an elevated PSA. mpMRI is now the preferred first diagnostic test following a raised PSA result and will determine if a biopsy is required.  

Ultrasound-guided transperineal approach is now the preferred biopsy method to reduce infection risk, as opposed to transrectal. The optimal number of cores for targeted biopsy have been reduced from 21-24 to a minimum of 3-4. 

 The RACGP recommended the development of a national registry for prostate cancer screening be considered by the PCFA.  

“This will help avoid duplication of testing for patients who see multiple providers, as a central system will capture people who move to a different GP and/or clinic, and allow GPs to undertake the recalls and reminders for screening,” they wrote. 

They also suggested providing a clear list of changes to screening tests, such as the removal of the free-to-total ratio. 

“I would like to see the development of resources that help GPs to work with their patients to weigh the good things and the bad things about testing so that patients can reach a decision on testing that is in keeping with their own values,” Dr Montgomery said. 

“I know that good people are working on such a resource now.” 

This article was updated to include comments by Dr Montgomery.

Here is the link:

https://www.medicalrepublic.com.au/prostate-cancer-screening-gets-revamp/117609

A useful summary of the current recommended approach.

David.

This Was An Atrocity Perpetrated By The Religious Self-Rightgeous On The Innocent IMVHO!

 This appeared last week:

https://www.theaustralian.com.au/nation/world/irish-inquest-hears-indians-abortion-refusal-was-catholic-thing/news-story/802582c3959f49ff7fb66a54c023eb7e

Irish inquest hears Indian's abortion refusal was 'Catholic thing'

Updated 9:56AMApril 10, 2013

AFP

AN Irish inquest into the death of a pregnant Indian woman who was allegedly denied a termination heard from a witness who said an abortion was refused due to a Roman Catholic ethos.

Savita Halappanavar, a 31-year-old dentist originally from India, died in a hospital in Galway, on the west coast of Ireland, last October after suffering a miscarriage.

She was 17 weeks pregnant and miscarrying when she went to Galway University Hospital on October 21, complaining of backache.

During evidence on the opening day on Monday, her husband Praveen said his wife, a Hindu, repeatedly requested that doctors terminate the pregnancy when it was clear the pregnancy was not viable but they refused because there was still a foetal heartbeat.

In evidence, family friend Mrudala Vasepalli recalled being present when Savita asked if anything could be done to save her baby, and when told there was not, requested if anything could speed up the inevitable.

"We don't do that here, dear. It's a Catholic thing," Ms Vasepalli recalls being told by the midwife.

She described her friend as being in great emotional distress when she discovered her baby would not survive.

"She was crying every time. She said: 'Either way it hurts me. If the heartbeat is there, it hurts me. If it stops, it hurts me. What kind of mother am I, waiting for my baby to die'," she told the packed courtroom.

The medics who treated Savita gave evidence, with questioning focusing on whether due care was given to the risk of infection when it became clear Savita was miscarrying.

The court heard blood tests taken the night she was admitted that showed raised white blood cells -- an indication of infection -- were not acted on until three days later.

An experienced midwife, who cared for Savita in the days before her death, said she was frightened by the rate of deterioration in her condition.

"I have never seen a woman suffering a miscarriage get so sick so quickly and I have been on that ward seven years," nurse Miriam Dunleavy told the court.

The consultant doctor whom Praveen Halappanavar said on Monday refused a termination due to a Catholic ethos in Ireland also read her statement, although cross examination was adjourned until today.

Dr Katherine Astbury said she had discussed termination with Savita after she requested medicine to expedite the process after she was told the outlook on the pregnancy was poor.

Dr Astbury told the court she had explained to Savita that the legal position in Ireland did not permit her to carry out a termination at that time.

Her legal team have indicated she will strenuously deny making any reference to Catholicism in her dealings with the couple.

Abortion is illegal in Ireland unless there is a substantial risk to the life of the mother, with Astbury stating she discussed this option with Savita when her condition had worsened.

"I also informed Mrs Halappanavar that if she did not continue to improve we might have no option but to consider termination drugs."

Savita Halappanavar died on October 28 from complications as a result of septicaemia.

Praveen Halappanavar said the inquest was his last chance to discover the truth about how and why his wife was treated.

Almost 70 statements from hospital staff, police and other sources have been gathered for the inquest but not all of their authors will appear as witnesses.

The case has once again focused attention on the Irish Republic's strict abortion laws.

Dublin has vowed to introduce legislation, expected in July, to make the rules surrounding abortion easier for doctors and patients to follow.

AFP 

All I can say this was a very sad piece of Irish history which is now recognised for the wrongs it clearly caused through heartless application of Roman Catholic doctrine. There are some heartless people in the world I must say!

I hope we will never see such wrongs again!

David.

Having Had Two Of These There is Pretty Sould Advice Here I Reckon!

 This appeared last week:

 Everything I wish I had known before, and after, my hip replacement

So you’re thinking about a hip replacement. Here’s what you can learn from my experience before and after surgery, from pain management to when to get your teeth cleaned … and will you be able to manage the dog?

Natasha Robinson

15 June, 2025

When I had a total hip replacement earlier this year, like many people I had no idea what I was in for. These are all of the things I wish I’d known before and after the procedure.

Why wait? Your artificial joint might last a lot longer than you think

I was limping around for almost three years before my hip replacement, doing everything I could to delay the procedure. I figured I should wait for as long as possible before going under the knife given what I’d been told about prostheses generally lasting only around 20 years. I was stunned when I went to see my orthopaedic surgeon and he told me the new generation joint he would implant in my body could well last me a lifetime.

Nobody really knows the life of these new joints, but the prospects of them lasting a lot longer than 20 or 30 years seems high, according to orthopaedic surgeons.

One thing that many people don’t necessarily consider when they try to put off hip surgery is the biomechanical impacts on the rest of the body. Lack of mobility in the hips and an impaired gait has knock-on effects on the posture and potentially the knees.

No orthopaedic surgery is without risks, and a total hip replacement is not a decision to be taken lightly. There’s no guarantee of a perfect result, but the surgery is one of the most successful orthopaedic surgeries with a very high rate of good outcomes. Despite being relatively young for this surgery, I’m glad I didn’t wait any longer than I did.

New-generation prosthetic hips may last as long as 50 years.

The surgical approach

The traditional surgical method in a total hip replacement is the posterior approach, in which an incision is made at the back of the hip near the buttocks. During the surgery, the surgeon will split the gluteus maximus muscle to access the hip joint.

Some surgeons instead perform hip surgery via an anterior approach, where the incision is made at the front of the hip. This avoids cutting through muscle and can lead to less soft-tissue damage, less pain and a faster recovery, but it is associated with a small risk of nerve damage.

Another modern technique is hip resurfacing, which involves trimming damaged parts of the femoral head and replacing the hip socket with a metal cap. Hip resurfacing may be suitable for younger people who are keen to return to high-impact exercise after surgery (this is the type of hip surgery the British tennis player Andy Murray had before going on to continue playing professional tennis).

Preparing for surgery

In the weeks leading up to your surgery, you’re going to want to get organised with a set of crutches, a “grabber” to allow you pick things up off the floor as you won’t be able to bend down for several weeks after the surgery, and a shower chair for the first couple of weeks. A raised toilet seat is highly recommended as if you have the posterior approach, it’s recommended that your bottom is always higher than your hips when sitting – this is one of the hip precautions to minimise the risk of dislocation.

For the same reason, a wedge cushion for sitting on chairs or the couch is also very useful. Be sure to have a couple of ice packs on hand at home as well.

In the months leading up to your surgery, you should do all that you can to strengthen your lower body. This will stand you in good stead for your recovery. The stronger you go in to the surgery, the stronger you’ll come out.

Call in help

Be sure to stock your freezer with meals for the first week or two, or organise a food delivery service. If you have a dog, organise someone to walk your dog for a few weeks. Even though you’ll be walking soon after surgery, you won’t be able to manage walking a dog while you’re on crutches. If you’re on your own, as long as you have these factors organised, having a carer with you for more than a couple of days probably won’t be necessary, but be prepared to let the cleaning go for a few weeks.

The days before

Your anaesthetist should call you in the week leading up to surgery. If you’ve taken pain medicines before, make sure you tell them what has worked well for you in the past and what hasn’t. Hospitals typically give endone as pain relief immediately after surgery, but some people are non-responders to this medication and if it hasn’t worked for you in the past, you should tell your anaesthetist. It’s useful to specifically discuss with your anaesthetist what the protocols are for pain management. Oxycodone given orally is the first line of pain management in some hospitals, and believe me if it’s not doing anything for you, you’re going to want to know what the protocol is for accessing stronger drugs or an IV unit.

On the day before the operation, it’s recommended you use an antibacterial wash on your skin the night before and the morning of surgery to minimise infection risk. Make sure you stay really well hydrated the day before surgery. Some people take Gatorade for this reason.

Immediately after the surgery

You’ll typically have a spinal anaesthetic as well as general, so pain should be minimal upon waking up from surgery. Your legs may feel numb from the spinal. Nurses may give you oxycodone orally or via IV once you’re on the ward. It’s very important to stay on top of your pain relief after surgery. Doctors speak of “staying ahead of the pain”, and this means you should never wait until you’re in a lot of pain to take medication. It’s best to take pain meds continually so the pain is manageable – this is really important in order to get you up and moving as soon as possible.

Robinson was on crutches for a short time after her hip replacement. Picture: John Feder

You’ll have a urinary catheter in immediately after surgery so you don’t need to worry about navigating your way to the toilet for the first 24 hours or so.

You’ll typically be visited by a physio within 12 or 24 hours after the surgery who will help you take a small walk supported by a walking frame. Hospital stays after hip replacement are generally a few days, and during this time physios will help you learn to manage stairs and let you know when you may be ready to progress from a walker to crutches. People are generally discharged from hospital on crutches (you’ll need your own).

Don’t worry if you have stairs in your house – navigating stairs after hip replacement is really very easy, with the method being to lead up the steps with your non-operated leg, and down steps operated leg first.

You will be able to shower sitting in a chair in the hospital as soon as you’re mobile – surgical dressings used these days are very waterproof.

Be prepared to deal with constipation – oxycodone blocks most people up. The hospital will generally give you an osmotic laxative daily, but be sure to drink a lot of water and don’t be shy to ask nurses to give you a glycerol suppository if you haven’t moved your bowels after a few days. Prunes and pears are great to have on hand.

Pain and swelling

Don’t be surprised if your operated leg is black and blue after surgery. Significant swelling is also normal, and this should subside within a few weeks but sometimes can hang around a lot longer. Apply ice packs regularly in the days and weeks after surgery.

It’s difficult to predict how much pain you may experience. Hip replacement is major surgery. Some people are in a lot of pain in the days after surgery, and others not. For most people, the worst of the pain subsides within about a week.

Sleeping

For the first couple of days after surgery you’ll have to sleep on your back, which can be a challenge for side sleepers. After a few days, ask your doctor whether it’s okay to sleep on your non-operated side with a pillow between your legs. You won’t feel comfortable to sleep on the operated side until a few weeks after surgery.

Take as many naps as you need in the weeks after surgery. Many people feel a lot of fatigue.

Keep moving

Walking is the best thing you can do for rehabilitation. You can build up a little more every day, but try not to increase your step count or distance too quickly – a little more every day is the key. After two to three weeks, you may be able to walk a kilometre or even two on your crutches, but don’t worry if you’re much slower to progress. All recovery is individual.

Physios in the hospital will give you some exercises to do. Usually these include leg slides in your bed, squeezing your glute muscles in bed, and then progressing to standing lateral raises and vertical raises of your operated leg, and perhaps sitting up and down out of a chair if you’re ready.

If you are in a health fund, your policy should provide you with ongoing physio at home for a few weeks, either through a hospital in the home rehab provider or a private physio. You also have the option of choosing to go to a rehabilitation facility, although the outcomes between these two options are little different, according to the evidence.

Rehabilitation in a swimming pool after a hip replacement is highly recommended. Picture: Getty Images

Once your incision is fully healed, generally after a few weeks, you will be able to move your rehab to a swimming pool if you wish. The water provides excellent resistance during exercises such as walking in the water or performing lateral raises or kickbacks to build up your strength.

Returning to work

I was able to return to work after three weeks, working a couple of days from the office and the rest of the time at home. Some people need a lot longer. Prepare your workplace that you may need six weeks off, or more if you work a manual job.

The long term

After you see your surgeon for the six-week follow-up and get the all-clear to return to exercise, if you wish you can progress your movement to stationary-bike cycling. Avoid treadmills at first as they are too risky given the moving platform. Under the guidance of your physio you should also be able to start to increase the resistance using bands or weights in strength-based exercise to rebuild your legs, focusing on quads, glutes, abductors, adductors and hip flexors. Be sure to be gentle on yourself; after surgery, your body is still working to integrate your metal joint by growing native bone around the prosthesis. If you are a gym-goer, performing upper-body strength work as normal should be fine after six weeks but be guided by your physio.

I would stay away from gym classes for a while as they can be too fast and unpredictable. My surgeon said yoga was OK but just be careful of your hip precautions (such as avoiding too much hip flexion) and let the teacher know you’ve had a hip replacement. My surgeon also recommended never squatting below 90 degrees or deep lunging after a hip replacement, and to avoid any rotational movements for the first few months.

Expect to notice a significant difference in strength between your operated and non-operated leg for a substantial period of time. It’s likely to take a year or even more to feel fully back to normal.

As far as driving goes, you’ll need to get clearance from your surgeon before getting back behind the wheel. You won’t be able to drive until your operated leg has recovered sufficiently to be able to operate the pedals – for most people this generally takes four weeks or so.

Leg length discrepancies

Some people notice that their operated leg seems longer than the other one after surgery. It’s very rare that there is a true leg length discrepancy given that surgeons are so precise in their measurements. Usually the cause is a tilt or twist of the pelvis because of the impaired way you’ve been walking prior to having the surgery. Try not to panic if your legs seem markedly different in length. The body usually naturally balances itself out. If you feel particularly uneven in the longer term you can see a podiatrist who may recommend an orthotic, or you can wear heel lifts in your shoes. Often people may need the other hip replaced in future too – and if this is the case your legs will generally end up the same length once you’ve had your other hip done.

Red flags

There is a small risk for weeks, months or even years after surgery of an infection forming in the prosthesis. A lot of people opt to get a dental scale and clean before the surgery as this procedure can release bacteria into the bloodstream. You should be particularly careful that any cuts or scrapes don’t become infected after you’ve had surgery, and to take antibiotics promptly if you develop a urinary tract infection. If you notice any redness developing around your incision site at any point, contact your surgeon or see your doctor immediately.

Preserving the life of your new hip

Unless you can’t live without it, it’s not recommended to return to jogging or any high-impact exercise after a hip replacement. If you do so, be prepared that your new hip won’t last as long. Otherwise, life can return to normal in every other way after recovering from a hip replacement. Most people are overjoyed to be able to live a pain-free life. Oh, and you’re probably not going to set off any alarms at airport security either. The days when prosthesis triggered alerts seem to be behind us in most airports.

 Here is the link:

https://www.theaustralian.com.au/health/medical/everything-i-wish-i-had-known-before-and-after-my-hip-replacement/news-story/7d81450e275b560b01d14ebf047e7cfa 

 I thought this was a pretty useful summary, from a fellow victim of this surgery!

All I can say is that it is a fabulous operation that has made me pain free and lasted a good two decades. Amazing and just fabulous outcome from my perspective!

David