Volume 197 Issue 8

Overseas-trained doctors need guidance through the labyrinth of providing medical care in a new countryAustralia, like many other developed countries, depends on international medical graduates (IMGs) to fill workforce shortages. About one in every three to four members of our medical workforce are trained overseas,1 and this dependency is likely to continue for many more years. IMGs are a heterogeneous group with varied skills and ...

Balakrishnan R Nair AM, MD, FRACP, FRCPE · Mulavana S Parvathy MB BS, FRACGP

Around the world, intestinal transplantation has become the standard of care for patients with irreversible intestinal failure associated with life-threatening complications of parenteral nutrition. Until the recent establishment of an intestinal transplantation service in Victoria, Australians with strong indications for intestinal transplantation had to either succumb to their condition or ...

Simone I Strasser MB BS, MD, FRACP

A new treatment target includes mucosal healing as well as clinical remissionIn the late 1990s, controlled trials confirmed the efficacy of tumour necrosis factor-alpha (TNF-α) antibodies in treating active Crohn’s disease, signalling a major breakthrough in treatment. TNF-α monoclonal antibody therapy has since been shown to lead to significant improvements in quality of life and symptom control and a decrease in the need for surgery ...

Crispin Corte MB BS, BSc(Med), FRACP · Warwick S Selby MB BS, MD, 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.

Eighty fewer deaths were recorded in the year following the adoption of the 4-hour rule by the emergency departments (EDs) of three tertiary hospitals in Western Australia1 — equivalent to almost half the state road toll. This remarkable result is regarded by some as preliminary. But if it stands the test of time, it will be testament to what is achievable with good up-front resourcing from a health department, plus improved communication — in this case, between the ED and the wards ...

Rachel E Nowak BSc, MA, PhD

On 2 January 2012, during a period of extremely hot weather, a South Australian electricity distributor deliberately cut power to several thousand homes because it was concerned that its electricity assets might cause a bushfire. Its action raises an important question: when does the risk of electricity assets causing a bushfire outweigh the benefits of having a power supply? ...

Richard A Broome MA, MB BS, MSc · Wayne T Smith MPH, FAFPHM, PhD

We support the recommendation of Runciman and colleagues for national agreement on clinical standards of health care, and highlight the importance of including routine health promotion activities as a core part of quality care in clinical practice. The indicators used by Runciman et al fail to consider core aspects of preventive care, such as screening and evidence-based behavioural interventions for lifestyle risk ...

Annemarie Wright · Bruce Bolam

Tests for serum vitamin B12 and red cell folate levels are commonly requested in elderly inpatients to rule out reversible causes of cognitive impairment (eg, delirium). This imposes some cost on the community. The evidence for the association of cognitive impairment and vitamin B12 deficiency is inconclusive. It is also unclear whether other markers, such as elevated mean corpuscular volume (MCV) and ...

Celia S M Ting · John C Oldroyd · Michele R Levinson

The implication by Wilson and colleagues that selection processes might at any stage be designed “to identify students ... who are likely to develop physical or mental illness ... that will impair their ability to practise in an empathic and professional manner” raises significant ethical and legal issues. The solution suggested by Wilson et al with reference to “fitness to practise” processes in place in medical schools suggests a link ...

Patrick D Mahar

To the Editor: Most of us in the medical profession would have had encounters with colour blind doctors at some stage, perhaps unknowingly. Colour blindness, more formally known as congenital colour vision deficiency (CVD), affects 8% of males and 0.4% of females.1 For those of us who perceive the world in a different spectrum, tasks involving colour in the workplace may provoke anxiety.2 One could argue ...

Navin I Dadlani

To the Editor: The closet is a common lesbian response to prejudice, discrimination and stigma. Many rural lesbians choose to “pass” as heterosexual and keep their sexuality secret.1,2 Research shows that this secrecy is fuelled by the fear of violence, including harassment, ostracism and rejection,2 and it is unlikely that a lesbian will disclose her sexuality to a doctor unless she feels safe. Without full ...

Cathy Wheel

To the Editor: The latest guidelines for the management of absolute cardiovascular disease (CVD) risk released by the National Vascular Disease Prevention Alliance1 question the utility of conventional risk assessment methods to accurately estimate cardiovascular risk of individuals with depression. Subsequently, these guidelines advocate that individuals assessed for CVD risk be assessed for depression and other psychosocial factors. This appears to be a promising advance, ...

Adrienne E O’Neil

To the Editor: Hyperhidrosis is uncontrollable, excessive sweating. Severe primary focal palmar hyperhidrosis is a significant disability. It interferes with many activities of daily living and induces social avoidance behaviours that can lead to symptoms of social anxiety disorder. Symptoms begin in childhood or around puberty and affect both sexes equally.1 There are a number of treatments for palmar hyperhidrosis, which have varying degrees of success. ...

Ingrid C Chung · Bruce C L McGeorge

To the Editor: Alkali drain cleaner has previously been reported to cause oral, oesophageal and cutaneous burns.-4 The risk of these cleaners causing full thickness cutaneous burns in children needs to be emphasised. Two toddlers recently presented to our hospital with severe burns after exposure to alkali drain cleaning products. An 18-month-old boy opened the box and bit open the silver foil packet of a foaming ...

Rachel A D’Cruz · Erik R La Hei · Andrew J A Holland

To the Editor: In deference to Grattan-Smith,1 defendant doctors are clearly advantaged and plaintiff patients disadvantaged by the High Court’s decision in Tabet v Gett,2 because a patient must now prove on the balance of probability (> 50%), not possibility (< 50%) as before, that negligence by the doctor caused harm. Nonetheless, like us, Grattan-Smith empathises with the harmed plaintiff who receives no compensation and bears all litigation ...

Neera Bhatia · James Tibballs

Objective: To determine whether international medical graduates (IMGs) have more complaints made against them to medical boards and experience more adverse disciplinary findings than Australian-trained doctors.Design and setting: Data on all complaints made against doctors to medical boards in Victoria and Western Australia over 7.5 years and 5.25 years, respectively, were extracted and linked with information on all doctors registered in those states over the ...

Katie Elkin LLB, BSc · Matthew J Spittal PhD, MBio · David M Studdert LLB, ScD, MPH

These data show a sustained and substantial decline in severe rotavirus disease and all-cause AGE since the introduction of rotavirus vaccination, most pronounced in the target age group, but with evidence of herd immunity. The impact of rotavirus vaccination in Indigenous children in hyperendemic settings was less remarkable.

Aditi Dey MB BS, MPH, PhD · Han Wang MStats · Robert Menzies BAppSc, MPH, PhD · Kristine Macartney MB BS, MD, FRACP

Objective: To estimate the risk of active tuberculosis (TB) in immigrants to Victoria, Australia, as a function of time since arrival and stratified by age group and region of origin.Design, setting and subjects: Longitudinal study of the incidence of active TB in Victorian immigrants, excluding New Zealanders, who arrived in Australia between 1975 and 2007. Victorian immigration data were used to describe annual arrival ...

Emma S McBryde MB BS, PhD, FRACP · Justin T Denholm BMed, MPHTM, FRACP

With the completion of the first liver–intestinal transplant in Australia in July 2010, the Austin Hospital in Victoria became one of only 35 active centres worldwide to offer this life-saving procedure to patients with irreversible intestinal failure and associated life-threatening complications of parenteral nutrition.Clinical recordA 32-year-old man was initially referred to our centre in 2005 after the progression of multiple complications of long-term parenteral nutrition (PN) for ...

Mayur Garg MB BS, FRACP · Robert M Jones MB BS, FRACS · Darius Mirza MB BS, FRCS, MS · Bao Zhong Wang MB BS, FRACS · Michael A Fink MB BS, FRACS · Graham Starkey MB BS, FRACS · Rhys B Vaughan MB BS, FRACP, PhD · Adam G Testro MB BS(Hons), FRACP, PhD

Clinical record A 58-year-old man with a history of Crohn’s disease presented to the emergency department of a peripheral hospital in March 2011. He had been ill for the past day, with confusion, fluctuating expressive dysphasia, frontal headache and fever, preceded by 12 hours of lethargy and myalgia. The patient had been diagnosed with Crohn’s disease 2 years earlier after a colonoscopy for profuse bloody stools, which revealed extensive ...

Kaspar J Willson MB BS, BMedSci · Antony Jacob MB BS, MRCP(UK) · Mohit P Shetti MB BS, MD(Med), DNB(Med) · Rajesh Bhatia MB BS, FRACP · Kwang Yee MB BS(Hons), FRACP · William Osler MBChB, FRACP

At birth, Moses Kharat was given a life sentence of poverty and suffering. Born a lower-caste Dalit in the rural Indian district of Buldhana, he would spend most of his childhood helping his family with hard labour, and was unlikely to ever know an education. Today, he is a medical doctor, and he reminisces about the day missionaries came to his village, providing him and others with the schooling and health care needed to break out of the cycle of poverty.

Bharat Ramakrishna BMedSci · Michelle Y Li BMedSci · Ray Wang BMedSci · Lily T Ho-Le BMedSci · James S Wei BMedSci · Henry R Jennens BMedSci

Hepatology offers many rewards in research and patient care

Marge Overs

Dr Sarah Walker is doing a PhD in hepatology with the Storr Liver Unit, Westmead Millennium Institute, University of Sydney. She also works part-time at Concord Hospital in Sydney. Dr Walker completed advanced training in gastroenterology at Westmead Hospital

Cate Swannell

Professor Geoff McCaughan is one of Australia’s leading hepatologists. He works in both clinical medicine and laboratory-based research at Sydney’s Royal Prince Alfred Hospital (RPA), where he is head of the Liver Immunobiology Group at the Centenary Institute, and director of the AW Morrow Gastroenterology and Liver Centre. He is also co-director of the Australian National Liver Transplantation Unit.

Interview by Marge

Adventure and medicine are a powerful combination for Dr Gareth Andrews

Sophie McNamara

Should you renovate your consulting rooms? Here are four key questions to ask before you take the plunge

Amanda Bryan