Volume 200 Issue 2

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

Off-label prescribing (to patient groups or for indications not listed in a medicine's product information) is okay if supported by evidence

J Paul Seale MB BS, PhD, FRACP

Consider the evidence before prescribing medications off-label and use non-pharmacological treatments where possible

Ian B Hickie MD

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

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

Appropriate guidance is lacking in long-term nutritional monitoring and support

John B Dixon MB BS, PhD, FRACGP

Most people don't know alcohol is a Group 1 carcinogen. Is it time to update the public health message?

Jaklin A Eliott PhD, BA(Hons) · Emma R Miller PhD, MPH

Pyrrolizidine alkaloids in food could be a cause of chronic disease

John A Edgar BSc(Hons), PhD

Is the researcher held to a higher standard than the clinician?

Ian A Harris MB BS, MMed(ClinEpi), PhD · Justine M Naylor BAppSc(Phty), PhD

Current guidelines disregard sugar content when assessing foods for inclusion in school canteens

Kieron B Rooney

Despite the prevalence of obesity, restrictive diets should not be encouraged at a general population level

Anita M Star · Phillipa J Hay

To the Editor: Hypoglycaemia is a common problem in inpatients with diabetes and is associated with morbidity and mortality.,2 We conducted a retrospective single-centre cohort study to evaluate the management (notifying a doctor and taking appropriate preventive actions, defined as altering the hypoglycaemic agent that led to the event or commencing dextrose in appropriate cases by the doctor) of the first hypoglycaemic episode and its ...

Dilantha T De Alwis · Suresh Varadarajan · Kwang Lim

To the Editor: After-hours communication of tasks between nursing staff and junior medical officers (JMOs) traditionally uses paper lists, whiteboards, face-to-face requests and frequent paging, regardless of task urgency.1,2 This fragments workflow, which increases cognitive demand and the risk of errors.3-5 Computer-based task allocation systems, still in their infancy, have not been objectively evaluated. The aim of our study was to determine whether using a ...

Nicholas J Whitehead · O’Neil N Maharaj · Michael Agrez

To the Editor: The recently updated warfarin reversal guideline recommends prothrombin complex concentrate (PCC) dosing based on international normalised ratios (INRs), rather than fixed dosing.1 While achieving a target INR may be made more likely, this may be inconsequential clinically.2 The reasons are these. The relationship between vitamin K-dependent clotting factor levels and INR or bleeding is uncertain. As INR increases above 5.0, these levels decline ...

Krishna G Badami

In reply: Badami suggests that international normalised ratio (INR)-based prothrombin complex concentrate (PCC) dosing for warfarin reversal may not be clinically useful and is cumbersome to use. We agree that the INR variably reflects factor II, VII, IX and X activity in patients on warfarin therapy. However, the INR is a rapid, valid and readily available test, and an INR-based PCC dosing regimen provides guidance ...

Huyen A Tran · Sanjeev D Chunilal · Huy Tran

To the Editor: Pharmacometrics is an emerging field in Australia, with use in a wide range of therapeutic areas including cardiovascular disease, critical patient care, diabetes and paediatrics.1-4 The results of pharmacometric analyses are often referred to in Therapeutic Goods Administration-approved product information; however, for many clinicians, pharmacometrics remains a mysterious area of research. Therefore, we seek to promote the discipline of pharmacometrics in clinical ...

Vidya Perera · Michael J Dolton · Andrew J McLachlan · Vaughan J Carr · Richard O Day

To the Editor: It is common for unwanted and expired medicines to be disposed of through general waste or, as raised recently by Fisher and colleagues, into the sewage system.1 These practices adversely affect not only the environment, but also social and economic determinants of health. For example, medicines discarded in household bins may be accessible to unintended recipients including children, increasing the risk of ...

Phillip J Bergen · Simon E Appel

Enforcing vaccination or mask-wearing leads to increased vaccination rates among heath care workers

Rhonda L Stuart · Elizabeth E Gillespie · Peter G Kerr

To the Editor: Lee and colleagues assessed the hospital caesarean section (CS) rates among hospitals in New South Wales according to the Robson 10-group classification. They identified the 20th centile CS rate for each group.1 These data could be used in Australian maternity services to reduce CS rates and potentially increase the quality of care. Monitoring the quality of care in maternity services has been difficult ...

Rick J Fielke

In reply: We thank Fielke for his interest in our article.1 Our study used the 20th centile method of the Australasian clinical indicator report on obstetrics, conducted by the Australian Council on Healthcare Standards (ACHS).2 The ACHS defines the 20th centile as a “best practice rate” that is potentially achievable and uses it to identify and prioritise clinical areas in which research and quality improvement ...

Yuen Yi (Cathy) Lee · Christine L Roberts · Jillian A Patterson

Nearly a third of children presenting with burns receive inadequate, inappropriate or no first aid

Ela J Hyland · John G Harvey · Andrew J A Holland

To the Editor: O’Brien and colleagues report high rates of recurrence of Mycobacterium ulcerans disease after surgery without adjuvant antibiotics.1 In the other major Australian endemic focus for M. ulcerans, the Daintree region of far north Queensland (where it is known as Daintree ulcer), nearly all of 92 confirmed cases between 1964 and 2008 were treated with surgery alone, with 10 recurrences.2 In 2011, there was an outbreak of 65 confirmed cases. ...

Christina M Steffen

In reply: We thank Steffen for reporting her and her colleagues’ experience with surgical management of Mycobacterium ulcerans disease in the Daintree region of far north Queensland. We note she reports lower recurrence rates after surgical treatment alone than in our study from Victoria’s Bellarine Peninsula (8%–11% v 32%).1,2 As older age may increase recurrence risk, this difference in rates may be influenced by the higher ...

Daniel P O’Brien · Anthony McDonald · Peter Callan

To the Editor: I agree with Baum on the objective evidence of the good health of Australians and that there still is room for improvement in our primary health care system, but I think it is simplistic of her to characterise “fee-for-service general practice” as providing “episodic care”.1 The Royal Australian College of General Practitioners description of “person centred, continuing, comprehensive and coordinated wholeperson health ...

Mark R Nelson

In reply: Australian general practice generally provides good primary medical care. However, while Nelson says a significant amount of activity is disease prevention, the Bettering the Evaluation and Care of Health study indicates that, in terms of problems at general practitioner–patient encounters, prevention constitutes less than 9.1% of activity and, in terms of reasons for encounters, it constitutes less than 15.9%.1 The general practice model works ...

Fran E Baum

To the Editor: Zimmet draws attention to the looming catastrophe of diabetes.1 However, there is a concomitant health catastrophe — climate change, “the biggest global health threat of the 21st century”.2 We believe that it is not useful to argue whether diabetes or climate change is a greater threat to health. Rather, diabetes and climate change are predictable manifestations of contemporary human ecosystems: The conjoined processes of ...

Rosalie Schultz · Peter Tait

NHMRC funding is disproportionally low compared with the burden of musculoskeletal conditions

Allison M Bourne BSc(Hons), BA, PhD · Samuel L Whittle MB BS(Hons), MClinEpi, FRACP · Bethan L Richards MB BS(Hons), MClinEpi, MSportsMed · Chris G Maher BAppSc(Phty), PhD · Rachelle Buchbinder MB BS(Hons), MSc, PhD

Is this initiative having an impact on reducing premature death and disability caused by poor diet?

Tamara Elliott MB BS, BSc · Helen Trevena MHumNutr, MBA · Gary Sacks PhD · Elizabeth Dunford PhD, MPH, RNutr · Jane Martin BA, MPH · Jacqui Webster PhD, RPHNutri · Boyd Swinburn MB ChB, MD, FRACP · A Rob Moodie MPH, DTMH, MB BS · Bruce C Neal MB ChB, PhD, FRCP

There’s been a marked increase in the proportion of male medical students since interviews were ended.

David Wilkinson BSc(Hons), MB ChB, PhD · Mavourneen G Casey BA(Hons), MEd, PhD · Diann S Eley BSc, MSc, PhD

Most junior doctors’ informal and formal education doesn’t add up to much — are we investing enough in them?

R Kim Oates MD, DSc, FRACP · Kerry J Goulston MD, FRACP · Craig M Bingham BA, DipEd, MA · Owen F Dent PhD

Does completing a year in the bush encourage graduates to join the rural medical workforce?

Denese E Playford PhD · Sharon F Evans PhD, AStat · David N Atkinson MB BS, MPH · Kirsten A Auret MB BS, FRACP · Geoffrey J Riley AM, FRANZCP, FRACGP

Objectives: To provide the first national profile of the characteristics of young people (aged 12–25 years) accessing headspace centre services — the Australian Government’s innovation in youth mental health service delivery — and investigate whether headspace is providing early service access for adolescents and young adults with emerging mental health problems.Design and participants: Census of all young people accessing a headspace centre across the ...

Debra J Rickwood BA(Hons), PhD, FAPS · Nic R Telford BSS, MSS · Alexandra G Parker BA(Hons), MClinPsych, PhD · Chris J Tanti BA, BSW, AMP · Patrick D McGorry MD, PhD, FRANZCP

A 35% drop in invasive pneumococcal disease has been found in older people after 6-7 years of vaccine use

Robert I Menzies BAppSc, MPH, PhD · Sanjay H Jayasinghe MB BS, MSc · Vicki L Krause MD, DTM · Clayton K Chiu MB BS, MPH · Peter B McIntyre MB BS, PhD, FRACP

Repatriated patients from high-risk countries may place a significant burden on Australian hospitals

Kyra Y L Chua FRACP · M Lindsay Grayson FRACP, MD · Adele N Burgess FRACS · Jean Y H Lee MB BS · Benjamin P Howden FRACP, FRCPA

Doctors may be liable for failing to diagnose atypical presentations of melanoma

Melody R Abikhair MB BS(Hons) · Patrick D Mahar MB BS(Hons), LLB(Hons), MBA · Adrian R Cachia FRCPA, LLB(Hons), FACLM · John W Kelly MB BS, MD, FACD

Top-down and bottom-up approaches are both needed to improve diabetes outcomes worldwide

Alicia J Jenkins MB BS, MD, FRACP

there is something comforting about sitting here with my hand on Robert’s breast he says, here, steady yourself against me here, he says, after a pause, he is thinking how best to fit me, he says it must have been bad but you’re here, you’re with us the surroundings burst with surgical fittings it all looks very Weimar, very neue Sach i expect fishnets, a crossed leg, a trail of ...

Lucy Dougan PhD

CorrectionError in author name: In “Detecting undiagnosed diabetes using glycated haemoglobin: an automated screening test in hospitalised patients” in the 21 February 2011 issue of the Journal (Med J Aust 2011; 194: 160-164), an author’s name was incorrectly spelled. The correct spelling of the fourth author’s name is Parind P Vora.

Nyoli A Valentine MB BS · Tariq M Alhawassi BScPharm, MClinPharm · Greg W Roberts BPharm, FSHP, BCPS · Parind P Vora MB BS, MPH · Stephen N Stranks MB BS, FRACP · Matthew P Doogue MB ChB, FRACP

The burden of bureaucracy in medical practice has long been a problem and technology is not yet making it any easier

Annabel McGilvray

Neurosurgeons see tough things, including young people killed and maimed by one punch. If you’re choosing it as a specialty, be prepared to do the hard yards, says Professor Andrew Kaye — one of the world’s best

Cate Swannell