Volume 197 Issue 3

New evidence from an international prospective meta-analysis should be incorporated into clinical and Pharmaceutical Benefits Scheme guidelinesThere is no doubting the fundamental role of statin therapy in patients with established cardiovascular disease. However, its role in primary prevention, particularly among patients with lower absolute cardiovascular risk, has been uncertain.1 In 2010, in a meta-analysis of data from 170 000 individual patients with or without cardiovascular disease, the ...

Anthony C Keech MB BS, MSc, FRACP · Jordan R Fulcher BSc(Med), MB BS · John Simes MD, SM, FRACP

A scarcity of funding resources is limiting patient access to major advances in medicine. Health care spending represents a substantial and increasing proportion of national expenditure in most countries. Total annual health care spending in Australia now exceeds $120 billion, or 9.4% of gross domestic product. The highest proportion of health care funding is spent on cardiovascular disease, which accounted for 11% of total expenditure in the ...

David W M Muller MB BS, MD, FRACP

Can we be optimistic?An 8-year-old Aboriginal girl presents with shortness of breath and severe mitral regurgitation, and requires urgent surgery; a young Torres Strait Islander mother has a disabling stroke related to mitral stenosis; and a middle-aged Aboriginal community leader dies from infective endocarditis associated with a mechanical valve. These are the realities of acute rheumatic fever (ARF) and rheumatic heart disease (RHD) in Australia. Globally, ...

Graeme P Maguire MB BS, FRACP, PhD · Jonathan R Carapetis MB BS, FRACP, PhD · Warren F Walsh MB BS, FRACP, FACC · Alex D H Brown BMed, MPH, PhD

The full content of this article is available by downloading the PDF.

The full content of this article is available by downloading the PDF.

Nathan Grills examines unhealthy alliances that highlight corporate social irresponsibilityIndustry sponsorship of charitable causes is increasingly promoted and practised across the corporate sector in Australia and overseas. But should such “corporate social responsibility” be limited in certain circumstances? Apart from tobacco companies, there are currently very few restrictions on which industries are allowed to support which charities. But there is a need to consider whether ...

Nathan J Grills MB BS, DPhil, MPH

A national registry for acute coronary syndromes will improve patient care and clinical resultsAcute coronary syndromes (ACS) represent a substantial burden of morbidity and mortality within Australia.1 Modern treatment of these syndromes requires efficient risk stratification, timely angiography and revascularisation, and use of proven secondary prevention therapies.2-4 With a robust evidence base, it is a reasonable societal expectation that care be applied as completely as ...

Derek Chew MB BS, MPH, FRACP · David Brieger MB BS, PhD, FRACP · Carolyn M Astley RN, BN(Hons) · Andrew Georgiou PhD, FACHI, FCHSM

Ambulatory monitoring is critical in accurately assessing blood pressure to calculate absolute cardiovascular risk. Recently, there has been debate about the need for ambulatory blood pressure monitoring (ABPM) in clinical decision making, promoting instead the use of an absolute cardiovascular disease (CVD) risk-based approach. While we fully endorse hypertension management based on absolute risk, inherent in this assessment is the accurate measurement of blood pressure (BP). ...

Geoffrey A Head BSc, PhD · Barry P McGrath MB BS, MD, FRACP · Mark R Nelson MB BS(Hons), PhD, FRACP · Michael Stowasser MB BS, MD, FRACP

To the Editor: There have been claims that the non-medical use of prescription stimulants is widespread and increasing in the United States and other developed countries, particularly among university students.1 In the context of rising education and general living costs, economic uncertainty and high rates of anxiety and depression among young people,2 it is plausible that some students may cope with study demands by using ...

Jayne C Lucke · Wayne D Hall

To the Editor: On a similar topic to the recent series by McNamara on the length of medical education, a provocative piece published earlier in the Journal of the American Medical Association suggested that medical training could be shortened by 30% in the United States, without detriment to clinical skills. The reality is that there is a paucity of evidence for the ideal duration of ...

Matthew H Anstey

To the Editor: The 2 April issue of the Journal contained several articles on pain, but no mention of patients who suffer with head pain. Headache is one of the commonest acute and chronic pain conditions. Studies have shown that episodic migraine affects 18% of women and 8% of men.1 Daily headache afflicts 4% of people worldwide, and half have chronic migraine.2 According to data from ...

Alessandro S Zagami

To the Editor: I read with interest the recent article on concussion in Australian football by Gilbert and Partridge, and although it is well written, and I agree with virtually all that was said, there is a significant glaring error. In discussing the guidelines on return to play after concussion, they give the impression that the National Rugby League (NRL) is somehow lagging behind the ...

Ron Muratore

To the Editor: In their letter, Spencer, Howe and Manolios call for investment in fracture liaison services.1 Our own business plan showed that for an investment of $55 000 to hire a nurse, the dividend is $1.5 million in second surgeries prevented. This plan has failed to impress successive chief executive officers or their finance managers, and for good reason. The obstacle is a financial paradox. If a chief ...

Nikolai Bogduk

To the Editor: In Australia, cancer, heart disease, stroke and diabetes mellitus contribute to 56% of all deaths,1 and have a significant nutrition-related lifestyle component. In 2008, 68% of men and 55% women were classified as overweight or obese,1 and of those in residential aged care, 50% were moderately or severely malnourished.2 Accreditation standards for medical schools (currently under review) specify that medical graduates have ...

Caryl Nowson · Marjo Roshier-Taks · Brendan Crotty

To the Editor: I refer to Geelhoed and de Klerk’s article1 and related correspondence.2,3 While concerned with the rise in the overall rate of emergency department (ED) presentations, I am alarmed by the disproportionate increase in the ED admission rate (24% increase, from 3960 admissions per 10 000 ED presentations in July 2007 to June 2008, to 4910 admissions per 10 000 ED presentations in July 2010 to June 2011) since the introduction of ...

Shyan L Goh

To the Editor: A woman was assessed after an episode of goat cheese anaphylaxis. She had been using goat milk soap (various brands) to treat dry skin and mild eczema since 2009. In 2010, she experienced itchy mouth while eating goat cheese, and later in the year, she had contact urticaria after applying goat milk moisturiser (use discontinued). In early 2011, she developed tongue and ...

Raymond J Mullins

To the Editor: Medical students around the world are taught that staphylococcal bacteriuria may be indicative of concurrent bacteraemia.1 Yet there is little published evidence to support this “golden rule” of infectious diseases, and a retrospective review has suggested that no such relationship exists.2 To determine the relationship between Staphylococcus aureus (SA) bacteriuria and bacteraemia, we performed a retrospective review of microbiology results at the Alfred ...

Janine M Trevillyan · Denis Spelman

To the Editor: Murray Valley encephalitis virus (MVEV) is rarely seen in south-eastern Australia, as described in the recent review in the Journal by Knox and colleagues.1 During the MVEV transmission period in early 2011, there was extensive flooding, and high notification rates were reported for other mosquito-transmitted infections, including flavivirus infection among horses. MVEV seroconversion was detected in sentinel chicken flocks. However, despite concerns ...

Joseph S Doyle · Suellen Nicholson · Jennifer A Leydon · Rodney J Moran · Michael G Catton

To the Editor: Patients who survive subarachnoid haemorrhage (SAH) are at significant risk of visual impairment, further complicating their recovery. This may arise as a result of Terson syndrome,1 which is the phenomenon of intraocular haemorrhage associated with any intracranial bleed and raised intracranial pressure. We report a case of missed Terson syndrome at a tertiary referral centre. A 36-year-old previously well woman presented with a ...

Akbar N Ashrafi · Rahul Chakrabarti · John Laidlaw

About 80% of congenital heart disease (CHD) is multifactorial and arises through various combinations of genetic and environmental contributors. About 20% of cases can be attributed to chromosomal anomalies, Mendelian syndromes, non-syndromal single gene disorders or teratogens. Down syndrome and velocardiofacial syndrome are the most commonly seen syndromes in patients with CHD. To date, more than 30 genes have been linked to non-syndromal forms ...

Gillian M Blue MSc, GradDipGenCouns · Edwin P Kirk MB BS, PhD, FRACP · Gary F Sholler MB BS, FRACP · Richard P Harvey PhD · David S Winlaw MB BS, MD, FRACS

Objective: To investigate whether bias in clinical history affects accuracy of electrocardiograph (ECG) interpretation among doctors working in emergency departments.Design and setting: Observational study conducted at four teaching hospitals in Sydney from May to September 2011.Participants: Emergency registrars and physicians (senior doctors), and interns, resident medical officers and senior resident medical officers (junior doctors).Intervention: Participants interpreted 30 ECGs ...

Monique F Cruz BSc(Med), MB BS · James Edwards MB BS, MMedEd, FACEM · Michael M Dinh MB BS, MPH, FACEM · Elizabeth H Barnes MStat

In the early years of transplantation, organs were retrieved from patients who were considered to have died by traditional cardiopulmonary criteria (now known as donation after cardiac death [DCD]) or from live donors. The introduction of diagnostic criteria for brain death provided a more practical and controlled pathway to organ donation. Donation after brain death (DBrD) allowed organ retrieval without prior cessation of circulation, thus minimising warm ischaemic time and enhancing organ function in the recipient.

Tim G Coulson BM, BSc · David V Pilcher MRCP, FRACP, FCICM · Shena M Graham RN, CCC, BN · Gregory I Snell MB BS, FRACP, MD · Bronwyn J Levvey RN, GradDipEpi, BEdStudies · Steve Philpot FCICM · Alvin Teo FCICM · Andrew R Davies FRACP, FCICM

Objective: To compare the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS initiative with the Better Outcomes in Mental Health Care initiative, to test contentions that Better Access is used more often by advantaged major city patients and that the role of GPs has been reduced to that of referrers.Design and setting: Analysis of Bettering the Evaluation and ...

Christopher M Harrison BPsych(Hons), MSocHlth · Helena C Britt BA, PhD · Janice Charles BA, MSc(Med)

Objectives: To describe the clinical syndrome associated with definite tiger snake (Notechis spp) envenoming and to examine the ability of tiger snake antivenom (TSAV) to bind free venom in vivo. Design, setting and participants: We conducted a prospective cohort study within the Australian Snakebite Project, reviewing all definite tiger snake envenoming cases between October 2004 and June 2011. Definite cases were identified by ...

Geoffrey K Isbister · Margaret A O’Leary · Matthew Elliott · Simon G A Brown

Objective: To determine the increase in intensive care unit (ICU) bed availability that would result from the use of the New South Wales and Ontario Health Plan for an Influenza Pandemic (OHPIP) triage protocols.Design, setting and patients: Prospective evaluation study conducted in eight Australian, adult, general ICUs, between September 2009 and May 2010. All patients who were admitted to the ICU, excluding ...

on behalf of the Influenza Pandemic ICU Triage (iPIT) Study Investigators

The full content of this article is available by downloading the PDF.

Choong-Siew Yong MB BS, FRANZCP, CertChildAdolPsych

PATIENTS COMMONLY have problems in the mouth, nose and throat. This new book by Geoffrey Quail, who is Clinical Associate Professor at the Department of Surgery, Monash University, Melbourne, and Director of the Dental and Maxillofacial Surgery Unit at Southern Health, Melbourne, provides clear and succinct information on the diagnosis of conditions affecting these areas. It will be helpful to anyone who needs an illustrated and ...

Michael Barakate

She was not told the meaning of absence why parents could not visit except on weekends — and then only for an hour. The 1906 Home Handbook of Domestic Hygiene and Rational Medicine outlines the treatment for rheumatic afflictions — hot blanket packs, repeated. She remembers those who wrapped her body in hairy blankets to preserve her rheumatic heart — remembers how the blankets electrified her body so ...

Jennifer Harrison

Sir Keith Jones, who died on 2 March 2012 in his 101st year, had a long and distinguished medical career, during which he gave service to the medical profession through the British Medical Association in Australia and, later, in various capacities, the Australian Medical Association (AMA) after its formation in 1962. He was President of the AMA from 1973 to 1976 and Chairman of the Board of the Australasian ...

George D Repin

Cardiology is a growing specialty that can be tailored to your skills and lifestyle

Marge Overs

Dr Kathryn Waddell-Smith is a final-year advanced cardiology trainee at Flinders Medical Centre in Adelaide

Interview by Marge

Dr Michelle Ammerer is an interventional cardiologist and director of the largest coronary care unit in Western Australia, at Sir Charles Gairdner Hospital in Perth. She is also in private practice at Western Cardiology, based at St John of God Hospital Subiaco. In 2004, Dr Ammerer completed a Fellowship in Interventional Cardiology at Brigham and Women’s Hospital in Boston, through the Harvard Medical School.

Marge Overs

Music helps Dr Rowan Thomas to escape the pressures of medicine

Sophie McNamara

Social networking is starting to find a foothold in medical practice

Amanda Bryan