Volume 199 Issue 10

Prevention remains the best approach to lung cancer, but ensuring best practice through access to continually updated guidelines for treating patients who already have the disease will improve outcomes.

Ian N Olver MD, PhD, FRACP

Low vitamin D levels may increase the risk of reactivation of TB, but there is relatively little evidence supporting the use of vitamin D supplementation.

A Stewart Truswell AO, MD, FRCP

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

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

Cancer genetic services can provide optimised risk management for patients and their families.

Ingrid M Winship MB ChB, MD, FRACP · Kathy Tucker MB BS, FRACP

Angelina Jolie’s announcement of her preventive double mastectomy has contributed to increased demand for genetic testing, with rapid growth in referrals to familial cancer centres of people concerned about their personal and family history of breast and ovarian cancer.

Paul A James MB ChB, DPhil, FRACP · Gillian Mitchell MB BS, PhD, FRACP · Michael Bogwitz BSc, PhD, FHGSA · Geoffrey J Lindeman MB BS(Hons), FRACP, PhD

Many questions remain unanswered about accurate vitamin D testing and interpretation, the benefits of supplementation, and potential harms of oversupplementation.

Anna P Ralph MPH, FRACP, PhD · Robyn M Lucas MB ChB, PhD, FAFPHM

Harmonising national data collection processes and establishing reliable linkage of data from different repositories has the potential to improve efficiency in monitoring the quality of stroke care.

Dominique A Cadilhac PhD, MPH, BN · Karen M Moss BBSc(Hons) · Christopher J Price BSc, BSW · Natasha A Lannin PhD, BSc(OT), GradDip · Joyce Y K Lim RN, GradDipComHlth, MNurs · Craig S Anderson BMedSci, MB BS, PhD

Unresolved issues regarding screening for latent tuberculosis infection and management make it difficult to strike a balance between costs (including risks) and benefits of screening.

David W J Griffin · Mark D Kelly

In reply: I thank Griffin and Kelly for elaborating on some practical elements of immigration screening for latent tuberculosis infection (LTBI) in light of their experience with isoniazid prophylactic therapy in a high-risk context. Any screening program must strike a balance between costs (both the financial costs and the risks associated with screening) and benefits in a specific setting. Accumulating evidence suggests that higher levels of ...

Justin T Denholm

Clinicians should sometimes just say no to the “just in case” peripheral intravenous catheter to reduce harm caused.

Claire Dendle · Rhonda L Stuart · Diana Egerton-Warburton

The coincident seasonality of active TB cases and vitamin D deficiency suggests that low vitamin D levels may increase the likelihood of reactivation of tuberculosis. Vitamin D testing and supplementation is therefore recommended for high-risk groups.

Jennifer H MacLachlan · Benjamin C Cowie

The PSA test is an important clinical tool that must be considered in its correct context.

Kenneth A Sikaris · Bronwen A Ross · Teck Y Khong

The monoclonal antibody bevacizumab is used to treat symptomatic bleeding in patients with hereditary haemorrhagic telangiectasia; the bleeding often recurs in time, and it seems it may be effective and safe to re-treat with bevacizumab.

Gwo Yaw Ho · Edward Zhong · Boris Chern

The prescribing information for sotalol does not warn of the risk of life-threatening cardiogenic shock when this drug is used in patients with left ventricular dysfunction, and should probably be amended.

Simon D Leslie

Whenever a case of “deathcap” mushroom poisoning occurs, the possibility of ongoing risk of poisoning should be investigated by public health units.

Andrew J Pengilley · Paul M Kelly

Not enough women are being informed about the need for supplementation with iodine by their antenatal care providers.

Karen E Charlton · Creswell J Eastman AM

The increasing use of psychotropic medicines has led to a need to understand the safety of antipsychotics in pregnancy.

Roisin N Worsley · Heather Gilbert · Jayashri Kulkarni

Is it fair that we, as colleagues in health care, should collude in keeping the truth away from the unsuspecting person walking through the door?

Navin I Dadlani

Despite widespread professional and public endorsement, coupled with supporting legislation in every state and territory, uptake of advance care planning in Australia has been slow. All general practices, hospitals and residential care facilities need to commit to systematically eliciting, documenting and enacting patients’ future care preferences.

Ian A Scott FRACP, MHA, MEd · Geoffrey K Mitchell MB BS, FRACGP, PhD · Elizabeth J Reymond MB BS, FRACGP · Michael P Daly MB BS, MHA

Cardiac complications such as myocardial infarction, cardiac arrest and acute heart failure are a common cause of death and major morbidity in patients undergoing non-cardiac surgery. Part 6 of our Cardiology series looks at how preoperative evaluation and medical optimisation can improve outcomes for surgical patients.

Ian A Scott MB BS, FRACP, MHA · Hasan A Shohag MB BS, FRACP · Peter C A Kam MB BS, FANZCA · Michael V Jelinek FRACP, MD, FCSANZ · Golam M Khadem MB BS, FRACP

There is room for improvement in the management of patients with lung cancer, which remains the leading cause of death from cancer in this country. Tissue diagnosis, active treatment for all patients, postsurgical adjuvant chemotherapy and case discussion at multidisciplinary meetings would all help, as would screening those at high risk to detect cancers earlier.

Paul L R Mitchell MB ChB, FRACP, MD · Vicky J Thursfield BSc, GradDipAppStat · David L Ball MD, FRANZCR · Gary E Richardson MB BS, FRACP · Louis B Irving MB BS, FRACP, FRACGP · Yvonne Torn-Broers BA(Hons) · Graham G Giles BSc, Msc, PhD · Gavin M Wright MB BS, FRACS

The use of risk-reducing surgery and medications by women who carry mutations known to predispose them to cancers of the breast, ovary, fallopian tubes and peritoneum is not as common as might be expected; this means that the full potential of genetic testing is not being realised.

Ian M Collins MB, MSc, FRACP · Roger L Milne BSW, MSc, PhD · Prue C Weideman GradDipHealthPromEd · Sue-Anne McLachlan MB BS, MSc, FRACP · Michael L Friedlander PhD, FRACP · Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer Kathleen Cuningham Foundation Consortium for Research into Familial Breast Cancer · John L Hopper PhD · Kelly-Anne Phillips MB BS(Hons), MD, FRACP

Although consumers have been able to directly report possible adverse drug reactions to the Therapeutic Goods Administration since 1964, most such reports still come from health professionals and pharmaceutical companies. It seems that lack of awareness of the reporting mechanisms is a major limiting factor for consumers, and promotion and education of reporting systems are required.

Jane Robertson BPharm, MMedSc, PhD · David A Newby BPharm, GradDipEpi, PhD

A cross-sectional study using the BEACH (Bettering the Evaluation and Care of Health) methods for general practice assessed the clinical practices of chiropractors in Victoria and found that they manage a range of conditions, mostly musculoskeletal-related. This study’s results can be used by stakeholders of the chiropractic profession in workforce development, education and health care policy.

Simon D French PhD, MPH, BAppSc(Chiro) · Melanie J Charity MSc, BSc · Kirsty Forsdike BA(Hons), PgDipLaw, PgDipLegalPractice · Jane M Gunn PhD, FRACGP, MB BS · Barbara I Polus BAppSc(Chiro), MSc, PhD · Bruce F Walker DC, MPH, DrPH · Patty Chondros BSc(Hons), MSc, PhD · Helena C Britt BA, PhD

Public regional and private hospitals need more antimicrobial stewardship support, particularly in the areas of policy development, antimicrobial approval systems, prescription review and auditing.

Rodney S James BMedSci, BMed, FRCPA · Kylie A McIntosh BPharm(Hons), PhD · Susan B Luu BPharm, MPH · Menino O Cotta BPharm · Caroline Marshall MB BS, FRACP, PhD · Karin A Thursky MB BS, FRACP, MD · Kirsty L Buising MB BS, FRACP, MD

This study shows that different approaches may be required to reduce unsanctioned use of different pharmaceuticals due to differences in how drugs are sourced. The data also highlight that plans to monitor only Schedule 8 benzodiazepines and prescription opioids may have limited effects on prescription opioid users who use non-prescribed sources and may represent a lost opportunity for reducing unsanctioned benzodiazepine use.

Suzanne Nielsen BPharm, BPharmSc(Hons), PhD · Raimondo Bruno PhD · Louisa Degenhardt BA(Hons), MClinPsych, PhD · Mark A Stoove PhD, BAAppSci(Hons) · Jane A Fischer BA, MSPD · Susan J Carruthers MPH, PhD · Nicholas Lintzeris MB BS, FAChAM, PhD

A 78-year-old man of Laotian descent develops the first Australian case of Histoplasma capsulatum septic arthritis while receiving treatment for seropositive rheumatoid arthritis.

Andrew S Jordan BSc(Med), MB BS, FRACP · Ruchir Chavada MD · Vanathi Nagendra MB BS · H Patrick McNeil MB BS, PhD, FRACP · Katherine Kociuba FRCPA, FRACP · Kathryn A Gibson BM BCh, FRACP, PhD

Are global health leaders and funding bodies doing enough to ensure that the rhetoric surrounding health system strengthening becomes reality, or has the concept been relegated to that of a buzzword?

Mary C Boyle MB BCh, DTM

Breaking bad news is a necessary, never-ending challenge for doctors.

Emma Foster MB BS

Hubert (Hugh) Harris was a country doctor who earned the respect and affection of all who knew him. Hugh was born in Stockton, New South Wales, in 1919 to Dr Hubert and Emily Harris. He was educated at Armidale and studied medicine at the University of Sydney. On graduating in 1943, Hugh was appointed a resident medical officer at Grafton Base Hospital. In 1944, he enlisted in the ...

James Rae

is a fortress, you press a button and wait like some malevolent bacterium. “I’m here to see my wife” a click, a heavy sliding. Arterial corridors a nurse at a station an orderly with a trolley of folded white sheets. Another nurse, a tiny ante-room. Hygiene is vital: over your clothes, you pull a white gown of tough matt paper, you tie the back slip on a face-mask, elastic behind your ears — your breathing’s toxic. An ...

John Upton

CorrectionIncorrect competing interests statement: In “Australia’s dietary guidelines and the environmental impact of food ‘from paddock to plate’”, a letter to the Editor from Alexandra McManus, Director of the Centre of Excellence for Science, Seafood and Health, in the 7 October 2013 issue of the Journal (Med J Aust 2013; 199: 457), the competing interests statement should have read: “The Centre of Excellence for Science, Seafood and ...

Alexandra McManus

Junior doctors are pushing to create pathways to more diverse careers

Annabel McGilvray

The Therapeutic Goods Administration (TGA) says it will "continue to monitor the situation" following the release of the European Commission's Scientific Committee on Emerging and Newly Identified Health Risks (SCENIHR) updated opinion on the safety of PIP [poly implant prothese] silicone gel-filled breast implants.

Cate Swannell

Award-winning general practitioner and businesswoman Dr Jennifer Wray explains how giving to her local community and the junior medical community have helped her “have it all”.

Annabel McGilvray