Volume 198 Issue 2

The challenge is delivering accessible screening services, followed by optimal management, to the community.

Jonathon Q Ng MB BS, BA, PhD · Nigel Morlet MB BS, FRANZCO, FRACS

Early detection and management can slow the progression of atherosclerosis.

on behalf of the Executive Committee and all participants in the National Secondary Prevention of Coronary Disease Summit, 2011

Early detection and management can slow the progression of atherosclerosis.

Ian R Hamilton-Craig PhD, FRACP, FCSANZ · Gerald F Watts DSc, 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.

While research supports use of psychotropic medications by nursing home residents in some clinical situations, we use them too often, for too long, at doses too high, in dangerous combinations and without adequate consent.

Sarah N Hilmer MB BS(Hons), FRACP, PhD · Danijela Gnjidic BSc(Hons), PhD, MPH

Delays in a uniform approach to detecting gestational diabetes mellitus and providing adequate management represent a missed opportunity to improve pregnancy outcomes and maternal health.

H David McIntyre MD, FRACP · Jeremy J N Oats DM, FRCOG, FRANZCOG

A real-time reporting system for controlled drugs may improve the safety of Schedule 8 medicinesOver the past decade, increased prescribing of pharmaceutical opioids in a number of countries has raised professional and public concern about iatrogenic opioid dependence and fatal opioid overdoses. Most fatal drug overdoses in the United States are now from opioids.1 Although not as high as in the US in absolute terms, the ...

Fiona L Shand BSc(Hons)(Psych), MClinPsych, PhD · Gabrielle Campbell BA(Psych), MCrim · Wayne Hall BSc(Hons) (Applied Psych), PhD · Nicholas Lintzeris BMedSci, MB BS, PhD · Milton Cohen MD, FRACP, FFPMANZCA · Louisa Degenhardt BScHon, MClinPsych, PhD

To the Editor: The recent article by Elshaug and colleagues identifying potentially low-value health care practices1 does not distinguish between surgery for obstructive sleep apnoea (OSA) in adults (which is largely used as an adjunctive or salvage intervention in Australia) and children (which is primarily a first-line intervention). Their article excludes high-level clinical trials in OSA surgery in adults that reflect closely protocols used in a ...

Stuart G MacKay

To the Editor: Elshaug and colleagues identified chlamydia screening of under-25-year-olds in the general population as a potentially low-value health care practice.1 They cite a systematic review that found that evidence from randomised controlled trials (RCTs) on the impact of chlamydia screening on reducing pelvic inflammatory disease (PID) was limited to high-risk populations, had methodological limitations and had never involved repeated rounds of screening. However, ...

Jane S Hocking · Basil Donovan · Rebecca Guy

To the Editor: The article by Elshaug and colleagues on potentially low-value health care services raises an important issue, given spiralling health care costs and limited resources. However, we are concerned by the authors’ claim that use of prophylactic implantable cardioverter defibrillators (ICDs) “did not reduce the risk of death, was more expensive and less effective than control therapy”. Elshaug and colleagues did not consider ...

Kim H Chan · Justin Ghosh · Mark A McGuire

To the Editor: The Medical Journal of Australia’s recent focus on making the best use of finite health resources is an essential discussion if Australia is going to continue to enjoy a high-quality and affordable health care system. One study identified large-scale use of resources on health care practices with no proven benefit. In my area of oncology, these included the overdiagnosis and overtreatment of many ...

Ian E Haines

In reply: In this issue of the Journal, several correspondents weigh in on our recent article in which we flagged services of potentially low value within Australia’s Medicare Benefits Schedule (MBS).1 Their letters highlight informative and unique reactions to such work. I would like to begin by clarifying that we are not the party suggesting items are of low value. Rather, we have flagged items that ...

Adam G Elshaug

Accidental carbon monoxide poisoning as a result of burning charcoal briquettes has continued despite the introduction of mandatory warnings.

Jared A Brown · Nick A Buckley

To the Editor: Clozapine therapy is a recognised risk factor for myocarditis and cardiomyopathy; however, there are no national guidelines for cardiac monitoring. Similar to many centres in Australia, and consistent with the consensus view from major psychiatric facilities in Victoria,1 our institution’s policy is to monitor patients with a baseline echocardiogram before starting treatment with clozapine, at 6 months and 12 months after starting treatment, and ...

Stuart D Murch · David L Prior · David J Castle

To the Editor: The donation after cardiac death (DCD) procedure used by Coulson and colleagues is ethically problematic and is not, as claimed, re-implementation of the practice followed before brain-death organ donation protocols were introduced. First reported in 1992, the more precise term is controlled donation after cardiac death or controlled non-heart-beating organ donation.2 What is controlled is the timing, mode and criteria of death, ...

Judith R Kennedy · Michael C Kennedy

To the Editor: We congratulate Coulson and colleagues for sharing their single-centre experience of donation after cardiac death (DCD).1 Our recently published Queensland DCD data2 reflect their experience and highlight the efficacy of DCD in augmenting the pool of donors with organs available for transplantation. The number of Australian DCD organ donors is increasing. There were 19 in 2007 and 86 in 2009. In 2011, of the 337 total ...

Raj Kumar · Kiran Shekar · John F Fraser

In reply: The Alfred Hospital’s donation after cardiac death (DCD) program was developed in full knowledge of ethical concerns such as those raised by Kennedy and Kennedy. All are covered under “DCD guideline development and implementation” in the methods section of our article.1 Specifically, no patient was denied a chance of survival, because all would have undergone withdrawal of cardiorespiratory support even if donation were ...

Tim G Coulson · David Pilcher

Is activity-based funding stifling the use of new technologies in the public sector?

Michael D Coory · Bridie S Thompson · Susan J Jordan

This abridged version of the Osteoporosis Australia white paper Building healthy bones throughout life (available at MJA Open) gives an overview of the recommendations for building healthy bones at all stages of life.

Peter R Ebeling MB BS, MD, FRACP · Robin M Daly BAppSci(Hons), PhD, FASMF · Deborah A Kerr PhD, MSc, GradDipDiet · Michael G Kimlin PhD

A study comparing single-field fundus photography with expert clinical examination finds the former is a valid tool in detecting diabetic retinopathy in Indigenous people in remote communities of Central Australia.

Janice J-Y Ku MB BS · John Landers PhD, FRANZCO · Tim Henderson MB, ChB, FRANZCO · Jamie E Craig DPhil, FRANZCO

A small exploratory study finds that most patients with diabetes attending for routine blood monitoring are willing to undergo non-mydriatic retinal photography administered by pathology collection staff.

Melanie F Larizza BBSc, GradDip(Sec) · Lauren A Hodgson BSc(Hons) · Eva K Fenwick MA, BA(Hons) · Ryo Kawasaki PhD, MD, MPH · Ralph Audehm MB BS · Jie Jin Wang PhD, MB BS, MMed(OphthalPath) · Tien Y Wong PhD, FRCEEd, MMed · Ecosse L Lamoureux PhD, BEd, MApplSci

A retrospective audit of patients referred for venous thromboembolism-related imaging reveals that the availability of new screening and diagnostic tests may have led to overdiagnosis of clinically insignificant pulmonary embolism.

Tatiana Segard MD · William B G Macdonald MB BS, MPH, FRACP

The authors explore the reasons for barriers to discharge from inpatient rehabilitation and whether these can be predicted by demographic or clinical variables.

Peter W New MB BS, MClinEpi, FAFRM(RACP) · Damien J Jolley MSc(Epidemiol), MSc, A Stat · Peter A Cameron MB BS, MD, FACEM · John H Olver MB BS, MD, FAFRM(RACP) · Johannes U Stoelwinder MB BS, MD, FRACMA

Brisbane clinicians describe two patients who acquired this well recognised syndrome as a result of traumatic experiences during flash flooding.

Stuart J Butterly BSc(Hons), MB BS, FRACP · Mathivathana Indrajith BSc(Hons), MB BS, MRCP · Paul Garrahy MB BS, FRACP · Arnold C T Ng MB BS, PhD, FRACP · Paul A Gould MB BS, PhD, FRACP · William Y S Wang MM BS, PhD, FRACP

A neurosurgeon’s personal account of the experience of, treatment for and recovery from a basilar artery occlusion provides a unique "insiders view" into acute locked-in syndrome.

Gordon Stuart MB BS, FRACS

THE TREATMENT of epilepsy has undergone rapid change in the past decade. New drugs, novel treatment options and the impact of genetics are having an impact on the therapy of this common condition. This edition of Fast facts is authored by three senior and experienced clinicians. The book is easy to read, well set out, has excellent tables and images, and each chapter has a ...

Geoffrey K Herkes

Marjan Kljakovic was a general practitioner for over 30 years. He was Professor of General Practice at the Australian National University when he died on 14 August 2012, some 2 weeks after a devastating heart attack. Marjan was a man of great passion and enthusiasm for life, and, beneath an often larger-than-life outward persona, a man of great sensitivity and thoughtfulness. He brought all of these qualities to his ...

Anthony C Dowell · Karen M Flegg · Les J Toop

Robert Bohdan Mikolaj (Bob) Ravich was born on 26 August 1937 in Gdansk, Poland. He immigrated to New Zealand after World War II and later studied medicine at the University of Otago, graduating in 1962. He was a resident at Christchurch Hospital, then a senior medical registrar and senior registrar in haematology. In 1968 he took up an appointment in Australia as a senior research fellow in haematology ...

Kate M Ravich · Frances M Boyle, AM

Learning about leadership isn’t just about career leverage. Whether you’re eyeing the lofty heights of national leadership or want to make a difference on the ground, developing leadership insight might be a step in the right direction

Karen Burge

Career advice for students. So you want to be a doctor? A guide to prospective medical students in Australia by Dr Kerry J Breen is an excellent book to help prospective students decide if being a doctor is for them. The first section about knowing yourself and understanding why you wish to choose medicine is essential reading for any prospective medical student. The importance of personal characteristics and suitability for a career as a doctor is very well explained with a sensitive approach to how to decide if you will have an aptitude for this career. Where possible the author has used research to support his advice, and covers all the questions likely to be asked by a secondary student. Section 2 gives practical advice about medical schools and their selection processes, including the benefits and challenges of undergraduate versus postgraduate courses. There is a very good section on issues that may make your time as a medical student and doctor more difficult. Section 3 covers the questions likely to be asked about life as a medical student, and the author provides a balanced view of the enjoyable aspects of being a medical student and then doctor, but has equally provided realistic information about the challenges. Section 4 covers career paths, including an overview of the Australian health system which will help both prospective and current medical students understand the complexity of the system. This section will encourage students to consider the longer term — not just getting into medical school without consideration of future training requirements and job prospects. This book draws together the evidence in medical education and the experience gained by the author during a distinguished career to provide a comprehensive guide to the prospective medical student. By Professor Barbara Workman, Chair of the Year 5/D Management Committee for the MMBS course at Monash University, and Anna Power, a fourth year medical student at Monash.

Cate Swannell

Professor Zsolt Balogh is the Director of Trauma for the John Hunter Hospital and the Hunter New England Area and a professor of traumatology at the University of Newcastle. His dedication to trauma care extends from the operating table and bedside to the community, where he is also committed to injury prevention, education and research

Interview by Karen

Dr David Dewar is the senior orthopaedic registrar at the Royal Newcastle Centre and John Hunter Hospital. He cares for orthopaedic patients in both trauma and elective settings, and is supervised by Professor Zsolt Balogh.

Cate Swannell

A firsthand look at the confronting issue of obstetric fistula in Ethiopia set the wheels in motion for palliative care nurse Bruno Cordier, who has found his own way to raise awareness and funds

Karen Burge

Finding time to look after your investments can be difficult but with some easy steps it’s possible to streamline your financial affairs so your money works hard, and you don’t have to

Linda Drake