Volume 197 Issue 9

To measure the effectiveness of innovations in health care, it is critically important to define the intervention studied. Unfortunately, this step is often lacking in health services research: definitions are often inadequate for reproducibility, and outcomes attributed to the intervention are consequently difficult to adjust for other variables. Meta-analysis can become messy. Defining a health service ...

Michael Montalto MB BS, PhD · Bruce A Leff MD

Colorectal cancer (CRC) is one of the most common cancers in Australia, with a risk in people under the age of 75 years of one in 18 for men and one in 26 for women. Each year, about 15 000 Australians are diagnosed with CRC, and about 4000 die from it.1 the 5-year survival from CRC is 62%, which is ...

Ingrid Winship MB ChB, MD, FRACP · Aung Ko Win MB BS, MPH

The demands placed on the health system are increasing faster than population growth. Demand for services in emergency departments (EDs) increased 3.2% per annum in the 5 years to 2010–11. The present model of service delivery is unsustainable and changes are required. What is not clear is what these changes should be. There ...

Patrick G M Bolton MB BS, PhD, FRACMA · Michael H G Golding BMed, FACRRM, FACEM

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

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

Eating fish once or twice a week is promoted as good for your health — but is there a downside as well? With the global decline in wild fish stocks, there is an ever-increasing demand for aquaculture-produced fish and other aquatic foods. The aquaculture industry is relatively new but is growing rapidly in ...

Mary D Barton BVSc, PhD, FACVS · Olasumbo L Ndi BSc, MSc, PhD

Helicopter emergency medical services (HEMS) have a considerable history in Australia, with operations in Sydney dating back to 1973. HEMS have evolved from their original use in water-based search and rescue to become an established mode of medical transport in the local health system, helping to alleviate the “tyranny of distance” that restricts equitable access to health ...

Colman B Taylor BPhEd, MND · Stephen Jan BEc, MEc, PhD · John A Myburgh PhD, FCICM, FAICD

Joyce contends in her recent article that “medical workforce supply levels follow a predictable, if lengthy, cycle between phases of shortage and surplus”. If this is the case, the scramble by the Australian Health Ministers’ Advisory Council to find internships for graduating medical students represents a stunning lapse in workforce planning. Marked growth in student numbers has occurred since the early 2000s, ...

Michael A Bonning · William J Milford · Rob D Mitchell

We read with interest the report by Handelsman describing an increase in Australian testosterone prescriptions, including a particular increase in prescribing of topical testosterone gel. The topically applied formulation of testosterone has a unique adverse-effect profile because of inadvertent exposure to it via direct skin contact. We report progressive virilisation in a 2-year-old girl who presented in 2011 with an 18-month history of body ...

Jacqueline K Hewitt · Margaret R Zacharin

In their recent article on false-positive screening mammograms and their effect on rescreening rates within the BreastScreen WA program, Sim and colleagues posit that an absolute reduction in future rescreening of 3 percentage points can be seen among women who are recalled for assessment but do not have breast cancer. The analysis presented did not adjust for other factors known to influence rescreening ...

Nathan A M Dunn

To the Editor: The recent editorial by Kefford1 fails to mention that (i) the 5-year survival for malignant melanoma is excellent at 89% for males and 91% for females; (ii) treatment with the new melanoma drug ipilimumab for the 1279 people who died from melanoma in 2007 would cost the Australian Government $156 million based on the quoted drug cost of $120 000 for a course of four injections; and ...

Graeme W Morgan

To the Editor: Kefford’s contention that making cancer drugs affordable requires coherent policy and cannot be left to market forces1 is correct. Two new drugs, ipilimumab and vemurafenib, are now approved by the United States Food and Drug Administration and the Australian Therapeutic Goods Administration for use in metastatic melanoma. However, their efficacy in a minority of patients is low. The cost of this palliative treatment ...

Sonia Fullerton

In reply: The letters of Morgan and Fullerton correctly emphasise the importance of palliative care in the management of patients with metastatic melanoma. They also draw attention to the immense cost of new drugs for melanoma, and their limited efficacy in life extension — something I also emphasised.1 Much ignored in this debate is the rapid and dramatic improvement in quality of life experienced by ...

Richard F Kefford

To the Editor: Methylnaltrexone is a peripheral opioid antagonist registered for the treatment of opioid-induced constipation (OIC) on the basis of quality Phase III studies.1 Monitoring uptake of a new medication such as methylnaltrexone after it has been listed on the Pharmaceutical Benefits Scheme (PBS) is crucial to understanding how such medications can be best used in routine clinical practice. Compared with the whole population, higher ...

Debra S Rowett · Katherine Clark · Maxine K Robinson · David C Currow

To the Editor: In September 2012, the Australian Institute of Health and Welfare (AIHW) released its report on cancer survival and prevalence in Australia from 1982 to 2010, incorporating incidence and mortality estimates for all malignancies reported to Australian cancer registries.1 Cancer is a leading cause of morbidity and mortality in Australia, accounting for about 20% of the total disease burden and 30% of deaths.2 Liver cancer ...

Jennifer H MacLachlan · Benjamin C Cowie

To the Editor: On 5 June 2012, the forum “Eliminating childhood lead toxicity in Australia — a little is still too much” was held at Macquarie University to examine new evidence on the toxicity of lead and its implications for Australian children and communities. Presently, the National Health and Medical Research Council (NHMRC) recommends an increasingly obsolete intervention level that was established in 1993: blood lead levels ...

Mark P Taylor · Chris Winder · Bruce P Lanphear

Marfan syndrome is a multisystem disorder of connective tissue that is inherited in an autosomal dominant fashion, and results from mutation of the FBN1 gene on human chromosome 15. There are a number of conditions of the connective tissue with a similar phenotype that can be confused with Marfan syndrome. Modifications of the diagnostic criteria have recently been published, facilitating the differentiation of Marfan ...

Kim M Summers BSc(Hons) PhD · Jennifer A West RN · Annette Hattam BSc, FHGSA · Denis Stark MB BS, FRCS(Edin), FRANZCO · James J McGill MB BS, FRACP · Malcolm J West MBBS, FRACP, PhD

GP referrals had the highest level of appropriateness, and healthdirect- and self-referrals had similar levels of appropriateness. More than half the healthdirect-referred patients attended the ED despite a contrary recommendation, probably due to difficulty accessing after-hours health services.

Joseph Y Ng MB BS, FANZCA · Daniel M Fatovich MB BS, FACEM, PhD · Valendar F Turner MB BS, FRACS, FACEM · Jennifer A Wurmel RN · Sally A Skevington BWS(Hons) · Michael R Phillips BSc(Hons), MMedSci

Together with reports of the decreasing prevalence of smoking among Indigenous people, this first report of a significant reduction in heavy smoking by Indigenous smokers is good news. Reducing smoking intensity and prevalence will lead to fewer deaths and less illness due to smoking. Reducing the number of heavy smokers will also assist smoking cessation among Indigenous people. These changes in smoking intensity occurred before the recent increase in attention to and investment in tobacco control in Indigenous communities, but at a time of significant mainstream anti-tobacco public health activity. Similar trends in smoking intensity have been reported in the total Australian population.

David P Thomas MB BS, PhD, FAFPHM

There is a mismatch between the high proportion of registered trials in advanced colorectal cancer and the areas of priority identified. The development of specific trials in these priority areas depends on the availability of funding and the existence of plausible interventions likely to improve patient outcomes.

Rachel F Dear MB BS, PhD, FRACP · Alexandra L Barratt MB BS, MPH, PhD · Alison Evans PhD · John Simes MD, PhD · John Newsom BA · Dan Kent GDM · Sally Crossing BEc · Catherine Holliday PhD · Eva Segelov MB BS, FRACP, PhD · George Hruby MB ChB · Martin HN Tattersall MD

Objective: To assess the effect of “hospital in the home” (HITH) services that significantly substitute for inhospital time on mortality, readmission rates, patient and carer satisfaction, and costs.Data sources: MEDLINE, Embase, Social Sciences Citation Index, CINAHL, EconLit, PsycINFO and the Cochrane Database of Systematic Reviews, from the earliest date in each database to 1 February 2012.Study selection: Randomised controlled trials (RCTs) comparing HITH care with ...

Gideon A Caplan MB BS, MD, FRACP · Nur S Sulaiman MB BS · Dee A Mangin MB ChB · Nicoletta Aimonino Ricauda MD · Andrew D Wilson MD, FRCGP · Louise Barclay BN

Clinical record A 40-year-old, previously healthy woman presented with sudden loss of consciousness and collapse. Her work colleagues noted that she had become drowsy and light-headed moments before the collapse. She had reported a suspected spider bite about 10 hours earlier, which had caused her skin to become generally itchy. Paramedics found the woman to be in a state of pulseless electrical activity 20 minutes after the cardiovascular collapse. ...

Su Shian Lee MB BS · Gary A Unglik MB BS, FRACP, FRCPA · Adrian W Y Mar MB BS, FACD

Australian cancer care is among the best provided in the world. Yet, many cancer patients choose to either forgo aspects of conventional treatment or seek unproven complementary therapies. My own recent cancer treatment prompted me to wonder whether these choices may, at least in part, be due to the failure of Western medicine to address the psychological ...

Tanya L Hall BMed, FRANZCP

In the past, most deaths took place at home. There has recently been a lot of interest in providing patients and their families with a “good death”, and research has shown that if a choice was given to terminally ill patients in the intensive care unit (ICU), they would prefer to die at home. Much ...

Vineet Sarode MB BS, MD, FCICM · John Reeves MB BS, FANZCA, FCICM · Jonathan Barrett MB BS, FRACP, FCICM · Jennifer McCambley CCRN, BEdSt, PGDipPsych

I have always known all of this, although I’m not sure how. You’ll just have to believe me, because I’m the only one who knows the whole story. My mother must have told me about her poor sister, because that all happened many years before I was conceived. But there was a lot more. My mother’s sister was young, about 35, when the doctors found she had ...

Nicholas R C Wilcken MB BS, PhD, FRACP

ALTHOUGH THIS compendium cannot possibly encompass the depth and breadth of complementary and alternative medicines (CAMs) as they are practised today, it does provide an array of interesting insights into what is a relatively uncharted field within the “modern occidental” medical community.Aligned with the background of the editors — Ian Olver and Monica Robotin — from the Cancer Council Australia, Perspectives has a clear focus ...

Hosen Kiat

“This regeneration process also restores the physiological respiratory function of the lungs, which is mediated by amplification of various epithelial progenitor cells and regeneration of the alveolar sacs” — Dr Bi-Sen Ding, Cornell University Visitation resumes first with the most ardent ornithologists. Loony they pierce, stride right on in, primed by the song of ocular gadgets to a once-blighted habitat that’s chalked up its comeback to a mad cheeping action poker-faced finches go ...

Kent E MacCarter MA(Lit)

Oncologists combine science with humanity

Marge Overs

Dr Nick Zdenkowski is a final-year medical oncology advanced trainee at the Calvary Mater Newcastle, NSW

Cate Swannell

Professor Bogda Koczwara is Professor of Medical Oncology at Flinders University, Adelaide, and Head of the Department of Medical Oncology at the Flinders Centre for Innovation in Cancer at Flinders Medical Centre. She is also President of the Clinical Oncological Society of Australia.

Interview by Marge

Dr Ana-Louise Martin believes acting skills can help doctors to communicate with their patients

Sophie McNamara

Most doctors work way too hard for far too long, but advisers say there is a better way

Amanda Bryan