Volume 199 Issue 3

Australian health policy can and should address, as a core aim, cardiovascular health in less economically advanced nations

Stephen R Leeder MD, PhD, FRACP

A “real world” audit comparing patient characteristics, patterns of investigation, treatment and patient outcomes can highlight variations in care and areas for improvement

Peter S MacDonald MB BS, MD, PhD · Phillip J Newton RN, BN(Hons), PhD · Patricia M Davidson RN, BA, PhD

Industry self-regulation initiatives, introduced in 2009, have not reduced the overall number of unhealthy food ads that children see on television

Lisa G Smithers PhD, GradCertPublicHealth, GradDipHumNutr · Tracy L Merlin BA(Hons), AdvDipPM, MPH · John W Lynch PhD, MPH, MEd

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

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

Hospital governance that prioritises waiting times or patient throughput does not adequately address health care qualityAt the 2007 federal election, Kevin Rudd announced plans to reform the health system. The National Health and Hospitals Reform Commission (NHHRC) was established the following year to find solutions. In 2010, Rudd presented his response to the NHHRC’s report, proposing local hospital networks interfacing with primary health care, with governance ...

David G Penington AC, DM, FRCP

Overcoming the barriers and seizing the opportunities to provide more equitable health care for Australia’s rural populationAustralia’s rural population, which comprises a third of our total population, presents distinct challenges for health care delivery. The low population density of much of rural Australia, the great distances involved, and the limited number of larger centres offering high-level medical care make equitable health care delivery difficult to ...

Gabriel J Shannon BSc, MB BS, FRACP

In light of the increasing utility of novel oral anticoagulants, strategies to improve anticoagulation management in patients with atrial fibrillation must take patient factors into account

Basia O Diug BBioMedSci(Hons) · Judy A Lowthian PhD, MPH, BAppSc(SpPath) · Michael Dooley BPharm, GradDipHospPharm

Renal sympathetic denervation has shown promise in situations where antihypertensive pharmacotherapy has proved ineffective. Future research will focus on monitoring its long-term safety and durability, assessing its cost-effectiveness, and developing markers that predict its efficacy.

Sonny C Palmer MB BS, FRACP · Christopher Judkins MB BS, FRACP · Paul D Williams MA, BM BCh · Robert J Whitbourn MB BS, FRACP

Providing teaching skills training through peer-assisted learning can help students interact with patients as well as improve their own understanding of course content

Benjamin I Silbert MB BS(Hons) · Stephanie JP Lam MB BS · Robert D Henderson MB BS · Fiona R Lake MD, FRACP

To the Editor: In their editorial on stroke care in Australia, Hoffman and Lindley state “only 7% of ischaemic stroke patients received thrombolysis treatment, yet for every 100 patients who receive it, there are up to 10 extra independent survivors”,1 citing the most recent meta-analysis.2 This research also found a significant increase in the risk of early death with thrombolysis, mostly from intracranial haemorrhage. For the individual ...

Stephen P J Macdonald

To the Editor: We concur with Hoffman and Lindley that dedicated funding for implementation of a comprehensive stroke strategy is overdue.1 The importance of funding the implementation of evidence-based care has been recognised by the New South Wales Agency for Clinical Innovation (ACI). Two key projects are currently putting high-level evidence into practice in NSW. The first is the Quality in Acute Stroke Care (QASC) ...

Sandy Middleton · Nigel Lyons

In reply: In response to Macdonald’s letter, we agree there are many effective interventions for stroke that should be routinely available, including stroke units and early coordinated care for minor strokes and transient ischaemic attacks (early care is particularly neglected in Australia). However, thrombolysis is one of the interventions that should be more widely available. Australian and international guidelines (the National Health and Medical Research ...

Tammy C Hoffmann · Richard I Lindley

To the Editor: The evidence that industrially produced trans fatty acids (TFAs) increase the risk of coronary heart disease is compelling, and it is widely agreed that their use in food products should be minimised.1-3 Dietary TFAs are generally found in higher quantities in “unhealthy” food products,4 consumption of which is also found to follow predictable socio-demographic patterns.5 Thus, although the average TFA intake for ...

Kathryn Backholer · Anna Peeters

Renal infarction is a rare cause of abdominal or flank pain. This is the first reported case of an acute thrombosis in an accessory renal artery causing a renal infarction.

Elizabeth C Travis · Vicki A Quincey

Using a new assay method on an old set of samples reveals that the role of high-sensitivity troponin in the real world still requires clarification

Daniel M Fatovich · Michael R Phillips · Kelley M Hubble · Samuel D Vasikaran

To the Editor: Alcohol and other drug (AOD)-related harms are considerable,1 yet individuals with AOD disorders are reluctant to seek treatment.2,3 Barriers to help-seeking include issues of stigma and a lack of understanding of what treatment involves. One possible approach to improving access is the use of online tools that provide advice about available help options. While online screening for alcohol has shown value as ...

Ann S Wilson · David W Best · Michael Savic · Dan I Lubman

Why should authors choose to submit articles to the MJA?

Dev A S Kevat

In reply: Thank you for your endorsement of the MJA’s “likeability”. We agree that the total time from submission to online or print publication is an important consideration for intending authors and a meaningful journal metric. Currently, our manuscript submission system, which collates publishing statistics, does not have the capability to inform our team of the mean time from submission to publication or from acceptance ...

Astika K Kappagoda · Ruth Armstrong

The third part of our Cardiology series provides an overview of the current key issues in the provision of ACS care, including the importance of early diagnosis of ischaemia; risk stratification; provision of timely, appropriate and evidence-based management; and prevention of recurrent events

David B Brieger MB BS, PhD, FRACP · Julie Redfern BSc, BAppSc(Physio), PhD

In 2003, the National Heart Foundation of Australia published a position statement on psychosocial risk factors and coronary heart disease (CHD). This consensus statement provides an updated review of the literature on psychosocial stressors, including chronic stressors (in particular, work stress), acute individual stressors and acute population stressors, to guide health professionals based on current evidence. It complements a separate updated statement on depression and ...

Nick Glozier MB BS, FRANZCP, PhD · Geoffrey H Tofler MB BS, MD, FRACP · David M Colquhoun MB BS, FRACP, FCSANZ · Stephen J Bunker RN, PhD · David M Clarke PhD, FRACGP, FRANZCP · David L Hare DPM, FRACP, FCSANZ · Ian B Hickie MD, FRANZCP, FASSA · James Tatoulis MB BS, MD, FRACS · David R Thompson MA, PhD, FRCN · Alison Wilson MBA · Maree G Branagan MPH

There may be objections, but the bottom line is that point-of-sale monitoring would reduce tobacco purchasing by young people and open avenues for helping adults to quit

Roger S Magnusson BA/LLB(Hons), PhD, GradDipManagDevelop · David C Currow BMed, MPH, FRACP

Objectives: To characterise management of suspected acute coronary syndrome (ACS) in Australia and New Zealand, and to assess the application of recommended therapies according to published guidelines.Design, setting and patients: All patients hospitalised with suspected or confirmed ACS between 14 and 27 May 2012 were enrolled from participating sites in Australia and New Zealand, which were identified through public records and health networks. Descriptive and ...

Derek P Chew MB BS, MPH, FRACP · John French MB BS, FRACP · Tom G Briffa PhD · Christopher J Hammett MB ChB, MD, FRACP · Christopher J Ellis BM, FRACP, FCSANZ · Isuru Ranasinghe MB ChB, MMed(ClinEpi), FRACP · Bernadette J Aliprandi-Costa RN, BHSc · Carolyn M Astley RN, BN, DrPH · Fiona M Turnbull MB ChB, PhD, FAFPHM · Jeffrey Lefkovits MB BS, FRACP · Julie Redfern PhD, BAppSc(Physio)(Hons), BSc · Bridie Carr BA, SRN, OND · Greg D Gamble MSc · Karen J Lintern MNurs, BHlth(ClinStud), CCC · Tegwen E J Howell BEcon, MEcSt · Hella Parker RN · Rosanna Tavella BSc(Hons), PhD · Stephen G Bloomer PhD, HPM · Karice K Hyun BSc, MAppStats · David B Brieger MB BS, PhD, FRACP

Over the past decade, NPS MedicineWise implemented several educational programs to improve cardiovascular management in primary care. This study finds that four such programs had small but clinically relevant beneficial effects.

Svetla V Gadzhanova PhD, MSc · Elizabeth E Roughead PhD, MAppSc, BPharm · Mark J Bartlett BSc, MPH, GradDipAppEpi

Even in the hands of experts, listening through a stethoscope is not the best way to screen for rheumatic heart disease in Indigenous children, according to this cross-sectional screening survey of more than 1000 children

Kathryn V Roberts MPHTM, FRACP, MB BS · Alex D H Brown BMed, MPH, PhD · Graeme P Maguire PhD, FRACP, MB BS · David N Atkinson MPH, MB BS · Jonathan R Carapetis PhD, MB BS, BMedSci

Objective: To determine the utility of exercise electrocardiography testing (EET) in evaluating suspected coronary artery disease in a remote Australian setting where a significant proportion of patients are Indigenous Australians.Design: Retrospective cohort study with grouping based on EET results.Patients and setting: 268 patients with suspected coronary artery disease who underwent EET at Alice Springs Hospital — a specialist teaching hospital ...

Patricia N Hurune MB ChB · Justine M O’Shea MB BS · Graeme P Maguire MB BS, PhD, FRACP · Saliya S Hewagama MB BS, FRACP

This first decision-impact study of the Oncotype DX breast cancer assay in Australia provides evidence that recurrence score information influences treatment recommendations for hormone receptor-positive early-stage invasive breast cancer in the multidisciplinary meeting setting

Richard H de Boer MB BS, FRACP · Caroline Baker MB BS, FRACS · David Speakman MB BS, FRACS · Calvin Y Chao MD · Carl Yoshizawa PhD · G Bruce Mann MB BS, PhD, FRACS

Clinical record A 73-year-old man presented with recurrent ventricular tachycardia (VT) on a background of severe, non-ischaemic dilated cardiomyopathy (ejection fraction, 20%) and cardiac resynchronisation therapy with an implantable cardioverter defibrillator (ICD). Over the previous 6 months, he had frequent appropriate ICD shocks for VT after unsuccessful antitachycardia pacing. A coronary angiogram was normal. Amiodarone had been successful in reducing VT burden and ICD shocks, but was ...

Louis W Wang BSc(Med), MB BS, MM · Rajesh N Subbiah MB BS, PhD, FRACP · Michael J Kilborn BM BCh, DPhil, FRACP · Richard F Dunn MB BS, FRACP, FCSANZ

A doctor gets to know the man of few words who has conveniently set up shop across the road from the hospital

Geoffrey C Mullins MB BS, FANZCA, FRCPC

GREAT SCIENCE is characterised by discovery and by finding solutions to real problems. Unlike physics, where a prediction based in theory leads to a search for supporting evidence, progress in biology depends more on systematic experimentation and observation than on any grand hypothesis. This is because biological systems have sequentially and adaptively evolved via mutations in the designer code of our genes. Without an overarching ...

Peter C Doherty

Good staff are the basis of good practice management. What are the best steps for finding them?

Annabel McGilvray

“SimMan”, a portable and advanced human patient simulator used to test students’ clinical and decision-making skills during real-life patient care scenarios, is at the heart of the newly opened Ingham Institute Clinical Skills and Simulation Centre in Sydney. Driven by software and interactive technology, SimMan can breathe, talk and generate heart, breath and bowel sounds to create real-life emergency scenarios for students, nurses and junior doctors to practise their craft and test their skills. This includes treating patients with life-threatening conditions including a cardiac arrest, or managing a major trauma scenario like a car accident. Andrea Herring, coordinator of the Simulation Centre and a veteran of 28 years as a nurse, the last nine specialising in simulated medical training, told the MJA that SimMan was the Centre’s “standout technology”. “Simulated learning embraces experiential learning and replaces the ‘see one, do one, teach one’ mantra of medical training with the ability to learn and practise in a patient safe environment”, Ms Herring said. “It enables students to learn, practise and repeat procedures to correct mistakes and finetune their skills, without compromising patient safety. This ultimately improves the patients’ health outcomes and saves lives. It’s the way of the future for health and medical training in Australia. “The beauty of setting up the different scenarios is that the students’ confidence and competence levels improve and you can train them to deal with high-stress and trauma situations before they come face to face with it in the real world”, she said.

Cate Swannell

Professor Michael Ashby is the calm and steady hand on the shoulder of dying patients at Royal Hobart Hospital. It is necessary work that is both humbling and rewarding

Cate Swannell

Med J Aust 2013; 199 (3 Suppl).