Volume 203 Issue 8

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Cate Swannell

CSIRO survey data indicate that one in seven adult Australian respondents not diagnosed with coeliac disease avoid wheat or dairy foods

Sinead Golley · Philip Mohr · David Topping

A personal checklist for the time-poor clinician

Jeanette Ward MB BS, MHPEd, PhD

There remains an overriding belief in Australian correctional systems that PNSPs are incompatible with security; a contention not borne out by international experience

Mark Stoové BAAppSci(Hons), GradDip(Ed), PhD · Carla J Treloar PhD · Lisa Maher PhD · Helen Tyrrell BA, MBA, FCHSM · Jack Wallace MSc(IntDev)

“without the signal that the HKC gives to parents … children will continue to miss out on preventive health activities”

Karyn E Alexander MB ChB, FRACGP, MPH · Danielle Mazza MD, FRACGP, DRANZCOG

This case highlights the severe and often irreversible nerve damage arising from toilet bowl palsy

Gregory J Wilson MB BS · George T John MD, DM, FRCP, FRACP

Gaining ethics approval at one ethics committee involves effort, but in multicentre research projects, the effort is multiplied with non-concordant approval requirements

Merin V Pariyadan BPharm(Hons) · Elizabeth D Hotham PhD, MAppSc(Pharm), BPharm · Sean Turner MSc, BPharm · Sanjay Garg PhD, MPharm, MMgt

The 2014 New South Wales Population Health Survey provides insights into e-cigarette use in the state

Timothy C Harrold BCom/BSci, MBiostat · Audrey K Maag BSocSci, MIntSec MPH · Sarah Thackway BSocSci, MPH · Jo Mitchell PostGradDipNutrDiet, MPH, DrPH · Lee K Taylor MB BS, MPH, FAFPHM

The optimal management of paraquat poisoning, as with most pesticide poisonings, remains unclear

Elise Davey MB BS(Hons) · Justin Davis MB BS, BBiomedSci · Deborah Friedman MB BS, FRACP, MD, MPH

A new set of indicators to improve mental health care and help prevent suicide

Sebastian P Rosenberg MPubAdmin · Ian B Hickie MD · Patrick D McGorry PhD, MD, FRANZCP · Luis Salvador-Carulla MD, PhD · Jane Burns BA(Hons), PhD · Helen Christensen MPsych(Hons), PhD, FASSA · John Mendoza BEd, GradDipHealthEd · Alan Rosen MB BS, FRANZCP · Lesley M Russell BSc(Hons), BA, PhD · Sally Sinclair BSc(Hons)

The federal government has announced formation of a Medicare Benefits Schedule (MBS) Review Taskforce, described as the most comprehensive review of the MBS in its near 50-year history. The Relative Value Study (RVS) was the last major collaborative attempt between the government and the medical profession to restructure the MBS. The RVS was a review of services and fees of the MBS conducted between 1994 and 2001 that was never implemented. This article provides a historical narrative of the RVS and discusses the failure of its implementation in terms of health policy theory. Understanding the specific difficulties of the RVS methodology, and the broader challenges of health care reform, may allow for more successful implementation of the current Medicare review.

Michael Wright MB BS, MSc, FRACGP

Did South Australian clinicians meet legal requirements regarding documentation of the grounds for involuntary mental health admission?

John Brayley BM BS, MHSM, FRANZCP · Andrew Alston BJuris, LLB, LLM · Kynan Rogers LLB(Hon)

Attitudes to what men should be told before undergoing a PSA test were examined

Chris Degeling PhD, BVSc · Lucie Rychetnik PhD, MPH · Kristen Pickles MPH · Rae Thomas PhD · Jennifer A Doust BM BS, PhD, FRACGP · Robert A Gardiner MD, FRCS, FRACS · Paul Glasziou BM BS, PhD, FRACGP · Ainsley J Newson PhD, LLB(Hons), BSc(Hons) · Stacy M Carter PhD, MPH(Hons)

Cardiac troponin is a useful biomarker for acute coronary syndromes, but caution in primary care contexts is needed

Helen M Wilcox MB BS (Hons), FRACGP, DCH · Alistair W Vickery MB BS, FRACGP · Jon D Emery MB BCh, FRACGP, DPhil

Always obtain a complete travel and exposure history when assessing febrile travellers, and not just their most recent travel

Andrew Burke MB BS, DTMH, FRACP · Stephen R Graves BSc(Hons), MB BS, PhD · Nicholas M Anstey PhD, DTMH, FRACP

An unsuspected neck injury sustained during an amusement ride

Monica S Badve MB BS, FRACP · Sandeep Bhuta MB BS, FRANZCR

The work as a doctor on the RFDS base in Port Hedland is often strenuous but extremely varied

Catarina Widing MD

Nanette Stacy Waddy worked to provide much-needed psychiatric services to the community even into her late 80s

Ian W Webster AO, MD, FRACP, FAChAM · Alex D Wodak FRACP, FAChAM, FAFPHM · Russell Carvolth OAM, BA(Hons)

If, under sterile conditions, using local anaesthesia …

David Francis MD, FRACS

Incorrect information in tables: In “State-based legal requirements for Schedule 8 prescriptions: why so complicated?” in the 20 July 2015 issue of the Journal (Med J Aust 2015; 203: 64-66), there were inaccuracies in the information provided in the tables in Box 1 and Box 2. The corrected tables and revised reference list, reviewed and approved by the relevant regulatory authority in each jurisdiction, are available in full at https://www.mja.com.au/doi/10.5694/mja14.01587.

Incorrect information in figure: In “New guidelines for the management of paracetamol poisoning in Australia and New Zealand” in the 7 September 2015 issue of the Journal (Med J Aust 2015; 203: 215-218), there was an error in the figure in Box 3. The corrected figure is available at https://mja.com.au/doi/10.5694/mja15.00614.

Dr Aleeta Fejo survived a long and arduous journey to qualify as a general practitioner. She has curated a book telling stories of Indigenous medical registrars and their common experiences of racism, bullying and an endless series of hurdles

Cate Swannell

Professor Colin Raston, from Flinders University, has the singular honour of winning an Ig Nobel prize, and international acclaim in less than a year, and with the same device. Professor Raston and his team of researchers developed the thermos-sized Vortex Fluidic Device (VFD) with which they successfully unboiled an egg, winning them the Iggie. Now they have successfully synthesised lidocaine with the VFD, a process which Professor Raston says “signals a paradigm shift in pharmaceutical manufacture”, allowing production of lidocaine in high need areas, such as war zones and developing countries. “The VFD uniquely controls how drug molecules can be made, and this is under continuous flow, such that research in making drug molecules can be readily translated into industry, avoiding conventional scale up problems and large reaction vessels — just leave the VFD running to make as much as you need,” he said. “This device creates a unique way to develop more sustainable and cost-effective products, services and technologies which can accelerate innovation in a range of industries, from drug manufacturing to food and biodiesel production,” he said. According to Professor Raston, it is the VFD’s ability to “streamline the loading of drugs into nano-packages for better results and less waste”, that leaves traditional batch processing techniques in its wake.

Cate Swannell

The cream of Australian researchers have been honoured at the annual National Health and Medical Research Council Research Excellence Awards in Canberra, presented by the Federal Minister of Health, Sussan Ley. The Marshall and Warren Award, given to the applicant with the most highly innovative and potentially transformative project grant application, went to Professor Peter Thompson and his University of Western Australia team, to follow up on the promising results of a clinical trial to confirm whether a low cost drug can reduce incidents that may damage the heart muscle in patients with stable coronary heart disease. This follow-up study will involve around 5 000 participants, up from around 500 in the earlier trial. The Rising Star Research Excellence Award, given to the top-ranked application by an Indigenous researcher in the Early Career Fellowship scheme, went to Mrs Catherine Chamberlain, from the University of Melbourne, for her research into the cardio-metabolic health of Indigenous Australian women during pregnancy and after birth. Mrs Chamberlain will investigate and pilot strategies to achieve this aim, with the strategies based on the best available evidence about women with gestational diabetes, epidemiological data and data on social determinants. Dr Si Ming Man, from the University of New South Wales, was awarded the Frank Fenner Early Career Fellowship for his research into the role of interferons, and the proteins that regulate their production, in immune responses against the foodborne bacteria Salmonella and Listeria. This research aims to uncover new treatments and ways to prevent these bacterial infections. The Gustav Nossal Clinical Scholarship went to Dr Jonathan Brett from the University of Sydney, who will seek to reduce waste in the health system, focusing on situations where the prescribing of medications results in little benefit for the associated cost. He will look specifically at inappropriate antipsychotic use in residential aged care facilities and within the general community. Three Elizabeth Blackburn Fellowships were awarded. Professor Glenda Halliday, from the University of New South Wales, won the clinical fellowship for her research into the biological mechanisms behind non-Alzheimer dementias and degenerative motor syndromes. Professor Anushka Patel, from the University of Sydney, won the public health fellowship for testing two approaches to healthcare delivery – the first delegating specific roles to persons other than the treating physician; the second involving better delivery of essential medicines. The biomedical fellowship went to Associate Professor Anne Voss from the Walter and Eliza Hall Institute of Medical Research for her work on gene expression. Other Research Excellence Awards went to: Highest ranked Project Grant to Associate Professor Ian Seppelt (University of Sydney); Highest ranked Program Grant to Professor Alan Cowman (lead investigator), Professor Brendan Crabb, Professor Ivo Mueller, Professor James Beeson, Professor Stephen Rogerson (The Walter and Eliza Hall Institute of Medical Research); Highest ranked Research Fellowship to Professor Mark Smyth (QIMR Berghofer Medical Research Institute); Highest ranked Practitioner Fellowship to Professor Ben Mol (University of Adelaide); Highest ranked Career Development Fellowship – Clinical, Level 1 to Associate Professor Mario Alvarez-Jimenez (University of Melbourne); Highest ranked Career Development Fellowship – Population Health, Level 1 to Dr Philip Batterham (Australian National University); Highest ranked Career Development Fellowship – Population Health, Level 2 to Associate Professor Karen Canfell (University of New South Wales); Highest ranked Career Development Fellowship – Industry, Level 2 to Dr Tony Velkov (Monash University); Highest ranked Career Development Fellowship – Biomedical, Level 1 to Dr Kate Hoy (Monash University); Highest ranked Career Development Fellowship – Biomedical, Level 2 to Associate Professor Kevin Pfleger (University of Western Australia); Highest ranked Development Grant to Professor Mark Smyth (QIMR Berghofer Medical Research Institute). In addition, three NHMRC Biennial Awards were announced. The Ethics Award went to Associate Professor Ian Kerridge, from the University of Sydney, who has spent his career dissecting ethical issues in health practice and policy, and promoting high ethical standards in health care and research. He was a member of the Legislation Review Committee that examined human cloning and the use of human embryos, and most recently, was a member of the Australian Health Ethics Committee and the Assisted Reproductive Technology Review Committee. The Science to Art Award went to Dr Victor Anggono (University of Queensland), a group leader at the Queensland Brain Institute and a member of the Clem Jones Centre for Ageing Dementia Research. His winning entry shows neurons extending their axons to establish synaptic connection and form neural circuits, the activity of which is essential for brain function such as learning and memory. Professor Melissa Little, from the Murdoch Childrens Research Institute, won the Outstanding Contribution Award. Over the last two decades, Professor Little has made extensive contributions to NHMRC and the broader medical research sector in Australia. She was a committee member on the two most recent federal reviews of health and medical research and also a member of NHMRC’s Research Committee from 2009 to 2015. https://www.nhmrc.gov.au/research-highlights/highlights/2015 Two medical educators from Flinders University have been recognised in the Australian Awards for University Training. Dr Sarah Mahoney (pictured) and Jacky Lowe are receiving joint citations for their academic and administrative leadership of Flinders’ Onkaparinga Clinical Education Program (OCEP). Dr Mahoney and Ms Lowe’s work at OCEP has led to “the development and ongoing success of a unique, immersive, longitudinal program of urban community-based medical education”. Dr Mahoney is a general medical practitioner with extensive clinical experience who began university teaching at Flinders University in late 2009, while Ms Lowe is an administrator with a long and successful track record in education, training and project management. Between them, they have overseen the growth of the OCEP from a small pilot in 2009 to a “robust, comprehensive, complex and unique community-based program that also incorporates social accountability”. http://blogs.flinders.edu.au/flinders-news/2015/09/23/top-of-the-class-flinders-educators-take-prestigious-olt-citations/ Flinders University’s Dean of Medicine Professor Paul Worley has been appointed as a Fellow of the Australian Academy of Health and Medical Sciences. Prof Worley’s work has focused the science of rural community based medical education, and its impact on addressing the maldistribution of doctors for rural and underserved areas. He is a past President of the Rural Doctors Association of SA, a previous national Vice President of Australian College of Rural and Remote Medicine, and a current Council Member of the AMA (SA). Also receiving their Fellowships were ophthalmology expert Professor Justine Smith, palliative care expert Professor David Currow, and Australia’s Chief Medical Officer and Flinders professorial fellow, Professor Chris Baggoley, AM.

Cate Swannell