Volume 199 Issue 4

Repeated warnings from health experts have fallen on deaf ears. So, yet again, strategy and action to prevent the looming diabetes apocalypse are being called for.

Paul Z Zimmet AO, MD, PhD, FRACP

Since ancient times, this disease has inspired mythology as well as discovery, and continues to challenge us today.

Stephen R Leeder MD, PhD, FRACP

A brief history of hand transplantation, and support for the team that performed Australia’s first successful transplant in what would generally be considered an unlikely recipient.

Warren C Breidenbach MD, FRCS

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

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

An incoming government must provide a full range of curative, rehabilitative, preventive and promotive health services and must take responsibility for the health impacts of every policy.

Fran E Baum BA(Hons), PhD

The quality and effective use of data must be strengthened if Australia is to meet the challenge of rising health care costs in the next electoral term.

Sally Redman BA(Hons), PhD · Robert W Wells BA

Spinal steroid injections are increasing in popularity, but not in therapeutic benefit; placebos work just as well, and the procedure itself carries risks, some quite serious.

Ian A Harris MB BS, MMed(ClinEpi), PhD · Rachelle Buchbinder MB BS(Hons), PhD, FRACP

To the Editor: Until recently, Australian medical workforce planning has seemed a rather ad-hoc affair. We have self-induced an undersupply of doctors (having actually reduced student numbers in the mid 1990s,1 taken a decade to increase production, and now have crashed into entirely foreseeable undersupply of intern placements). The establishment of Health Workforce Australia has promulgated some much needed detailed, future-focused planning, although the fragmented ...

Dev A Kevat · Shanti Raman

While it is encouraging that new, effective, anticoagulant agents have been added to the anticoagulant pharmacopoeia, specific concerns are raised about the management of intracranial haemorrhage in patients treated with dabigatran.

Piers A W Thomas · Nicholas B Schaerf · Jeffrey V Rosenfeld

To the Editor: I would like to endorse the call for better health data standards across Australia.1 However, while standardisation is a long-term goal, we at NPS MedicineWise believe that more can be done now, even with current limitations. NPS MedicineWise has recently embarked on an ambitious program called MedicineInsight to gather anonymised patient data from 500 general practices (equating to about 2 million patients) on an ongoing ...

Lynn M Weekes

In reply: Weekes agrees that better health data standards are needed, and suggests that MedicineInsight can gather valid data from current general practice electronic health records, to provide meaningful information. We have gathered representative data on general practice patient management through the Bettering the Evaluation and Care of Health (BEACH) program and earlier surveys for 20 years.1,2 In parallel we have worked to develop data standards with ...

Helena C Britt · Graeme C Miller

With the growing prevalence of obesity (including morbid obesity) in Australia, especially in those living in areas of lower socioeconomic status, improving access should be a priority health commitment.

Alessandra Doolan · Anne Trimmer

To the Editor: Data from the tertiary paediatric hospitals in Brisbane (Royal Children’s and Mater Children’s Hospitals) support Claessen and colleagues’ letter.1 A total of 1091 children aged < 18 years were initially admitted from 1 January 2001 to 31 December 2011 with a new diagnosis of type 1 diabetes (T1D) (Box). Diabetic ketoacidosis (DKA) was defined as venous pH < 7.3 or serum bicarbonate level < 15 mmol/L in association with hyperglycaemia and ketoacidosis. Severity was defined ...

Carol M Willis · Jennifer A Batch · Mark Harris

First-line monoclonal antibody therapy to prevent bone loss in bone-metastatic breast and prostate cancers is delivered subcutaneously, often by general practitioners who need to be aware that this treatment in patients with low vitamin D levels, impaired renal function and poor calcium absorption (all often seen in older patients) can lead to serious hypocalcaemia.

Jennifer M McLachlan · Gavin M Marx · Margaret Bridgman

To the Editor: Guidelines for the management of absolute cardiovascular disease risk, published recently by the National Vascular Disease Prevention Alliance, contain the following evidence-based recommendations (EBRs) for choice of blood pressure-lowering therapy: EBR 11: Treatment should begin with any one of the following agents: · ACE [angiotensin-converting enzyme] inhibitor · Angiotensin receptor blocker · Calcium channel blocker · Low dose thiazide or thiazide-like diuretic. EBR 12: If monotherapy does not ...

Timothy Usherwood

In reply: On behalf of the National Vascular Disease Prevention Alliance, I thank Usherwood for raising concerns about the evidence-based recommendations (EBRs) within the Guidelines for the management of absolute cardiovascular disease risk.1 These guidelines inform a comprehensive, absolute risk approach to prevention of cardiovascular disease, and were approved by the National Health and Medical Research Council in 2012. Usherwood’s concerns are specific to treatment recommendations ...

Robert D Grenfell

The use of glucagon-like peptide-1 receptor agonists combined with basal insulins is emerging as an option for treating patients with type 2 diabetes mellitus. However, cost, gastrointestinal side effects and long-term safety should be taken into account.

Neale D Cohen MB BS, FRACP · Ralph Audehm MB BS, DipRACOG · Elaine Pretorius MB ChB, FCP(SA), FRACP · Joey Kaye MB BS, FRACP, PhD · Leon H Chapman MB BS, FRACP · Stephen Colagiuri MB BS, FRACP

Five years on from the establishment of the National Health and Hospitals Reform Commission, it is timely to review the context for reform, actions taken to date, and to highlight remaining areas of concern.

Christine C Bennett MB BS, MPaed, FRACP

Does the appeal process against TGA decisions appropriately serve the Australian public interest?

Nick A Buckley MD, FRACP · Thomas A Faunce BA/LLB(Hons), BMed, PhD

A study examining the impact of the Medicare items introduced in Australia to increase support for the management of chronic illness shows some significant improvements in outcomes for patients with diabetes.

Leelani K Wickramasinghe BSc, PhD · Peter Schattner MD, MMed, FRACGP · Marienne E Hibbert BAppSc, MAppSc, PhD · Joanne C Enticott BSc, PhD · Michael P Georgeff BSc, BE, PhD · Grant M Russell FRACGP, MFM, PhD

This study adds overweight and obesity to the list of chronic disease risk factors highly prevalent among incarcerated youth. Changes to the food environment and the approach to physical activity in custody are needed.

Leigh Haysom PhD, MMed(ClinEpi), MB BS · Devon Indig PhD, MPH, BSc · Elizabeth Moore PhD · Louise L Hardy PhD, MPH(Hons) · Paul A van den Dolder PhD, MSc MPhysio

A new tutorial support program delivered face-to-face and by distance is helping specialist international medical graduates in anaesthesia prepare for their College examinations.

Niall S Higgins GDipeH, PhD · Kersi Taraporewalla MB BS, MClinEd, FANZCA · Sisira Edirippulige GCertHigherEd, MSc, PhD · Robert S Ware PhD · Michael Steyn MB ChB, MSc, FANZCA · Marcus O Watson BSc(Hons), MSc, PhD

This study finds that interstate air transport of donor corneas is a significant risk factor for graft failure and that efforts to avoid domestic air transportation of corneal tissue may therefore be warranted.

Miriam C Keane BPsych(Hons), PhD · Marie T Lowe BSc · Douglas J Coster MB BS, DSc, FRANZCO · Graeme A Pollock PhD, MPH · Keryn A Williams PhD

West Papuan refugees living in Australia are experiencing ongoing living difficulties and distress, after exposure to human rights violations and separation from their homeland.

Susan Rees PhD · Derrick M Silove MD · Kuowei Tay MPsych · Moses Kareth BA

Australia’s first successful hand transplant broke with convention to give back independence and quality of life to an older recipient with several health problems who had lost all four of his extremities.

Karen M Dwyer MB BS, PhD, FRACP · Angela R Webb MB BS, MS, FRACS · Hayley S Furniss MCritCareNursing, PostGradCertPlastic · Katie E Anjou BAppSc, PostGradCertHand · Josephine M Gibbs-Dwyer BAppSc, MOccupTherHandFellowship · David B McCombe MB BS, MD, FRACS · Damien G Grinsell MB BS, FRACS · Gillian F Dickinson BAppSc · Richard A Williams MB BS, PhD, FRCPA · Prudence A Russell MB BS, FRCPA · David A Scott MB BS, PhD, FANZCA · Christopher Baker MB BS, FACD · Simon J Vogrin BAppSci · Robyn G Langham MBBS, PhD, FRACP · Helen I Opdam MBBS, FCICM, FRACP · Wayne A Morrison MD, BS, FRACS

With consumer demand for storage of cord blood increasing, regulatory bodies need to develop policies to enable research that may lead to novel uses of cord blood.

Michael X Han · Maria E Craig MB BS, PhD, FRACP

Application of property law and the development of hybrid banking models may help to resolve the ethical and legal tensions between public and private cord blood banking.

Cameron L Stewart BEc, LLB(Hons), PhD · Lorena C Aparicio MPE · Ian H Kerridge MPhil, FRACP, FRCPA

A doctor meets a former patient who can’t quite meet her eye.

Leeann Carr-Brown MB BS, FRACGP

John (known as Warwick) Newman was born on 2 February 1928 at Cullen Bullen near Lithgow in New South Wales, where his father was the mines manager. He attended Sydney Church of England Grammar School (Shore) and commenced medicine at the University of Sydney in 1948. In his second year of medicine, he developed severe type 1 diabetes and needed to take 2 years off from his course. During ...

James B Roche

Physician–scientists are at the crux of medical research, so what are the pathways available for those wanting to make a career combining both the lab and the clinic?

Annabel McGilvray

A 96-BED, $87.5 million private hospital to be built at Hervey Bay on Queensland’s Fraser Coast will be Australia’s “first fully integrated digital hospital”, says UnitingCare Health. Scheduled to open in August 2014, St Stephen’s Hospital will come with advanced wireless technologies allowing all medical records, x-ray and pathology results, nurse call systems, phone systems and patient medical devices, such as blood pressure machines and infusion pumps, to be integrated. Richard Royle, executive director of UnitingCare Health, said the technology would provide accessibility to “doctors and nurses anywhere in the hospital, whether at the bedside, or remotely on tablets, mobile phones, laptops or mobile computers on wheels”. “For the first time clinicians will have information at their fingertips which will enable faster and more efficient decision making”, he said. The result would be improved sharing of information and results with patients, and less time wasted “trying to find other staff or equipment”, said the hospital’s director of nursing, Jill O’Brien. “The digital capability of St Stephen’s and the corresponding change and innovation in work practices is an exciting challenge for our clinicians”, she said. The federal government’s Health and Hospitals Fund will provide $47 million towards the cost of construction.

Cate Swannell

Dr Bruce Campbell is an award-winning neurologist with a pioneering drive to improve outcomes for stroke patients

Cate Swannell

Med J Aust 2013; 199 (4 Suppl).