Community-based access to oral antiviral treatments for COVID-19 in Australia.

BACKGROUND: The availability of oral antivirals for SARS-CoV-2 infection reduces the risk of severe, acute illness in people at higher risk for death and hospitalisation. OBJECTIVE: The process for antiviral prescription and dispensing in Australia is outlined using nationwide data. DISCUSSION: Australia has focused on providing rapid access to antivirals to high-risk people in the community via general practices and community pharmacies. Although the introduction of oral antiviral treatments is an important part of the response to the COVID-19 pandemic, vaccination remains the most effective way of mitigating the risk of developing severe complications of COVID-19, including hospitalisation and death.

The M-CHooSe pilot: the acceptability and utilisation of the nurse-led, general practice clinic co-located 'Mater CALD Healthcare Coordinator Service' for patients from multicultural backgrounds.

BACKGROUND: Patients from culturally and linguistically diverse (CALD) backgrounds often have unmet healthcare coordination needs. We aimed to evaluate the acceptability, utilisation and perceived benefits of the Mater CALD Health Coordinator Service (M-CHooSe), a pilot, nurse-led, general practice co-located, healthcare coordination service for patients from CALD backgrounds. METHODS: M-CHooSe began in March 2020 at five Brisbane (Queensland) sites. Process and service user data were collected over 12months at one site. A survey evaluated primary healthcare professionals' perceived benefits of the service. Another survey of M-CHooSe nurses examined indicators of service complexity. RESULTS: In total, 206 individuals accessed M-CHooSe over the 12-month period. Commonly delivered services included health service advocacy, chart reviews and health system navigation, including addressing social determinants. M-CHooSe nurses reported frequently performing tasks such as following up with external health services and performing health and social care system coordination. M-CHooSe benefits reported by primary healthcare professionals included better patient access to external health services and improved patient understanding of their conditions and treatments. CONCLUSION: Patients were accepting of referrals to M-CHooSE. Primary healthcare professionals also reported a variety of benefits to themselves and their patients because of M-CHooSe. M-ChooSe highlights the potential of a healthcare coordination service for multicultural patients to improve healthcare equity, accessibility, and system efficiency. This project demonstrates the potential value of coordination services to increase patient access and uptake of existing health and social care services for modern Australian communities, thus improving the efficiency and effectiveness of our health system. Further investigations, including user experience, opinions and cost analyses, will be required to confirm the promising benefits of embedding M-CHooSe into usual care.

What strategies have been effective in optimising COVID-19 vaccine uptake in Australia and internationally?

BACKGROUND: A key public health measure protecting the population from COVID-19 is vaccination. Unvaccinated people have higher COVID-19 case rates and death rates than those who are fully or partially vaccinated. It has, and continues to be, critical to optimise COVID-19 vaccination uptake in the community. OBJECTIVE: The aim of this study was to identify population groups who were less likely to be fully vaccinated against COVID-19 and strategies that were successful in increasing uptake in these often hard-to-reach groups. DISCUSSION: Strategies that have successfully increased COVID-19 vaccine uptake may also be effective in enhancing uptake across a range of vaccine-preventable diseases. These strategies include collaboration and building trust with local communities, targeted communication and education, optimising access to vaccines and the use of targeted incentives. Primary care providers are often central to these strategies and are well placed to take the time that people need to shift from uncertain to becoming vaccinated.

Effectiveness of general practitioner-delivered nutrition care interventions on dietary and health outcomes in adults with diet-related chronic conditions: a systematic review protocol.

OBJECTIVE: This systematic review will evaluate the effectiveness of nutrition care interventions delivered by general practitioners versus usual care or no care on dietary and health outcomes in adults with diet-related chronic conditions or risk states. INTRODUCTION: General practitioners are usually the first contacts in the health care system for patients with diet-related chronic conditions. While there is some evidence that general practitioners can be effective in delivering nutrition care for a number of outcomes, to inform future care, an update of the evidence is required as well as an examination of which components are associated with positive outcomes. INCLUSION CRITERIA: Published studies will be included if they report on adults with or at risk of diet-related chronic conditions; one-on-one nutrition care interventions individually delivered by general practitioners during primary care consultations; usual or no care as comparators; dietary and/or health outcomes with a minimum three-month follow-up; and randomized controlled trials. Included studies will be available in, or able to be translated into, English and will have no date restrictions. METHODS: The databases to be searched will include CINAHL, Embase, MEDLINE, and ProQuest Nursing and Allied Health. Following deduplication, two reviewers will independently screen the titles and abstracts in Covidence, followed by the full texts of potentially relevant studies. Disagreements will be resolved through discussion or with a third reviewer. Included studies will be critically appraised and data will be extracted using a modified JBI tool. Findings will be reported in tables and narrative synthesis, and pooled with statistical meta-analysis, where possible. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42021289011.

How have temporary Medicare telehealth item numbers impacted the use of dietetics services in primary care settings?

AIM: The aim of the study was to describe the quantity and cost of in-person and telehealth dietetics services reimbursed under Australia's Medicare Benefits Scheme, before and during the coronavirus pandemic. METHODS: Publicly available Medicare Benefits Scheme dietetics service activity data were extracted from an online database, between January 2019 and June 2021. For allied health telehealth items, it was assumed that between 10% and 20% of all consults were dietetic related. RESULTS: Dietetics service claims reimbursed through the Medicare Benefits Scheme averaged 115 thousand per quarter in 2019. In quarter 2 of 2020, service delivery dropped by 25% compared to quarter 1 of 2020 and 32% compared to 2019. This drop recovered in quarters 3 and 4, with dietetic consultations claimed through the Medicare Benefits Scheme remaining relatively comparable to 2019 data. Dietetics services cost AUD 5,868,021 in quarter 1 2019 and AUD 5,742,632 in quarter 1 2020. Since the introduction of allied health telehealth items, the number of consultations claimed per quarter has accounted for between 17.7% (quarter 2 2020) and 4.5% (quarter 2 2021) of all consultations per quarter. CONCLUSIONS: The provision and costs of dietetics services in Australia have remained relatively constant compared to 2019 data, indicating telehealth was being used for substitutive rather than additive care, apart from an initial reduction of 25% between March and June 2020. The introduction of telehealth items for dietitians has been modest, peaking at 17.7% and now consistently averaging 5% of total dietetics services. The permanent implementation of telehealth items is unlikely to cause significant increases in cost or access and will assist Australians to eat better to support improved chronic disease outcomes.

A 2020 Evaluation of Global Knowledge Networks in the UN Decade of Action on Nutrition (2016-2025): Proceedings of the 6th International Summit on Medical and Public Health Nutrition Education and Research

The six key action areas, outlined in the Work Programme of the UN Decade of Action on Nutrition, provide a blueprint for sustained nutrition action and are positioned within the 2030 Agenda for Sustainable Development, particularly Target 2.2, ending all forms of malnutrition by 2030.5 Five years on from when the Nutrition Decade was proclaimed, hunger and malnutrition remain problems of huge scale with diet-related health costs linked to mortality and non-communicable diseases projected to exceed USD 1.3 trillion per year.2 Although the change to date has been modest, the remaining years of the Nutrition Decade present an unprecedented opportunity for accelerated efforts. The NNEdPro Global Centre is an award-winning interdisciplinary think-tank, training academy and knowledge network anchored in Cambridge, UK.6 The work of NNEdPro focuses on developing adaptable and scalable models for nutrition education and combining clinical and public health knowledge with leadership training to aid and evaluate implementation in education, health care and community settings globally. [...]the unaffordability of eating well is exacerbated by the pandemic and highlights the need to revitalize nutrition commitments and strengthen accountability for such action.2 There is also a need to consider the impact of trade and investment policies on food systems and maximise action to improve food security and nutrition, and invest responsibly into agriculture and food systems.22 In Action Area 5, Safe and supportive environments for nutrition at all ages, there remains scope to scale-up and further strengthen country level action by improving food offered in public institutions (e.g., school, prison, and hospital settings), considering regulatory approaches to shape food price and availability, and subsequently food choice, and supporting the use of the Voluntary Guidelines on Food Systems and Nutrition of the Committee of World Food Security,23 as discussed at the Summit. The food system accounts for more than one-third of global greenhouse gas emissions, and conversely, the present environmental crisis also places additional strain on the food and healthcare systems.18 Diet-related greenhouse gas emissions are estimated to exceed USD 1.7 trillion per year by 2030 based on current food consumption patterns.18 The resources required to sustain current food systems are vast;food production consumes over 50% of the planets habitable land surface and 70% of freshwater.19 Health care systems constitute a large sector which requires considerable amounts of energy and resources and produces substantial emissions and waste.20 For example, in 2012 alone, the European health system produced 24.7 million tonnes of carbon dioxide emissions, the equivalent of the total greenhouse gas emissions of the entire country of Croatia that same year.21 In the context of the Nutrition Decade, we need increased recognition of the role of agriculture and food systems to promote crop diversification, to create healthy food environments, and to implement measures to ensure food safety standards.

How do patients want to receive nutrition care? Qualitative findings from Australian health consumers.

This qualitative descriptive study explored health consumers' preferences for receiving nutrition care in Australian primary care. The study was underpinned by a constructivist research paradigm. Semistructured telephone interviews were conducted with 25 health consumers (age 19-78 years; 19 female) from across Australia between May and August 2020. Content analysis, using an inductive approach revealed emergent themes. was used to reveal emergent themes. Five themes were identified in the data: (1) health consumers want to receive nutrition care from a qualified person; (2) nutrition care is viewed as important, and health consumers want to receive it in a format that meets their needs; (3) nutrition care should be low cost and available to everyone; (4) nutrition care services should be conveniently located; and (5) health consumers want nutrition care to be offered frequently, across their lifespan. Health consumers have a clear idea of how they would like to receive nutrition care in the primary care setting, but reported challenges to receiving this care within the current system. New models of service delivery are needed to meet the needs of health consumers.

Patient-centred care during the COVID-19 pandemic

THE WORLD HEALTH ORGANIZATION defines patient-centred care (PCC) as care that is respectful and responsive to the needs and wishes of patients.1 There are many reported benefits of PCC, including improved healthcare outcomes,2-5 enhanced relationships between providers and patients4 and enhanced patient satisfaction.2-6 There is a clear need to explore the processes and implementation of PCC because of its impact on patient experience, providers and organisations, and its long-standing emphasis within healthcare policy, such as the National Safety and Quality Health Service Standards7 in Australia. The COVID-19 pandemic has brought about sweeping changes to healthcare systems across the world, including in Australia, where physical distancing regulations and public health orders affected the availability of general practice staff and influenced the way patients accessed and interacted with general practice services.8 Initially, fewer patients attended general practice services for routine care.89 Then, general practices were called on to administer COVID-19 vaccinations to a significant proportion of the national population. Published in 2021, a Delphi study involving 114 healthcare experts, managers, clinicians and patients expressed there may be new priorities in achieving PCC in the COVID-19 era, including greater emphasis on patient safety, care for vulnerable patients, promotion of self-management and patient autonomy.10 These priorities diverge from what was known about enacting PCC prior to the pandemic, which focused on six key components: 1) understanding the whole person, 2) finding common ground, 3) experiencing time, 4) aiming for positive outcomes, 5) considering the system and collaborating in care and 6) optimising the general practice environment.11 Trustworthy qualitative research is valuable to understand the experiences and perspectives of PCC while capturing the contextual factors of the pandemic to inform higher levels of PCC. The researchers' view is that all knowledge is constructed by the interaction between human beings and their world, with important influence from the social context.14 A qualitative descriptive methodological approach15 will be employed to address the research questions, which are outlined in Table 1.

Patient-centred care during the COVID-19 pandemic: Protocol for a qualitative collective case study by high­performing general practice teams.

BACKGROUND AND OBJECTIVES: The COVID-19 pandemic has changed the way general practice teams interact with patients. This protocol article describes the rationale and design of an exploration of the experiences and perceptions of patient-centred care (PCC) by high-functioning general practice teams in Australia. METHOD: A qualitative descriptive approach and collective case study method will be used. Potential participants are individuals representing a high-functioning general practice team, who will be asked to participate in a semi-structured interview. Eligible general practice clinics have received a 'Practice of the Year' award or commendation from The Royal Australian College of General Practitioners or Australian General Practice Accreditation Limited. Interview data will be analysed thematically, with constant comparison and meta-synthesis. DISCUSSION: Collective case study research is valuable because it enables rich exploration of PCC within the context of the pandemic. Rapid research on PCC may highlight new approaches towards the delivery of PCC.

Proximity-dependent biotinylation detects associations between SARS coronavirus nonstructural protein 1 and stress granule-associated proteins.

The nonstructural protein 1 (nsp1) of severe acute respiratory syndrome coronavirus and severe acute respiratory syndrome coronavirus 2 is a critical viral protein that suppresses host gene expression by blocking the assembly of the ribosome on host mRNAs. To understand the mechanism of inhibition of host gene expression, we sought to identify cellular proteins that interact with nsp1. Using proximity-dependent biotinylation followed by proteomic analyses of biotinylated proteins, here we captured multiple dynamic interactions of nsp1 with host cell proteins. In addition to ribosomal proteins, we identified several pre-mRNA processing proteins that interact with nsp1, including splicing factors and transcription termination proteins, as well as exosome, and stress granule (SG)-associated proteins. We found that the interactions with transcription termination factors are primarily governed by the C-terminal region of nsp1 and are disrupted by the mutation of amino acids K164 and H165 that are essential for its host shutoff function. We further show that nsp1 interacts with Ras GTPase-activating protein SH3 domain-binding protein 1 (G3BP1) and colocalizes with G3BP1 in SGs under sodium arsenite-induced stress. Finally, we observe that the presence of nsp1 disrupts the maturation of SGs over a long period. Isolation of SG core at different times shows a gradual loss of G3BP1 in the presence of nsp1.

What information can I share with my patients about nutrition during COVID-19?

In the wake of the current COVID-19 pandemic, nutrition care that focuses on food security is imperative.