Volume 197 Issue 4

Better outcomes require tailored strategiesThe past 15 years has seen the advent of many new classes of antidiabetic agents. We now have biguanides, sulfonylureas, thiazolidinediones, dipeptidyl-peptidase IV inhibitors, glucagon-like peptide 1 receptor agonists, a variety of insulins and a-glucosidase inhibitors. This has resulted in a surfeit of choice, but has also increased the complexity of decision making as there is no simple algorithm for escalation of treatment ...

N Wah Cheung MB BS, FRACP, PhD

Increased foot problems due to diabetes means a national focus on coordinated foot care is essential. Data from the Australian Institute of Health and Welfare (AIHW) suggest that one Australian loses a lower limb every 3 hours as a direct result of diabetes-related foot disease (DRFD). Further data suggest there has been a 30% increase in diabetes-related amputations in Australia over the past decade, with 8% of ...

Shan M Bergin BAppSci(Pod), PhD · Jan B Alford RN, MEd(AdEd), CDE · Bernard P Allard MB BS, FRACS(Vasc) · Joel M Gurr BSc(Pod), MBA · Emma L Holland RN, CDE, MA(Ed) · Mark W Horsley MB BS, FRACS(Ortho) · Maarten C Kamp FRACP, MHA, GAICD · Peter A Lazzarini BAppSci(Pod) · Vanessa L Nube DipAppSci(Pod), MSc(Med) · Ashim K Sinha MB BS, MD, FRACP · Jason T Warnock DipAppSc(Chir), GradCertDiabEd · Paul R Wraight MB BS, FRACP, PhD

Making cancer drugs affordable requires coherent policy and cannot be left to market forcesMelanoma is 10 times more common in Australia than in most countries,1 and kills more than 1300 Australians every year.2 The good news is that we now have effective drug treatments for metastatic melanoma. Two drugs, ipilimumab3,4 and vemurafenib,5 are now approved by the United States Food and Drug Administration and the Australian Therapeutic ...

Richard F Kefford AM, PhD, FRACP

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

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

Ray Moynihan reports on the bitter battle over blood sugar levels and pregnancy. One of the freshest fights over the definition of disease is happening with gestational diabetes. A recent redefinition more than doubles the patient pool and labels up to one in five pregnant women as unwell. The new criteria arose at a conference in California in 2008, were published in 2010, and are now ...

Ray N Moynihan BA

Are current standards of evidence always appropriate when making the decision to subsidise treatment?

Wendy L Lipworth MB BS, MSc, PhD · Ken Ho MD, FRACP, FRCP · Ian H Kerridge BMed(Hons), MPhil, FRACP · Richard O Day AM, MD, FRACP

A single entry and exit point model would be more efficient for graduates and employers alike. Completion of a structured internship is a requirement for medical graduates seeking to progress from provisional to general registration in Australia. Despite minor historical variations between states and territories, there is increasing consistency among internship programs across the country. Driving forces behind this include the establishment of a national registration ...

Michael A Bonning MB BS, BAppSci(Hons) · Rick J Fielke MB BS, GradCertMed(PaedMed) · Rob D Mitchell MB BS(Hons), BMedSc(Hons)

Supporting a previously neglected group of doctors will improve the safety, efficiency and efficacy of patient careThe Hospital Skills Program (HSP) is a flexible training and professional development program for New South Wales career medical officer (CMO)-equivalent medical practitioners with needs that are not met by prevocational and specialist college training programs. The 510 enrolled doctors work in a range of public health services across NSW ...

Simon D Leslie MB BS · Peter Davy BEd · Michael Boyd MB BS · Mary Webber MB BS

To the Editor: We read with interest McNamara’s pieces on the length of Australian medical training. The current training system is more a crude result of historical evolution than the outcome of a strong evidence base. The extra time taken by Australian doctors to become competent at a procedure is likely mirrored in other areas of medical knowledge and skill because of both internal (doctor) ...

Dev A S Kevat · James M Hillis

To the Editor: We read with interest the letter by Playford and colleagues, but important questions remain about the authors’ methods and conclusions.1 First, not only do the data periods for assessing hand hygiene (HH) compliance and for rates of health care-associated Staphylococcus aureus bacteraemia (HCA-SAB) not overlap, but the data period for HCA-SAB rates precedes the HH compliance data period. Second, the study design ...

M Lindsay Grayson · Philip L Russo

In reply: We thank Grayson and Russo for their interest and comments. Clearly our intent was to stimulate much-needed debate about the presentation and interpretation of publicly disclosed infection control data. Given that no study has shown a reduction in the rate of methicillin-susceptible Staphylococcus aureus bacteraemia (SAB) through increased compliance with hand hygiene (HH), we again question why the MyHospitals interpretive comments for these data ...

Elliott G Playford · David McDougall · Mary-Louise McLaws

To the Editor: The frequency and intensity of floods and other weather-related disasters is likely to increase with climate change. These disasters may affect both the physical and mental health of people who are directly affected. The extensive rainfall and subsequent flooding experienced throughout Queensland in December 2010 and January 2011 had significant impacts on large sections of the population. To assess the health impacts of the ...

Lyle R Turner · Katarzyna Alderman · Shilu Tong

To the Editor: The incidence of type 1 diabetes (T1D) in children is rising globally, including in Australia.1 Diabetic ketoacidosis (DKA) is the leading cause of diabetes-related deaths in children.2 Clinical manifestations of DKA include dehydration; rapid, deep, sighing (Kussmaul respiration); nausea; vomiting; abdominal pain and a reduced level of consciousness.2 There is an inverse relationship between the frequency of presentation with DKA and background incidence ...

Femke M A P Claessen · Kim Donaghue · Maria Craig

To the Editor: We note Ahmed and colleagues’ extensive case series of patients with severe vestibulopathy due to aminoglycosides. We attempted to develop a hospital-based screening program to detect vestibulopathy in inpatients that may be informative for others considering similar programs. We established a pilot project involving student pharmacists. Patients who received more than a single dose of any aminoglycoside antibiotic were identified by therapeutic drug ...

Maryam Teimoori · Gina Mistry · Carmela Corallo · Allen C Cheng

To the Editor: Influenza is a common respiratory infection that is infrequently associated with severe disease requiring hospitalisation. We have conducted hospital-based surveillance in the Influenza Complications Alert Network (FluCAN) since 20091 and report on our findings in 2010 and 2011. In 2010, 15 hospitals based in capital cities or large regional centres were involved, as previously described.1,2 In 2011, eight hospitals in Victoria, South Australia, Western Australia ...

on behalf of the FluCAN Investigators

To the Editor: The paucity of human anatomy teaching at Australian medical schools is well established. Recently, a number of 4-year graduate-entry medical schools have sought to improve anatomy knowledge among students by introducing cadaver-dissection electives and extracurricular anatomy courses. Currently, 6-year undergraduate medical programs, such as at James Cook University (JCU), incorporate more anatomy education than their graduate-entry counterparts. However, even 6-year programs offer ...

Andrew T Hattam · Claudia M Diaz

For many years, the diagnosis of diabetes has been made through the laboratory-based measurement of fasting or random blood glucose levels, or using the oral glucose tolerance test. A glycated haemoglobin (HbA1c) level ≥ 6.5% (48 mmol/mol) is now also acceptable for diagnosing diabetes. Caution is needed in interpreting HbA1c test results in the presence of conditions affecting red blood cells or their survival time, ...

Michael C d’Emden MD, PhD, FRACP · Jonathan E Shaw MD, FRACP, FRCP · Peter G Colman MB BS, FRACP, MD · Stephen Colagiuri MB BS, FRACP · Stephen M Twigg MB BS, PhD, FRACP · Graham R D Jones MB BS, DPhil, FRCPA · Ian Goodall FAACB, FAIMS, FFSC(RCPA) · Hans G Schneider MD, FRCPA, FRACP · N Wah Cheung MB BS, PhD, FRACP

The publication of the Australasian Creatinine Consensus Working Group’s position statements in 2005 and 2007 resulted in automatic reporting of estimated glomerular filtration rate (eGFR) with requests for serum creatinine concentration in adults, facilitated the unification of units of measurement for creatinine and eGFR, and promoted the standardisation of assays. New advancements and continuing debate led the Australasian Creatinine Consensus Working Group to reconvene in 2010. ...

Australasian Creatinine Consensus Working Group

Optimal detection and subsequent risk stratification of people with chronic kidney disease (CKD) requires simultaneous consideration of both kidney function (glomerular filtration rate [GFR]) and kidney damage (as indicated by albuminuria or proteinuria). Measurement of urinary albuminuria and proteinuria is hindered by a lack of standardisation regarding requesting, sample collection, reporting and interpretation of tests. A multidisciplinary working group was convened with the ...

Australasian Proteinuria Consensus Working Group

Appropriate assessment and management of diabetes-related foot ulcers (DRFUs) is essential to reduce amputation risk. Management requires debridement, wound dressing, pressure off-loading, good glycaemic control and potentially antibiotic therapy and vascular intervention. As a minimum, all DRFUs should be managed by a doctor and a podiatrist and/or wound care nurse. Health professionals unable to provide appropriate care for people with DRFUs should ...

Shan M Bergin BAppSci(Pod), PhD · Joel M Gurr BSc(Pod), MBA · Bernard P Allard MB BS, FRACS(Vasc) · Emma L Holland RN, CDE, MA(Ed) · Mark W Horsley MB BS, FRACS(Ortho) · Maarten C Kamp FRACP, MHA, GAICD · Peter A Lazzarini BAppSci(Pod) · Vanessa L Nube DipAppSci(Pod), MSc(Med) · Ashim K Sinha MB BS, MD, FRACP · Jason T Warnock DipAppSc(Chir), GradCertDiabEd · Jan B Alford RN, MEd(AdEd), CDE · Paul R Wraight MB BS, FRACP, PhD

Objective: To examine the frequency and causes of snorkelling-related deaths in Australia.Design, setting and subjects: We conducted a retrospective analysis of snorkelling-related deaths recorded in Australia from 1994 to 2006 inclusive, based on information from the Divers Alert Network Asia–Pacific database, the National Coroners Information System, coronial files from all states and territories, and annual national drowning reports.Main outcome measures: Number ...

John M Lippmann BSc, DipEd, MAppSc · John H Pearn MD, FRACP, FRCP

Traumatic injury accounts for 9% of global mortality, and imposes significant physical and psychological disability on people of all age groups. It remains the leading cause of death in those under 45 years of age. Trauma systems facilitate the timely treatment of patients with major trauma at a trauma centre. This approach has reduced mortality in patients with trauma in Australia and internationally.

Kate A Curtis PhD, RN · Rebecca J Mitchell MA (Psych), MOHS, PhD · Shanley S Chong PhD · Zsolt J Balogh MD, PhD, FRACS · Duncan J Reed MB BS, FACEM · Peter T Clark FACEM, FCICM, FANZCA · Scott D’Amours MDCM, FRCS(C), FRACS · Deborah A Black PhD, MStat, BSc · Mary E Langcake BM BS, BSc(Hons), FRACS · Colman B Taylor MND · Patricia McDougall RN, Cert Hlth Economics · Peter A Cameron MB BS, MD, FACEM

Objective: To identify a level of iodine supplementation to recommend for pregnant and breastfeeding women in Australia.Design, setting and participants: Dietary modelling indicated that mandatory fortification of bread with iodine by replacing salt with iodised salt would still leave a gap in iodine intakes in pregnant and breastfeeding women in Australia. Iodine shortfall was estimated by two separate methods: (i) analysis ...

Dorothy E M Mackerras MPH, PhD · Creswell J Eastman MD, FRACP, FRCPA

The Foundation’s global work stems from the personality of an energetic and admired clinician, teacher and advocateIt’s quite simple really. The Fred Hollows Foundation is 20 years old. It started as Fred was dying from renal cancer. Fred was gifted and energetic and visionary but he had to hand the show over to colleagues, fundraisers and a handful of people who could organise things so that ...

David Moran MB BS(Hons), FRANZCO

David Morton was born in Wauchope, New South Wales, on 9 May 1929, the son of a teacher. He achieved a maximum pass in the Leaving Certificate from Sydney Boys High School and commenced medicine at the University of Sydney in 1946. His older brother Max and sister Marion were both prosectors in anatomy there. David’s first year marks made him the family’s third prosector — ...

Alan D Hewson

John Brown was born on 5 August 1934 in Meadowbank, New South Wales. He lost both parents early in his teenage years and was then raised by his aunt, Doris Johnson. Despite these setbacks, he attended Fort Street Boys’ High and subsequently studied medicine at the University of Sydney. On graduating in 1957, he entered the emerging specialty of paediatrics. While training at the Royal Alexandra Hospital for ...

Lachlan T Brown

OVER 4 million children present each year to emergency departments (EDs) across Australia for acute medical care. This represents, on average, one visit per year per child. The appropriate management of these acutely ill and injured children requires specific expertise and, as a result, paediatric emergency medicine has increasingly become an important area of subspecialty training.Most children, however, will present to general EDs for their care ...

Amy C Plint

Young doctors wanting to specialise in diabetes care should consider advanced training in a regional area such as Cairns

Marge Overs

Dr Daniel Chen, who finished his fellowship in endocrinology last year, is completing a PhD at the Garvan Institute of Medical Research in Sydney, as well as working as a specialist endocrinologist

Marge Overs

Professor Don Chisholm AO has been a leader in diabetes research, care and education. He was head of the Diabetes Research Program at the Garvan Institute of Medical Research in Sydney from 1978 to 2003. He was foundation director of the Diabetes Centre at St Vincent’s Hospital in Sydney from 1980 to 1991. He has retired from clinical practice apart from a monthly diabetes clinic at an Aboriginal medical service in western NSW, and continues to work in diabetes research at the Garvan.

Interview by Marge

Professor Bob Cumming turned his passion for international public health into a job

Sophie McNamara

Doctors may be cagey about reaching out to patients on Facebook or Twitter — but there are plenty of pay-offs for getting social media-savvy.

Amanda Bryan