Volume 199 Issue 9

Clinical guidelines can be easily updated with new evidence, continuously reviewed and widely disseminated if they are presented online on a MediaWiki platform which provides a collaborative website, similar to Wikipedia.

Ian N Olver MD, PhD, FRACP · Jutta J Von Dincklage BA, MA

Trends over the past three decades show that Australia has done vastly better in preventing cancer death than in primary prevention.

Bruce K Armstrong DPhil, FAFPHM, FAA

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 light of recent cuts to public health expenditure, we need effective evidence-based government health policy and legislative reform. This can only be achieved with input from non-government actors.

Claire E Brolan MA, LLB(Hons), BA · Jo Durham PhD

The PNG cholera crisis highlights the need for more investment in infrastructure, particularly in the area of water, sanitation and hygiene, and more locally appropriate and responsive health systems in PNG.

John J Hall MB BS, MTH, FAFPHM · James A Gillespie BA(Hons), PhD · Alexander Rosewell BSc, MIPH, MAE · Pilly Mapira MB BS, MSc

Several projects already underway may lead to national standards in competencies for medical students, but more work remains to be done before any model of nationwide, collaborative assessment is acceptable to most medical schools.

David Wilkinson MB ChB, DSc · Benedict J Canny BMedSc(Hons), MB BS, PhD · Jacob V Pearce BA(Hons), BSc · Hamish B Coates BA(Hons), PhD · Daniel J Edwards BA(Hons), PhD

Recent articles in the MJA reflect the continuing polarisation of the debate on prostate-specific antigen-based screening and the extent to which major clinical trials reveal whether lives are saved by intervention and/or watchful waiting.

George G Miklos

To the Editor: We are concerned by conclusions drawn by Del Mar and colleagues,1 in stating that because some autopsy studies have claimed more than 50% prevalence of latent prostate cancer in men aged over 60 years, this could be considered normal, and that these latent cancers result in a high level of overdiagnosis of prostate cancer. The study cited was conducted at Wayne State University, ...

Paul R McKenzie · Brett Delahunt · James G Kench

To the Editor: Recent articles in the Journal evaluating the evidence on screening for early-stage prostate cancer1,2 failed to mention one of the most important pieces of evidence ever published on the treatment of prostate cancer.3 This randomised controlled trial (RCT) showed that, compared with observation, radical prostatectomy did not significantly reduce all-cause or prostate cancer mortality over at least 12 years among men with clinically ...

Ian E Haines

To the Editor: We read with interest Del Mar and colleagues’ “re-examination” of the evidence for prostate cancer screening.1 Rather than presenting a balanced view, they have pursued a lopsided and flawed review of the data. First, they have given equal weighting to the results of the screening trials from Europe (ERSPC [European Randomized Study of Screening for Prostate Cancer]) and North America (PLCO [Prostate, Lung, ...

Nathan Lawrentschuk · Declan G Murphy · Anthony J Costello

In reply: We wish to make some comments in response to Haines’s point that the PIVOT (Prostate Cancer Intervention Versus Observation Trial) failed to show any benefit from radical prostatectomy (RP) over surveillance. First, in the PIVOT, a benefit of RP in terms of reduced all-cause mortality was suggested in men with a prostate-specific antigen (PSA) level > 10 ng/mL and in men with intermediate- and high-risk prostate ...

Jonas Hugosson · Sigrid V Carlsson

In reply: We thank Lawrentschuk and colleagues for the critical response. We would like to respond to several wrong assertions: We did not give equal weighting to the results of the ERSPC (European Randomized Study of Screening for Prostate Cancer) and the PLCO (Prostate, Lung, Colorectal, and Ovarian Cancer Screening Trial). Standard meta-analysis practice is to weight studies by the inverse variances of their effect estimates.1 ...

Chris B Del Mar*

Prostatic-specific antigen screening for prostate cancer is not recommended, but how does this help reduce the death rate from prostate cancer?

Mark Faigen

Smoking cessation measures and tobacco control are cost-effective means of reducing deaths from lung cancer, and more progress is needed before national lung cancer screening can proceed.

Henry M Marshall · Kwun M Fong · Rayleen V Bowman

To the Editor: The United States National Lung Screening Trial demonstrated a 20% reduction in lung cancer deaths among smokers screened with three low-radiation-dose computed tomography scans at yearly intervals. Hew and colleagues recently outlined the challenges in implementing such a screening program in Australia.1 However, the potential for saving lives is enormous. Currently only 14.1% of lung cancer patients survive 5 years — a marginal improvement ...

Paul L R Mitchell · Thomas John

In reply: We welcome the opportunity to respond to correspondence from Marshall and colleagues and Mitchell and colleagues about the impact of the National Lung Screening Trial (NLST)1 on three distinct issues: (i) current medical practice; (ii) developing public health policy; and (iii) implementation of future screening. Current medical practice: We do not currently recommend community screening. In the absence of resourced, educated, and coordinated referral ...

Mark Hew · Robert G Stirling · Michael J Abramson

The design and implementation of PBL has continued to evolve, to the point that debate now centres on the details of the approach, rather than its justification. It is therefore timely to reflect on how and why PBL has come to occupy such a central place in Australian medical education, and (re)consider its impact and value.

Neville G Chiavaroli BAppSc(Phty), MPhil, MEd · Stephen C Trumble MB BS, MD, FRACGP · Geoffrey J McColl MB BS, MEd, PhD

Part 5 of our Cardiology series provides a practical review of the issues faced in managing patients with AF, including considerations in deciding between rate control and rhythm control approaches, the role of catheter ablation, and the use of warfarin and the new oral anticoagulant drugs.

John V Amerena MB BS, FRACP, FCSANZ · Tomos E Walters MB BS · Sam Mirzaee MD · Jonathan M Kalman MB BS, PhD, FRACP

Women attending streamlined StepDown clinics did not experience significantly different levels of psychological burden than women attending the standard assessment clinic. However, those who felt uneasy about returning to screening were less likely to do so, irrespective of their baseline likelihood of attending screening or assessment clinic type.

Kerry A Sherman PhD · Caleb J Winch BPsych(Hons) · Natacha Borecky MB BS, Doctor of Radiology (Belgium) · John Boyages MB BS(Hons), FRANZCR, PhD

A comparison of mortality rates in regional and remote areas with those in metropolitan areas from 2001 to 2010 found 8878 excess cancer deaths; no improvement in age-standardised mortality ratios (SMRs) in men, and an increase in SMRs in women; and a slower decrease in the age-standardised cancer death rate in regional and remote areas, compared with metropolitan areas.

Michael D Coory MB BS, PhD, FAFPHM · Tsun Ho BE(Hons), PhD · Susan J Jordan MB BS, PhD

Objectives: To examine whether incidence of colorectal malignancy is increased in Australasian liver transplant recipients compared with the general population of Australia, and to assess the characteristics and outcomes of colorectal malignancy in this patient group.Design, setting and patients: Data on patients who underwent orthotopic liver transplantation (OLTx) and had a diagnosis of de-novo colorectal malignancy after transplantation during the period ...

Deborah J Verran MB ChB, FRACS · Marie H Mulhearn BAppSc (Nursing), GradDipHPEd · Pamela J Dilworth RN · Glenda A Balderson BSc · Stephen Munn MB ChB, FRACs · John W Chen MB BS, FRACS, PhD · Michael A Fink MB BS, FRACS · Michael D Crawford MB BS, FRACS, MMed · Geoffrey W McCaughan MB BS, PhD, FRACP

Objective: To describe quadrivalent human papillomavirus (HPV) vaccination coverage achieved in the HPV vaccination catch-up program for girls aged 12–17 years.Design: Analysis of data from the Australian National HPV Vaccination Program Register.Participants: Girls aged 12–17 years as at 30 June 2007.Main outcome measures: HPV vaccine coverage by dose (1, 2 and 3), age and state of residence, using Australian Bureau of ...

Julia M L Brotherton BMed(Hons), MPH(Hons), FAFPHM · Sharron L Murray RN, RM, GradDipChildHealth · Madeline A Hall MPH · Lynne K Andrewartha BHSc(Nur) · Carolyn A Banks · Dennis Meijer BA, MHL · Helen C Pitcher · Megan M Scully BSc(Nsg), DPH, MHA · Luda Molchanoff BN

Is there a politically feasible way to meet the urgent need for reducing alcohol-related harm in Australia?

Christopher M Doran BEc(Hons), PhD · Joshua M Byrnes MHealthEcon, MEcon, PhD · Linda J Cobiac PhD · Brian Vandenberg BAppSc, BA(Hons), MPH · Theo Vos PhD

The case of a woman who developed severe rhabdomyolysis shortly after the addition of pregabalin to a stable atorvastatin regimen serves as a reminder to clinicians to be aware of possible adverse drug reactions.

Roshan Gunathilake MB BS, MD · Laura E Boyce BPharm · Anne T Knight MB BS(Hons), FRACP

A physician partners with a filmmaker to create an educational video for clinicians, and reflects on the possibilities and pitfalls of using social media for medical education.

Joseph E Ibrahim MB BS, PhD, FRACP · Prateek Bandopadhayay MB BS, LLB, LLM

A personal battle between objectivity and emotion complicates decisions about our own health care.

John Best AO, MD BS, PhD, DSc(Hon)

Doctor–patient collaboration is at the heart of moves to make health care more collaborative

Annabel McGilvray

The World Health Organization's International Agency for Research on Cancer (IARC) has reclassified outdoor air pollution as carcinogenic to humans after a review of the latest scientific literature.

Cate Swannell

Dr Alessandro Demaio is determined to bring his generation and those younger to the forefront of the fight against non-communicable diseases and global poverty

Cate Swannell