Volume 198 Issue 4

New knowledge about the ability of the nervous system to change its structure and function will help our understanding, assessment and management of pain.

Philip J Siddall MB BS, PhD, FFPMANZCA

The goals of e-health are worthy, and alternatives are thin on the ground. Success will depend on respecting the laws of informatics as well those of medical science and health care.

Enrico Coiera MB BS, PHD, FACHI

A causal link is conceivable, but how strong is the evidence and how might this change clinical practice?

Bruce J Brew MB BS, MD, FRACP · Catriona A McLean MB BS, PhD, FRCPA · Eugene O Major 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.

Today, sex-based inequalities and inequities shape how individuals are disproportionately exposed to adverse determinants of health. Our sex can determine how well or ill we become, and if or how our health care needs are acknowledged and met.1 The underlying reasons for this disparity are complex and diverse, shaped by how sex and sexual customs interact within varying political and social contexts. Discriminatory values, norms ...

Izzeldin M M Abuelaish MD, MPH

How can the current health care system accommodate, integrate and implement the strategies required for quality end-of-life care for people on a longer-term trajectory of disease?

Teresa A Burgess GradDipNursing Management, MPHC · Annette J Braunack Mayer BMSc(Hons), PhD · Gregory B Crawford MB BS, MD, FAChPM · Justin J Beilby MB BS, MD, FRACGP

Tasmania is the only Australian jurisdiction to operate a state-funded registry and to require registration of completed enduring guardianship forms, but uptake is low.

Michael A Ashby MD, FRACP, FAChPM · Robert N Thornton BEd, MHPEd, PhD · Robyn L Thomas MB BS, FRACGP, FAChPM

People who are suffering and who will continue to suffer should have the right to request assistance to die gently and, if possible, at a time they choose, say the Doctors for Voluntary Euthanasia Choice.

on behalf of Doctors for Voluntary Euthanasia Choice

The barriers to conduct of clinical research will require solutions if we are to implement evidence-based health care reformReforms in the funding of health services, such as “activity-based” funding initiatives, seek to facilitate changes in how health care is delivered, leading to greater efficiency while maintaining effectiveness. However, often these changes in treatment strategies and service provision evolve without evidence demonstrating effectiveness in terms of ...

Ian D Davis MB BS, PhD, FRACP · Derek P B Chew MB BS, MPH, FRACP

Do the CSL snake venom detection kit dose recommendations need updating?

Alan Paul

In reply: A low-volume, polyvalent antivenom for brown and tiger snake envenoming would make treatment simpler and safer. Since 2001, when information cited by Paul was published, there have been over 15 peer-reviewed research publications addressing the issue of antivenom dosing.1-3 There is now consistent evidence that one vial is equivalent to larger doses, and there have been no cases of active venom being present after one ...

Geoffrey K Isbister · Nicholas A Buckley · Simon GA Brown

To the Editor: Caplan et al1 include in their meta-analysis a trial by Mather et al that compared home care with intensive care management of patients with acute myocardial infarction (AMI) between 1966 and 1968.2 A joint working party of the Royal College of Physicians and British Cardiac Society dismissed the results of this study because of design defects.3,4 Kalra et al5 performed a randomised trial with ...

Hugh G Dickson

In reply: Dickson argues for exclusion of randomised controlled trials (RCTs) if treatments have changed, but treatments are constantly changing so, following this rule, meta-analysis would be impossible. Similarly, diagnosis has changed — stroke was a clinical diagnosis, then computed tomography was required, and now magnetic resonance imaging is needed. Equipoise is not a requirement for inclusion in a meta-analysis. Complaints about research being simplistic because ...

Gideon A Caplan

A common injury in a popular sport that requires early referral and management

Mohammed Baba · Jason N Harvey · Anthony J Beard · Richard D Lawson

On behalf of the Australasian Society of Thrombosis and Haemostasis, six experts present strategies for managing patients with complications of warfarin therapy in different clinical settings, including patients undergoing surgery.

on behalf of the Australasian Society of Thrombosis and Haemostasis

A study designed to measure the effect of introducing a new electronic medical record system in a public hospital emergency department reveals deterioration in a number of key performance indicators following the introduction of the new system.

Murugabalaji K Mohan MB BS · Rod O Bishop MB BS, MPH(Hons), FACEM · James L Mallows MB BS, FACEM

First and foremost, do no harm. Second, do some goodOne of the key issues for high-volume, high-risk workplaces like hospital emergency departments (EDs) is the struggle of conflicting aims. While hospital managers need information systems for data collection and storage, clinicians need efficient clinical documentation, data retrieval and order-entry systems that save time rather than steal it from the patient. The work of clinicians is ...

Jon D Patrick PhD, MSc, BSc · Susan Ieraci MB BS, FACEM

Objectives: To examine the rate of detection of alprazolam among cases of heroin-related death (HRD) in Victoria, including the relationship between alprazolam supply and HRDs.Design and setting: Population-based study of community alprazolam supply in Victoria and HRDs reported to the Victorian coroner from January 1990 to December 2010.Main outcome measures: Number of prescriptions for alprazolam supplied; defined daily dose (DDD) ...

Angela C Rintoul BA, MSocSci · Malcolm D H Dobbin MB BS, PhD, MPH · Suzanne Nielsen BPharm, BPharmSc, PhD · Louisa Degenhardt BA(Hons), MPsychology(Clinical), PhD · Olaf H Drummer PhD(Med), BAppSc(Chem), FRCPA

In a survey of HIV-positive men with newly acquired hepatitis C (HCV), novel risk factors for HCV transmission (non-injecting drug use, sexual practices with increased likelihood of trauma, and presence of genital ulcers) were identified. These novel transmission routes and a limited knowledge of the risks of HCV are emerging as important risk factors in this group.

Andrew A Mahony MB BS, FRACP · Ellen J Donnan MAppEpid, MPH, BNurs · Rosemary A Lester MB BS, MPH, FAFPHM · Joseph S Doyle MB BS, MSc, FRACP · James Knox MB BS, BSc, DTMH · Samantha L Tracy BSc · Scott Bowden PhD · Joseph J Sasadeusz MB BS, FRACP, PhD

After extensive investigations, including a brain biopsy, clinicians found that the usual causative agent wasn’t present in this case.

Kathryn L Daveson MB BS, MPH, FRACP · Chong W Ong MB BS(Hons), FRACP, FRCPA · Scott Bowden PhD · Mark E Koina BSc(Hons), PhD · Lavinia A Hallam MB BCh, FRCPath, FRCPA

Introducing the MJA Ethics series, the series editor outlines some of the ethical challenges for medicine and society in the 21st century. The long-unresolved ethical conflicts surrounding the issue of providing “futile” care are discussed from clinical, ethical and legal perspectives, in this, the first instalment of the series.

Dominic J C Wilkinson MB BS, DPhil, FRACP

Deciding when to stop treatment can be a challenging task for health professionalsWith advances of modern medicine come increased expectations from society, and dilemmas regarding when to stop treatment are becoming increasingly common. The Medical Board of Australia code of conduct explicitly states “you do not have a duty to try to prolong life at all cost. However, you do have a duty to know ...

Bogda Koczwara BM BS, MBioethics, FRACP

We need to pay attention to the reasons why treatment is judged to be futileWhen doctors are confronted with making treatment decisions in the context of a terminally ill patient, the way forward is often difficult and confused. Bringing an ethics perspective to bear on the problem can help to resolve what the essential issues are, in turn enabling a clearer path to appropriate decisions ...

Dominic J C Wilkinson MB BS, DPhil, FRACP

Futility disputes highlight some important legal principles concerning the right to refuse treatment, advance directives and the role of substitute decisionmakersThe need for legal resolution of futility disputes is a rare occurrence in Australia and the jurisprudence is still emerging.1 The legal approach to futility disputes differs in each state jurisdiction, and a full analysis of the Australian law is beyond the scope of this ...

Cameron L Stewart BEc, LLB(Hons), PhD

A medical student’s painful learning experience provides a glimpse of the medical system from the other side.

Lloyd Reeve-Johnson DVM

Distinguishing medical conditions from artists’ stylistic embellishments in old master paintings can contribute to our historical understanding of diseases like arthritis.

George M Weisz MD, MA, FRACS · William R Albury BA, PhD

CORRECTION Typographical errors in tables of birthweight percentiles: In “Australian national birthweight percentiles by sex and gestational age, 1998–2007”, in the 3 September 2012 issue of the Journal (Med J Aust 2012; 197: 291-294; doi: 10.5694/mja11.11331), there were two errors in Box 3 and one in Box 4 (page 293). In Box 3, the 25th percentile for boys with a gestational age of 34 weeks should be 2100 g, not 200 g, and ...

Timothy A Dobbins BMath, PhD · Elizabeth A Sullivan MD, MPH, FAFPHM · Christine L Roberts MB BS, DrPH, FAFPHM · Judy M Simpson BSc(Hons), PhD

With an esteemed career in medicine, this year’s Senior Australian of the Year, palliative care pioneer Emeritus Professor Ian Maddocks AM, was honoured for his outstanding contribution to his field. He shares his journey and career highlights with Karen Burge.

Cate Swannell

The Royal Australian and New Zealand College of Psychiatrists (RANZCP) will run a workshop in Sydney for new psychiatrists, aimed at supporting, nurturing and mentoring fellows in the early stages of their career. It will be held on Saturday 25 May 2013 at the Four Points by Sheraton, Darling Harbour, in Sydney, immediately preceding the RANZCP 2013 Congress workshops. Sessions will focus on topics relevant to early career psychiatrists including: how you can manage your own mental healthleadership in public practice, andthe pitfalls in psychotherapeutic practice. The workshop will be led by a range of presenters and will include an interactive component, allowing attendees to benefit from the experiences of established psychiatrists in an informal and relaxed atmosphere. The move comes after the establishment of a formal Early Career Psychiatrists Special Interest Group, which was set up to more adequately address the needs of this group of fellows.

Cate Swannell

Associate Professor Eva Segelov is a Sydney-based medical oncologist with expertise in the diagnosis and management of upper and lower gastrointestinal cancers and breast cancer. She is also an academic and has had a firsthand role in inspiring the next generation of doctors — a role she believes can sometimes teach her more than it teaches her students

Interview by Karen

Dr Nicholas Hayden is an unaccredited plastic surgery/ENT registrar at Bankstown Hospital, Sydney, who combined his medical studies with a professional rugby career.

Karen Burge

More manageable workload and hours, as well as premium patient care are put forward by GP-specialists as the big benefits of working in narrow-focus clinics.

Annabel McGilvray