Digitally-enabled remote critical care: the challenges of geography and history?

The COVID-19 pandemic has rejuvenated interest in the possibility of using telemedicine as an approach to providing critical care services to patients in remote areas. Conceptual and governance considerations remain unaddressed. We summarise the first steps in a recent collaborative effort between key organisations in Australia, India, New Zealand, and the UK, and call for an international consensus on standards with due considerations to governance and regulation of this emerging clinical practice.

Multisystem inflammatory syndrome following mild COVID-19 in an unvaccinated Tongan adult.

Multisystem inflammatory syndrome in adults (MIS-A), is a rare post-infectious complication of COVID-19. We describe an illustrative case of MIS-A in an otherwise well, SARS-CoV-2 unvaccinated 25-year-old Tongan man who presented to hospital 30 days after mild COVID-19 illness. We highlight the progression of his illness, including treatment in the Intensive Care Unit (ICU) for cardiogenic shock, and detail temporal evolution of clinical, laboratory and radiographic features of his illness. Clinicians should be alert for possible MIS-A in the weeks after a surge in COVID-19 cases.

Prevalence of bullying, discrimination and sexual harassment among trainees and Fellows of the College of Intensive Care Medicine of Australia and New Zealand.

BACKGROUND: Anecdotal reports about bullying behaviour in intensive care emerged during College of Intensive Care Medicine (CICM) hospital accreditation visits. Bullying, discrimination and sexual harassment (BDSH) in the medical profession, particularly in surgery, were widely reported in the media recently. This prompted the College to formally survey its Fellows and trainees to identify the prevalence of these behaviours in the intensive care workplace. METHODS: An online survey of all trainees (n = 951) and Fellows (n = 970) of the CICM. RESULTS: The survey response rate was 51% (Fellows, 60%; trainees, 41%). The overall prevalences of bullying, discrimination and sexual harassment were 32%, 12% and 3%, respectively. The proportions of Fellows and trainees who reported being bullied and discriminated against were similar across all age groups. Women reported a greater prevalence of sexual harassment (odds ratio [OR], 2.97 [95% CI, 1.35-6.51]; P = 0.006) and discrimination (OR, 2.10 [95% CI, 1.39-3.17]; P = 0.0004) than men. Respondents who obtained their primary medical qualification in Asia or Africa appeared to have been at increased risk of discrimination (OR, 1.88 [95% CI, 1.15-3.05]; P = 0.03). Respondents who obtained their degree in Australia, New Zealand or Hong Kong may have been at increased risk of being bullied. In all three domains of unprofessional behaviour, the perpetrators were predominantly consultants (70% overall), and the highest proportion of these was ICU consultants. CONCLUSIONS: The occurrence of BDSH appears to be common in the intensive care environment in Australia and New Zealand.

College of Intensive Care Medicine: changes to intensive care medicine training.

The College of Intensive Care Medicine provides the standards for training and certification of intensive care medicine specialists in Australia and New Zealand. After reviewing and revising its training program, the College recently launched a new training curriculum for all trainees registering from 2014, aimed at maintaining quality. In this article, we aim to outline the context, changes and future directions for intensive care medicine training in Australia and New Zealand.

Multifocal choroiditis with panuveitis in a patient with disseminated Mycobacterium avium complex.

PURPOSE: The authors present a case of multifocal choroiditis and panuveitis secondary to disseminated Mycobacterium avium complex infection in a patient with human immunodeficiency virus/AIDS. METHOD: Case report and review of relevant literature. RESULTS: A 48-year-old woman with human immunodeficiency virus was admitted for the work up of abdominal pain, fevers, and weight loss. She was noncompliant with antiretroviral therapy with a CD4 count of 30 × 10/L. She reported bilateral reduction in vision with corrected acuities of 6/18 in the right eye and 6/36 in the left eye. Bilateral granulomatous panuveitis with multifocal choroiditis was present. A vitreous biopsy of the left eye confirmed Mycobacterium avium complex, also identified on mycobacterium blood cultures. She was started on oral azithromycin and ethambutol, and after 6 months, her corrected acuities were 6/9 in the right eye bilaterally with an improvement in uveitis and choroiditis. CONCLUSION: Mycobacterium avium complex infection should be considered as a cause of visual impairment in patients with human immunodeficiency virus/AIDS. Early detection and prompt management are essential for the prevention of visual and other systemic complications.