Volume 199 Issue 2

With very few new antibiotics in the pipeline, promoting their development is important, as is balancing priorities when treating patients

Allen C Cheng FRACP, MPH, PhD · Roger L Nation PhC, MS, PhD

CT screening of high-risk individuals approaches acceptable cost-effectiveness. But is there a better way?

Mark Hew MB BS, PhD, FRACP · Robert G Stirling BSc(Hons), MB BCh(Hons), FRACP · Michael J Abramson MB BS, PhD, FAFPHM

New guidelines, from the Kidney Disease: Improving Global Outcomes (KDIGO) group, emphasise balancing the risks and benefits of erythropoietin-stimulating agents and iron therapy.

Robert J MacGinley MB BS, FRACP · Rowan G Walker MD, FRACP, MPH

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

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

In the face of crippling rates of chronic disease linked to unhealthy lifestyles, our governments may need to intervene more to ensure food and alcohol industry self-regulation maintains credibility

Roger S Magnusson BA/LLB(Hons), PhD, GradDipManagDevelop · Belinda H Reeve BA(Hons), LLB

As the costs of both medical care and clinical trials continue to rise, do our current research endeavours represent good value for money? In this article, the last in a series based on the MJA Clinical Trials Research Summit, the authors propose a new model for funding investigator-initiated studies.

Ingrid M Winship MB ChB, MD, FRACP · John McNeil AM, MB BS, PhD · R John Simes MB BS, SM, FRACP

Recent enhancements to subacute care services are threatened due to the uncertain future of federal–state funding agreements The term “subacute” was coined for use in Australia 21 years ago to describe health care where the patient's need for care is driven predominantly by his or her functional status rather than principal diagnosis.1 Subacute care includes rehabilitation, palliative care, geriatric evaluation and management, and psychogeriatrics. Rehabilitation represents ...

Christopher J Poulos MB BS(Hons), PhD, FAFRM · Kathy Eagar MA, PhD, FAFRM(Hon) · Steven G Faux MB BS, FAFRM(RACP), FFPMANZCA · John J Estell MB BS, MSpMed, FAFRM(RACP) · Maria Crotty BMed, FAFRM, PhD

In 2011, we saw the Australian Census of Population and Housing recognise same-sex marriages for the first time.1 However, we have also recently witnessed the winding back of civil union legislation in Queensland, which had previously allowed for legally recognised unions between same-sex couples, and there have been suggestions that same-sex couples should be written out of surrogacy legislation in that state. It is in ...

Simon R Crouch MB BS, MA, MPH · Ruth P McNair MB BS, PhD, FRACGP · Elizabeth B Waters MPH, DPhil · Jennifer J Power PhD, GradCert(Stat), BA(Hons)

To the Editor: The perspective of the Doctors for Voluntary Euthanasia Choice needs to be challenged.1 Firstly, irrespective of one’s views on the matter, it does not seem reasonable for euthanasia to be legalised so that doctors can avoid the scrutiny of the law. Secondly, the authors point out that “pain may not be a prominent symptom, making death by morphine legally unjustifiable”, therefore implying ...

Paul F Dunne

To the Editor: The Doctors for Voluntary Euthanasia Choice want Australia to have enlightened euthanasia laws similar to those of the Netherlands.1 But a recent review of Dutch physician-assisted death (PAD) suggests that such practices are extremely difficult to control.2 They state that there has been some improvement in the rate of reporting of cases of euthanasia (a legal requirement), although only 2% of deaths classifiable ...

Roger K Woodruff

In reply: We thank Dunne and Woodruff for comments on our Perspectives article.1 Both colleagues firmly expressed their opinions. However, we find it telling that neither mentioned consideration of their patients’ opinions and both referred to euthanasia, not voluntary euthanasia (VE), which was the subject of our article. We agree with Dunne that “it does not seem reasonable for euthanasia to be legalised so that doctors ...

John O Willoughby · Robert G Marr · Colin P Wendell-Smith

The problem of excessive psychotropic drug use in Australian nursing homes is well known, but where are the solutions?

Juanita L Westbury · Gregory M Peterson

To the Editor: The article by Hilmer and Gnjidic1 raises issues about the management of behavioural and psychological symptoms of dementia (BPSD)2 in residential aged care facilities (RACFs). It is important to remember the context in which RACF residents’ care is provided. The federally managed aged care system is politically and organisationally perceived as supported accommodation, which is geared toward supporting or substituting for residents’ performance ...

Ludomyr J Mykyta

In reply: We thank Westbury and Peterson, and Mykyta for highlighting some of the issues raised in our article.1 While we acknowledge the important contribution of providing education programs to existing staff, staff education alone is insufficient to address the complex issues affecting psychotropic drug use in nursing homes.1 Better access to appropriately trained staff in nursing homes, including general practitioners, geriatricians, psychogeriatricians, psychologists, pharmacists, nurses ...

Sarah N Hilmer · Danijela Gnjidic

Data from a tertiary paediatric refugee health clinic show that instances of post-traumatic stress disorder are on the rise in this population, particularly in children who have been held in detention.

Joshua R Francis · Sarah Cherian · David Forbes

When considering this controversial procedure, how do we weigh the results of patient satisfaction surveys with those of clinical trials?

Wayne Adams

In reply: We thank Adams for providing private health insurance data that confirm the continued use of arthroscopic surgery for patients with osteoarthritis. We agree that the patient’s view of the benefits of the procedure is fundamental to assessing treatment success. We do not doubt that many patients are happy with the results of arthroscopic knee surgery, but this does not necessarily imply that the surgery ...

Rachelle Buchbinder · Ian A Harris

To the Editor: This letter encourages timely preoperative recognition of restless legs syndrome (RLS), for patient wellbeing, as well as for practical management of incidental procedures. RLS is a neurological disorder found in many older patients of either sex and in those with a variety of conditions including iron deficiency, pregnancy, uraemia, diabetes and rheumatoid arthritis. It may also affect patients with other neurological disorders ...

Ivan Cher

To the Editor: We read with interest the viewpoint offered by Mitchell and colleagues, highlighting the need for improved integration of global health training in postgraduate medical education in Australia.1 This subject has garnered interest in Australia and overseas with reference to ophthalmology. In the United Kingdom, the case for structured global health training has been advocated in ophthalmology postgraduate education, where financial and bureaucratic ...

Jan Kokavec · Lauren Hodgson · Justin C Sherwin

To the Editor: Mitchell and colleagues have done medical education a service by outlining all the potential benefits and harms associated with global health training.1 They are right to state that sustainability is key — however, all too often in the past, it has been sustainability that has been lacking. According to Yikona, writing in 2003: “Case by case analysis of medical schools in sub-Saharan ...

Kieran Walsh

In reply: We thank Walsh for highlighting that sustainability is a critical challenge in global health training (GHT) programs and that technology is creating new options for international engagement. He has also articulated a vision of qualified specialists taking a greater role in the delivery of clinical education in resource-poor settings. We share this aspiration. One of the end points of GHT is a lifelong commitment ...

Rob D Mitchell · Jennifer C Jamieson · Jake Parker · Fred B Hersch · Zoe Wainer · A Rob Moodie

Liver transplantation is an established treatment modality in Australia, but there continues to be a significant disparity between availability and demand. A way to reduce this gap is to maximise the use of extended-criteria deceased donor livers, with donation after cardiac death being one such option.

Jorieke M van der Stelt · Deborah J Verran MB ChB, FRACS · Ronald A deRoo MD · Hazel Christine · Michael Crawford MB BS, FRACS

Data from the 45 and Up Study identify a range of modifiable risk factors for erectile dysfunction, suggesting that attention to lifestyle factors could help prevent this common problem

Marianne F Weber BA(Hons), PhD · David P Smith BA, MPH, PhD · Dianne L O'Connell BMaths(Hons), PhD · Manish I Patel MB BS, PhD, FRACS · Paul L de Souza MB BS, PhD, FRACP · Freddy Sitas DPhil · Emily Banks MB BS, PhD, FAFPHM

Objective: To examine the relationships between birthweight, current size, and fasting glucose and fasting insulin levels in Aboriginal adolescents.Design, participants and setting: Longitudinal prospective study of a Northern Territory Aboriginal birth cohort of 686 Aboriginal babies born at the Royal Darwin Hospital between January 1987 and March 1990, and followed up between December 2006 and January 2008 in over 40 NT locations.Main outcome measures: ...

Susan M Sayers FAAP, FRACP, PhD · Susan A Mott BSc, RN, MPH · Kay D Mann MMathStat · Mark S Pearce BSc, MSc, PhD · Gurmeet R Singh PhD, MD, FRACP

Objective: To describe human hydatid disease in Tasmania since 1996, the year that the state was declared provisionally hydatid-free.Design, setting and participants: Individuals with a new diagnosis or history of hydatid disease between January 1996 and July 2012 were identified through a number of sources including public health notifications, discharge coding from Tasmanian public hospitals, and the Royal Hobart Hospital pathology laboratory information ...

Jennifer A O’Hern MPHTM, MB BS, BMedSci · Louise Cooley MB BS, FRACP, FRCPA

Lymphangioleiomyomatosis (LAM) is a rare disease disrupting cellular proliferation and growth. This open-label study examined the efficacy of the mammalian target of rapamycin (mTOR) inhibitor everolimus on lymphatic abnormalities in LAM. The five patients experienced significant shrinkage or complete resolution of their lymphangioleiomyomas during treatment.

Anna M Mohammadieh MB BS · Simon D Bowler MB BS, FRACP · Elizabeth J Silverstone MB, MRCP, FRANZCR · Allan R Glanville MB BS, MD, FRACP · Deborah H Yates MB BChir, MD, FRCP

A case of prolonged exposure to mercury vapour highlights the immediate and delayed effects of such poisoning on multiple organs. Prompt and sometimes prolonged treatment may prevent long-term damage.

Mohamed Saleem MB BS, FRCPA · Sam Alfred MB BS, DipTox, FACEM · Rebecca A Bahnisch BSc · Penelope Coates MB BS, FRACP, FRCPA · Daniel J Kearney MB BS, FRCPA

In the context of a recent reduction in the number of approvals granted by the Australian Electoral Commission for access to the electoral roll to conduct public health research, these authors provide advice for maintaining the roll’s integrity and preserving privacy, while also using it to support medical research

Bebe Loff LLB, MA, PhD · Elissa A Campbell BA LLB(Hons), MPH(PP) · Deborah C Glass MA, MSc, PhD · Helen L Kelsall MB BS, MPH, PhD · Claudia Slegers BA, GradDip(Soc), PhD · Deborah R Zion BA(Hons), MA, PhD · Ngaire J Brown BMed, MPHTM, FRACGP · Lin Fritschi MB BS, PhD

A new registrar on secondment typically lacks confidence, but contributing to a positive outcome can start to make a difference.

Rebecca C Rowe BSc(Med), MB BS, DRANZCOG

A medical student’s experience of a simple public health message that spread “like a message stick passed from house to house, summoning all and sundry to devotion”.

John E Farey BA(Media

Trying to keep a firm hold on things in a fraught initial weekDiving out of bed at 5.00 am on Monday, I shower and preen like it’s my Year 12 formal, dressing with purpose in my carefully selected outfit. By 6.45 am, the ruminations on why one would be stupid enough to choose medicine as a career have begun. “Imposter syndrome” has set in. I could have been ...

Rachel L Jones Lumby MB BS, BA, BCom

Graeme Lim was born on 29 December 1946 in Bandung, Indonesia. His arrival in Queensland at the age of 16 was an immense culture shock. He had no parents here and the White Australia Policy was in force. Graeme attended St Paul’s School in the Brisbane suburb of Bald Hills, mastered English, entered the medical course at the University of Queensland, studied hard and drove a taxi at night. ...

John D Morris

CorrectionIncorrect text: In “Frequency of sunburn in Queensland adults: still a burning issue” published in the 6 May 2013 issue of the Journal (Med J Aust 2013; 198: 431-434), the third sentence on page 431 should read: “In Australia, skin cancers cost more than other major cancers.2”

Adèle C Green · Louise Marquart · Susan L Clemens · Catherine M Harper · Peter K O'Rourke

A practice’s good name is a valuable asset that’s now more vulnerable than ever thanks to social media.

Annabel McGilvray

Professor Helen Chenery is a speech pathologist keeping a large group of neurosurgeons, engineers and ethicists on track as they research deep brain stimulation’s role in making patients’ lives better

Cate Swannell