Volume 198 Issue 5

From the “Black Death” of bubonic plague to the “White Plague” of tuberculosis, infectious diseases have had devastating effects on unprepared human populations. What must we do to avoid a similar fate from the “Red Plague” of multiresistant gram-negative bacteria?

David F M Looke FRACP, FRCPA, MMedSci(ClinEpidemiol) · Thomas Gottlieb MB BS, FRACP, FRCPA · Cheryl A Jones MB BS, PhD, FRACP · David L Paterson MB BS, PhD, FRACP

New guidelines remind us that CJD is often on a list of differential diagnoses for neurological diseases, and that equity in access to medical care is important for people with CJD and their families.

Ann P Koehler MB BS, FRCPA, MPH · Eugene Athan MB BS, FRACP, MPH · Steven J Collins MB BS, MD, FRACP

Despite improvements in stroke prevention and management, most patients in Australia do not have access to the latest evidence-based care.

Tammy C Hoffmann PhD, BOccThy(Hons) · Richard I Lindley 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.

Can we act in time to stem the rise of the superbug? Abdul Ghafur explains that we must help tighten antibiotic control policies both locally and overseas.

Abdul Ghafur MD, MRCP, FRCPath

Public reporting of hospital performance is welcome, but we need to understand the limitations of the data and report the most meaningful outcomes.

Leon J Worth MB BS, FRACP, PhD · Ann L Bull PhD · Michael J Richards MB BS, FRACP, MD

Researchers need an umbrella group to advocate on their behalf, identify the research gaps and provide a way to share ideas and infrustructure.

Ian N Olver AM, MD, PhD · Anthony C Keech FRACP, MSc(Epid)

To the Editor: In a recent article,1 Elkin and colleagues concluded that, compared with Australian-trained doctors (ATDs), international medical graduates (IMGs) posed a greater risk of attracting complaints to medical boards. However, we think the conclusion is not supported by the data, and might have been compromised by the analytical methods used. Box of the research article1 shows that IMGs accounted for 37% of the total ...

Nguyen D Nguyen · Tran V Nguyen

To the Editor: The article by Elkin and colleagues has certainly reheated the long-simmering debate about bringing highly trained international medical practitioners from other countries to provide health care in Australia. Yet, it does not discuss the clinical and cultural acclimatisation they need. There are many moral and social issues associated with condemning an IMG without helping them to adapt to their locality. The study ...

Shailja Chaturvedi

To the Editor: Elkin and colleagues acknowledged that “most [international studies] have found no association” between acquiring a medical degree overseas and being the subject of a complaint; however, their principal findings — which differ from these other studies — require care in interpretation. In the study by Elkin et al, the “clinical specialty was missing” for 75% of registered doctors. Yet, certain medical specialties are ...

Carlos Zubaran

To the Editor: In the article by Elkin and colleagues,1 the conclusions drawn from the data analysed do not appear to be adequately supported. It should be noted that only 30% of complaints against doctors had a final hearing, and the risk of adverse findings (ie, where the doctor was found to be guilty) was not analysed by country of origin. Although doctors from certain ...

Snehal P Akre · Amit C Achhra

To the Editor: While using medical board data for research purposes is very welcome, I have some reservations about ethical aspects of the study by Elkin and colleagues.1 Prospective ethics review of human research is intended to protect participants from foreseeable and avoidable harm. I suggest that, in this instance, avoidable harm has resulted, through generalised adverse and possibly unfair publicity about particular groups of ...

Kerry J Breen

In reply: Nguyen and Nguyen question our finding that international medical graduates (IMGs) are at higher risk of attracting complaints than Australian-trained doctors (ATDs),1 based on recalculations using the descriptive statistics we reported. They infer, from the fact that IMGs accounted for 37% of doctors and 30% of total complaints, that IMGs were at lower risk of complaints. Comparisons of simple proportions as above mislead for ...

David M Studdert · Matthew J Spittal · Katie Elkin

Funding such a recommendation would lead to little overall cost but would possibly save several Australian lives each year

D Ashley R Watson

To the Editor: We commend the clinical update of Bergin and colleagues on the management of diabetes-related foot ulceration.1 We agree that a multidisciplinary approach is the best way to manage these complex wounds. However, we believe that the use of hyperbaric oxygen treatment (HBOT) for ulcers which have failed to respond to 3 months’ standard treatment justifies more prominent consideration. The actions of HBOT are diverse, ...

Glen C Hawkins · Michael H Bennett · David R Smart

To the Editor: Following two articles in the Journal,1,2 I wish to provide an update on the pricing of statins in Australia and the implications for Pharmaceutical Benefits Scheme (PBS) expenditure. I was prompted to do so by a recent review by the Pharmaceutical Benefits Advisory Committee (PBAC), which was instigated by the Senate when it passed legislation enabling the current pharmaceutical pricing arrangements.3 The ...

Philip M Clarke

To the Editor: Neovascular age-related macular degeneration (NVAMD) is the most common cause of blindness in Australia.1 Current treatment to prevent further deterioration in vision, and an improvement in some, involves the antivascular endothelial growth factor (anti-VEGF) agents ranibizumab (Lucentis, listed on the Pharmaceutical Benefits Scheme [PBS] since August 2007) or bevacizumab (Avastin, used off-label for NVAMD).2 The Australian Macular Degeneration Foundation estimated the annual number ...

Robert P Finger · Robyn H Guymer

An antibiotic stewardship program in a tertiary referral hospital immediately reduced use of broad-spectrum antibiotics but will it stand the test of time?

Kelly A Cairns BPharm, GradDipClinPharm · Adam W J Jenney MB BS, FRACP, FRCPA · Iain J Abbott MB BS · Matthew J Skinner MB BS, FRACP · Joseph S Doyle MB BS, MSc, FRACP · Michael Dooley BPharm · Allen C Cheng MPH, PhD, FRACP

After the detection of four clusters of gram-negative bacteria harbouring the MBL gene blaIMP-4 in an intensive care unit, an epidemiological investigation uncovered an environmental reservoir of the organisms that proved difficult to clean up.

Despina Kotsanas BSc(Hons), MClinEpi · W R P L I Wijesooriya MB BS, MD, MPhil · Tony M Korman MB BS, FRACP, FRCPA · Elizabeth E Gillespie BN, MPubHlth · Louise Wright BN · Kylie Snook BN · Natalie Williams BN · Jan M Bell BSc · Hua Y Li MMed · Rhonda L Stuart MB BS, PhD, FRACP

Objectives: To determine research priorities of infectious diseases physicians for clinician-initiated randomised controlled trials (RCTs).Design, setting and participants: Online survey of infectious diseases physicians in Australia and New Zealand.Main outcome measures: Research priorities for, and perceived barriers to, clinician-initiated RCTs.Results: 122/550 infectious diseases physicians (22%) responded to the survey. The five highest ranked proposals for clinician-initiated RCTs were ...

on behalf of the Steering Group of the Australasian Society for Infectious Diseases Clinical Research Network*

Eight years after the first Bali bombing, a cross-sectional study of Australians who were directly affected by the attacks found that they tended to have good physical health but high rates of psychological distress.

Garry J Stevens BSc(Hons), MClinPsych, MAPS · Julie C Dunsmore BSc(Psych)(Hons), MPH, MAPS · Kingsley E Agho BSc(Hons), PhD, MPH · Melanie R Taylor BSc(Hons), PhD, CPsychol · Alison L Jones MD, FRCP, FRCPE · Jason J van Ritten BSc(Hons), GradCertSRM · Beverley Raphael MB BS, MD, FRANZCP

A retrospective study shows that microbiologically confirmed hookworm infection is now a rare event in the NT, persisting mainly in adults outside the target group of the community children’s deworming program.

Jane Davies* MB BS, MRCP(UK), DTM · Suman S Majumdar* BMed, MPHTM, MRCP(UK) · Robert T M Forbes BM BS, BSc, MSc · Pam Smith BSc · Bart J Currie FRACP, FAFPHM, DTM · Robert W Baird MB BS, FRACP, FRCPA

An unusual cascade of infectious complications after a prostate biopsy procedure highlights the importance of risk assessment, prophylactic and therapeutic antimicrobial use, and collaboration between urology and infectious diseases physicians.

Matthew J Roberts MB BS, BSc · Anisha Parambi MB BS · Lucinda Barrett MB BS, MRCP · Paul Hadway MB BS, FRCS · Robert A (Frank) Gardiner AM, MB BS, MD, FRACS · Krispin M Hajkowicz MB BS, FRACP · John Yaxley MB BS, FRACS

A case of septic arthritis after a joint injection led to an investigation of the possible source and a simple recommendation for infection control.

Nicholas R Coatsworth MB BS, MIntPH, FRACP · Peter G Huntington MMedSc(Path), BMedSc · Bruno Giuffrè MB BS, FRANZCR · George Kotsiou MB BS, FRACP, FRCPA

In a highly commended artwork entry for the 2012 Dr Ross Ingram Memorial Prize, a traditional dot painting style and storytelling is used as the basis for a health promotion poster addressing the risks and signs of dementia in Aboriginal people.

Anna L Dwyer AdvDipAustLanguage

Brian Heber was born on 22 March 1929 in Finsbury Park, London, into a family of 13 doctors. His mother was widowed when Brian was 6. At the age of 11, he won a scholarship to Christ’s Hospital School, West Sussex. On leaving, his classics master remarked to him that going into medicine would be a “waste of intellect”. After National Service, Brian obtained an ex-serviceman’s grant to study ...

Roger Wickins

There are skills to be learned, challenges to be overcome and great fun to be had for doctors working with sporting organisations. And some great sport to watch as an added bonus.

Karen Burge

Australian research has put a dollar value on the gender pay gap, showing that general practitioners who are mothers earn up to $105 000 a year less than male GPs with children.

Cate Swannell

Dr Sarah Michael is a psychiatry registrar, who has trained under Dr Gordon Shymko

Cate Swannell

Dr Gordon Shymko is the clinical director of the Peel and Rockingham Kwinana Mental Health Service (PaRK MHS) in Western Australia and the consultant psychiatrist responsible for the Early Episode Psychosis Program. His clinical interest is in the area of managing psychotic disorders, particularly early presentations of psychosis in youth and the psychopharmacology of these illnesses. Throughout his career, Dr Shymko has maintained a strong interest in supervision and teaching and has been an inspiration to those he has mentored

Karen Burge

General practitioners and medical educators Genevieve Yates and Gerard Ingham met while playing in a band and discovered a mutual interest in theatre, writing, music and entertaining. And so, GP the musical was born. Now the Melbourne International Comedy Festival beckons.

Cate Swannell

From tutus to morning teas, Australian general practitioners are beginning to think about team spirit

Annabel McGilvray

Incorrect authorship: In “Listening to what Indigenous people in remote communities say about alcohol restrictions and cannabis use: ‘Good thing that the alcohol’s gone, but the gunja has kept going’ ” in the 3 September 2012 issue of the Journal (Med J Aust 2012; 197: 275), it was incorrectly stated that Alan Clough was the sole author of this letter. Due to space constraints in the print version of the Journal and Journal policy concerning the authorship of letters, the members of the Cape York Cannabis Project team who co-authored the letter were not individually named in the original publication as co-authors of the letter. We wish to name these co-authors individually. They are: Susan Jacups, Jan Robertson, Bernadette Rogerson and Veronica Graham.

Alan R Clough MSc