Volume 197 Issue 7

Two studies testing interventions that made little difference to patient outcomes demonstrate the importance of translational researchGeneral practitioners are often expected to implement findings of clinical trials done in hospitals or academia. Health policymakers also develop and implement primary health care system changes without proper evaluation or being informed by translational research studies. Two clinical trials reported in this issue of the Journal give us ...

Mark R Nelson MB BS(Hons), FRACGP, PhD

Changing clinician beliefs and behaviour in response to credible evidence of lack of treatment efficacy remains highly challengingArthroscopy is commonly used to treat people with knee pain due to osteoarthritis. However, data collected from randomised controlled trials over the past two decades have provided compelling evidence that, in general, arthroscopic treatment comprising debridement and lavage is no more effective than placebo surgery or non-operative alternatives,1,2 ...

Rachelle Buchbinder MB BS(Hons), MSc, PhD · Ian A Harris MB BS, MMed(Clin Epi), PhD

The central role for Australian general practice in providing high-quality affordable health care for all Australians has been underlined repeatedly by national health bodies including the National Health and Hospitals Reform Commission (NHHRC), the Council of Australian Governments Reform Council, the National Primary Health Care Strategy, the National E-Health Transition Authority and Health Workforce Australia. The Australian Health Practitioner Regulation Agency has recognised general practice ...

Claire L Jackson MB BS, MD, FRACGP

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

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

Supermarket design and strategy encourages shoppers to buy large quantities of high-profit-margin products. The emergence of supermarkets as a form of retailing and increasing reliance on manufactured foods have paralleled the increase in the rate and severity of obesity. So, it makes sense to examine supermarkets and how they successfully market these now widely used goods to the community. Supermarkets have an almost universal captive market — ...

Molly E Bond BBiotech(Hons), DipLang · Brad R Crammond MA(Hons), LLM · Bebe Loff LLB, MA, PhD

Good correlation with out-of-office readings, virtual elimination of white-coat effectAn accurate blood pressure (BP) reading can be obtained if measurement guidelines are followed properly. However, BP readings recorded in routine clinical practice are often inaccurate and much higher than mean awake ambulatory BP values and readings obtained by home measurement. In studies that have included data on office BP readings that were recorded manually in ...

Martin G Myers MD, FRCPC · Mark R Nelson MB BS(Hons), PhD, FRACGP · Geoffrey A Head BSc(Hons), PhD

Published research evidence does not automatically diffuse into clinical practice but requires active processes of translation that start with clinicians’ awareness of the science and end with patient adherence to the recommended care. Many barriers thwart the uptake of valid and clinically important research into practice, with cognitive, motivational and sociological factors on the part of health professionals being among the most important. ...

Ian A Scott FRACP, MHA, MEd · Paul P Glasziou MB BS, FRACGP, PhD

Overactive bladder may be a marker of obstructive sleep apnoea or cardiometabolic riskThe lower urinary tract symptoms (LUTS) nocturia, urgency and frequency are grouped as “storage symptoms”. When troublesome, the presence of urgency plus one other symptom constitute overactive bladder (OAB).1 Dysfunction or irritability of the detrusor muscle of the urinary bladder is a primary cause of these symptoms, although coexistent prostatic disorders may be ...

Gary A Wittert MB Bch, MD, FRACP · Sean Martin BSc(Hons) · Peter Sutherland MB BS, FRACS · Susan Hall PhD · Varant Kupelian PhD · Andre Araujo PhD

To the Editor: In June 2007 we highlighted the inconsistent application of community-accepted harm minimisation strategies, when offered to prisoners, among the various Australian jurisdictions.1 We sought information from the eight prisoner health services to assess how harm minimisation strategies were being implemented in each jurisdiction (Box). Progress has been slow, particularly in Queensland and the Northern Territory. The positive progress, however, has been the trial of condom ...

Michael H Levy · Carla Treloar

To the Editor: Kowal’s article resonates with our experience.1 However, the National Health and Medical Research Council has supported genetic testing in Indigenous Australians for longer than she cites. Through a 1995–1997 project grant, a 1998 PhD scholarship,2,3 a 2006 program grant and an Australia Research Fellowship (2008–), the NHMRC has supported work on kidney and related chronic diseases, in protocols endorsed by two remote communities and approved ...

Wendy E Hoy

To the Editor: We read with interest the article by Kowal about genetic research in Indigenous health.1 As stated, this topic is extremely sensitive, but it is one that we must now tackle. The article raises a related issue that has not received any attention: the provision of genetic health services to Aboriginal and Torres Strait Islander people. We should not presume that Aboriginal and Torres ...

Gail Garvey · Christina M Bernardes

In reply: I thank Hoy, and Garvey and Bernardes, for their responses. Hoy highlights the difficulties her group has experienced in conducting genetic research in an Aboriginal community over two decades. Indeed, this was the project I referred to as losing its ethics approval as a direct result of the Human Genome Diversity Project. She attributes the difficulties she has faced to conflicting views between ...

Emma E Kowal

In Australia, chronic vascular diseases such as heart disease and diabetes are the leading causes of death and disability. Intensive lifestyle interventions have been shown to prevent vascular disease and diabetes in high-risk patients ...

Mark F Harris MB BS, MD, FRACGP · Mahnaz Fanaian BSc, MSc, PhD · Upali W Jayasinghe GradDipAppStat, MSc, PhD · Megan E Passey BMed, MPH, MSc · Suzanne H McKenzie MB BS, MMedSci, FRACGP · Gawaine Powell Davies BA(Hons), MHP · David M Lyle MB BS, PhD, FAFPHM · Rachel A Laws BSc(Nutrition), MSc(Nutrition · Heike Schütze BSc, MPH · Qing Wan MB BS, MPH, PhD

Objective: To evaluate a partnership model of care for patients with a diagnosis of chronic obstructive pulmonary disease (COPD).Design, setting and participants: Cluster randomised controlled trial with blinded outcome assessment of 44 general practices in south-western Sydney comprising 451 people with a diagnosis of COPD, conducted between 2006 and 2009.Intervention: Participants from intervention group practices were visited at their home by a ...

Nicholas A Zwar MPH, PhD, FRACGP · Oshana Hermiz MB BS · Elizabeth Comino BVSc, PhD · Sandy Middleton PhD · Sanjyot Vagholkar MB BS, MPH · Wei Xuan PhD · Stephen F Wilson PhD, FRACGP, FAFRM · Guy B Marks MB BS, PhD, FRACP

Objective: To assess the use of elective knee arthroscopy procedures for all adults 20 years and older, and for adults with a concomitant diagnosis of osteoarthritis (OA) in Victoria.Design, setting and patients: Retrospective, longitudinal cohort study of 807 030 elective orthopaedic admissions using routinely collected public and private hospital data from 1 July 2000 to 30 June 2009.Main outcome measure: Trends in rates of elective ...

Megan A Bohensky PhD, MPH, BA · Vijaya Sundararajan MD, MPH · Nick Andrianopoulos MB BS, MBiostat · Richard N de Steiger MB BS, FRACS, FAOrthA · Andrew Bucknill MSc, MB BS, FRACS · Christos M Kondogiannis MB BS, FRACS · Geoffrey McColl MB BS, PhD, MEd · Caroline A Brand MB BS, MPH

International and Australian studies show that well structured approaches to diabetes care can improve short-term and intermediate patient outcomes ...

Julia V Marley PgDipSc, PgDipPolSt, PhD · Carmel Nelson MPHandTM, FACRRM, FRACGP · Vicki O’Donnell DipBusMgt · David Atkinson MB BS, MPH

We describe the first reported cases of phenytoin-related drug-induced hypersensitivity syndrome in unrelated Indigenous Australians with the same HLA-B*56:02 allele. These patients shared common clinical and pathological features, and all three were found to have the otherwise rare HLA-B allele, which might represent a novel genetic susceptibility factor for this syndrome.Clinical recordsPatient 1A 32-year-old Indigenous man from a remote Western Australian community presented with a fever, ...

Damian J Harding MB BS, BSc(Hons), MRCP · Kavitha Subramaniam MB BS, FRACP · Gerry MacQuillan MB BCh, FRACP, PhD · Joshua Davis MB BS, FRACP, PhD · David Nolan MB BS, PhD

Long-term continuity of care and community engagement mean a lot to a doctor. When we pulled up in the driveway of our first rented house in Camperdown, south-west Victoria, a woman’s face appeared over the fence. “Hello”, she said, “Who are you? What are you doing here?” I explained that we were doctors and would be working in the town. “Oh, you got any family here?” ...

Ruth A Stewart MB BS, FACRRM, DRANZCOG

Embracing the positive consequences arising from adverse circumstances underpins an optimistic futureTracking and tracing through the roots of your life searching for the meaning inherent in the snippets of memory is challenging because it is uncomfortable, confronting and emotional, but it is ultimately a positive experience to be drawn on as the days go by. Marjorie Woodrow (Nan) is my grandmother and has a quite extraordinary ...

Mark J Lock BSc, MPH,PhD

Since 2008, the Bouverie Centre, a family therapy and healing centre, in association with La Trobe University, has provided training for Aboriginal and Torres Strait Islander child and family workers through a postgraduate certificate in family therapy. This landmark educational program is offered throughout Victoria and is delivered within the students’ communities. There are two training teams, each consisting of one Indigenous cultural consultant (family therapy-trained) ...

Robyne Latham MFA, GradDipEd

CorrectionIncorrect article title: The title of the article “Disciplinary notations on the Medical Register of Australia” published in the 4 June issue of the Journal (Med J Aust 2012; 196: 612-613) was incorrect. The title should read: “Disciplinary notations on the Australian Register of Medical Practitioners”.

Ian R Freckelton

Queensland’s Rural Generalist Pathway is leading the way for rural training

Marge Overs

Dr Claudia Collins is a Senior Medical Officer with the Rural Generalist Pathway in Longreach, Queensland. She hopes to sit her fellowship exams for the Australian College of Rural and Remote Medicine (ACRRM) next year

Cate Swannell

Dr Dan Manahan is medical superintendent of Stanthorpe Hospital in south-east Queensland and the medical director of the state’s Rural Generalist Pathway. The Pathway is a training program for junior doctors who want to pursue a career in rural generalist medicine, including advanced training in anaesthetics, obstetrics or surgery.

Interview by Marge

Life becomes art for general practitioner and writer Dr Jacinta Halloran

Sophie McNamara

Are large corporate-owned clinics better than the traditional small family practice? Doctors tell us how their experiences stack up.

Amanda Bryan