Volume 198 Issue 10

As the Journal approaches its 100th birthday, it has a new Editor-in-Chief and much to look forward to

Stephen R Leeder MD, PhD, FRACP

The longitudinal data from this medical graduate-tracking study is an increasingly valuable tool for matching training outcomes to national needs

Baldeep Kaur MIntStud · Don M Roberton MD, FRACP, FRCPA · Nicholas J Glasgow MBChB, MD, FRACGP

In view of the findings of a linked research article in this issue, clock watching should take a back seat to paying strict attention to insertion and maintenance practice to prevent IV catheter-related bloodstream infection

Claire M Rickard BN, GradDipN(CriticalCare), PhD · Joan Webster RN, RM, BA · E Geoffrey Playford MB BS(Hons), MMed(ClinEpi), 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.

A sensible approach to controlling tuberculosis in Australia would be universal screening of migrants from high-incidence countries, similar to the efficient and cost-effective program that is used in the United Kingdom

Justin T Denholm MPHTM, PhD, FRACP

Experts remain divided on the benefits and harms of screening for prostate cancer, but Del Mar and colleagues argue that prostate-specific antigen testing does little to reduce mortality from prostate cancer, and advise caution about the adverse effects of diagnosis and treatment.

Chris B Del Mar MD, FRACGP, FAFPHM · Paul P Glasziou PhD, MB BS · Geoffrey H Hirst MB BS, FRACS · Robert G Wright BSc(Hons), MB ChB, FRCPA · Tammy C Hoffmann PhD, BOccThy(Hons)

It is unquestionable that prostate-specific antigen screening is associated with overdiagnosis. However, the magnitude of this problem still remains uncertain because of the lack of sufficient robust, long-term follow-up data from ongoing trials.

Jonas Hugosson MD, PhD · Sigrid V Carlsson MD, PhD

An audit of cases treated at a major children’s hospital reveals that significant burns from motorcycle exhausts still occur much too frequently

Ela J Hyland · Rachel A D’Cruz · John G Harvey

To the Editor: Fernando makes a valid statement on the need for regulation of clinical software on personal mobile devices (PMDs).1 Her timely comment regarding acting now before the “courts decide” is fair, given that many doctors, including a high percentage of specialist trainees, are now using PMDs.2 However, it is important for doctors to remember that the security risks highlighted by Fernando are not ...

Sulakshan Rasiah · Jonathan K Kam

In reply: I appreciate the interest in my article.1 More comprehensive research work is currently underway to evaluate the application of personal mobile devices (PMDs) in the context of security risks posed by their intrinsic functions. The importance of such research findings is borne out by emerging discussions.1-4 Many platforms already offer security or locking software applications to avoid information breaches on PMDs, and nascent moves ...

Juanita I Fernando

Linked records for patients who died from primary advanced oesophageal carcinoma reveal an unfortunate trend in access to palliative care — greater socioeconomic disadvantage is significantly associated with decreasing odds of stent insertion for palliation of symptoms such as dysphagia and odynophagia

Jason P Bentley · David E Goldsbury · Guy D Eslick · Michael R Cox · Dianne L O’Connell

To the Editor: A shortage of training opportunities for medical students in public hospitals has led to greater need for collaboration with the private sector.1-3 In 2011, Sydney Medical School established the first private hospital clinical school in New South Wales at the Sydney Adventist Hospital (SAH). Essential to its success is the support of the hospital’s patient and medical community. We conducted two cross-sectional surveys, ...

Stephanie Phillips · Linda A Klein

To the Editor: Review of undergraduate mental health education is timely, given the growing disease burden of mental disorders and the need to better equip doctors for their central role in treatment. Curricula should prepare all doctors with competencies in recognising and treating mental health problems,1 because these occur frequently in patients across all branches of medicine, leading to poorer outcomes.2 Curricula should also prepare ...

Susan J Thomas · Brahmavar N Pai · Kerry Dawes

To the Editor: The thought-provoking editorial by Hu and colleagues laments the “erratic supply of medical educators”.1 Curriculum design and review, course accreditation, and student teaching and assessment at all levels require specialist expertise in education. The 17th National Prevocational Medical Education Forum, held in Perth in November 2012, revealed pressures throughout the medical education and training pipeline. With an unprecedented increase in student numbers in ...

William G Hart · Robert Pearce

To the Editor: The arguments put forward by Hu and colleagues for recognition of medical education as a specialty are persuasive, especially considering current national requirements for accreditation to ensure delivery of high-quality programs.1 In recent decades, medical educationalists have flooded journals and other publications with articles (Box). Many have resulted from, and led to, innovative educational programs. Unlike other areas of scientific research, however, the ...

David A Kandiah

In reply: We thank Hart and Pearce for supporting the views raised in our editorial, noting the unmet demand for medical education expertise. We also thank Kandiah for his response, and agree that medical graduates should be “clinically competent, reliable, keen to learn and show compassion to patients and colleagues”. We believe this outcome is best achieved by strong collaborations among “skilled clinicians and excellent mentors” ...

Geoffrey J McColl · Jill E Thistlethwaite · Tim Wilkinson · Lambert W T Schuwirth · Wendy C Y Hu

To the Editor: We congratulate Nowak on her discussion surrounding communication in the emergency department (ED).1 This is certainly an issue that has an impact on both patient safety and satisfaction, and is an area in which all medical personnel can improve. The challenges in ED are manifold, and time-based targets tend to militate against effective communication.2 A strategy that we have employed in our ...

Alan E O’Connor · William G Lukin · Victoria A Brazil

We propose an expanded approach to evidence for cancer screening policy and practice. First, we need to better understand why and how screening happens the way it does, sometimes at odds with evidence of benefits and harms. Second, we need to systematically investigate the ethics of cancer screening to illuminate moral concerns and expand the scope of screening research to address ethical dilemmas. ...

Lucie Rychetnik BSc, MPH, PhD · Stacy M Carter BAppSci, MPH, PhD · Alexandra Barratt MB BS, MPH, PhD · Les Irwig BSc, MB BCh, PhD

This analysis of Victorian prostate cancer registry data shows that, since 1993, there has been considerable “stage migration” towards earlier diagnosis. The findings also reveal that there has been a substantial increase in the proportion of men receiving treatment with curative intent.

Sue M Evans MClinEpi, PhD · Jeremy L Millar MB ChB, FRANZCR, FAChPM · Ian D Davis MB BS, PhD, FRACP · Declan G Murphy MB, FRACS, FRCS Urol · Damien M Bolton MD, FRACS, FRCS · Graham G Giles BSc, MSc, PhD · Mark Frydenberg MB BS, FRACS · Nick Andrianopoulos MB BS, MBiostat · Julie M Wood BSc · Albert G Frauman FRACP, FACP, FACCP · Anthony J Costello MB BS, FRACS, MD · John J McNeil FRACP, PhD, FAFPHM

Objectives: To apply the most recent evidence from randomised trials of prostate-specific antigen (PSA) screening and explore the potential value of risk assessments to guide the use of PSA screening in practice.Design: A decision model that incorporated a Markov process was developed in 2012 to estimate the net benefit and cost of PSA screening versus no screening as a function of baseline ...

Andrew J Martin PhD · Sarah J Lord MB BS, MS(Epi) · Hannah E Verry BEcon · Martin R Stockler MB BS, MSc, FRACP · Jon D Emery MB BCh, MA, DPhil

Incident cases of S. aureus bacteraemia occurring where intravenous catheters were inserted in wards and in emergency departments were investigated. The researchers suggest that timely removal is important for reducing risk of infection, particularly when the catheters are inserted under suboptimal circumstances.

Rhonda L Stuart MB BS, PhD, FRACP · Donna R M Cameron CertICS, BN, BAppSc · Carmel Scott RN Div 1, CICP · Despina Kotsanas BSc(Hons), MClinEpi · M Lindsay Grayson MB BS, MD, FRACP · Tony M Korman MB BS, FRACP, FRCPA · Elizabeth E Gillespie BN, MPubHealth · Paul D R Johnson MB BS, PhD, FRACP

With human papillomavirus vaccination for boys now on Australia’s National Immunisation Schedule, this study determined background rates of potential adverse events, assuming temporal association with vaccination but no other association. The findings will help to determine whether adverse event reports represent real safety flags that require urgent investigation.

Hazel J Clothier FIBMS, MSc, MAppEpid · Katherine J Lee BSc, MSc, PhD · Vijaya Sundararajan MD, MPH · Jim P Buttery FRACP, MD, MSc · Nigel W Crawford BM BS, MPH, PhD

The management of parathyroid cancer remains a therapeutic challenge, owing to the minimal evidence for effective systemic therapy in patients with inoperable disease. In this patient, denosumab offered prolonged calcium control with less frequent administration

Samantha E Bowyer MB BCh, MRCP · Alison M White MB BS, MPH · David T Ransom MB BS, FRACP · John A Davidson MB BS, FRACP, MBiostats

A tragic case of delayed diagnosis prompts a question from the patient’s father: are current guidelines appropriate and correctly interpreted in practice?

Anonymous

Persistent unexplained iron deficiency should always be investigated, but iron deficiency is common and colorectal cancer rare in young women — the risks of investigation must be balanced against the risks of serious pathologyWe would like to express our sympathy to the family and to acknowledge the tragedy of the circumstances in regard to the death of their 29-year-old family member from metastatic colon cancer. To ...

for the Gastroenterological Society of Australia

Consultation has begun to find a compromise on federal support for ongoing medical education

Annabel McGilvray

Iraq-born Ibrahim Zardawi has a passion for pathology and a desire to see the discipline flourish, particularly in regional areas where the challenges of working alone are balanced by the ability to do a lot of good.

Cate Swannell