Volume 208 Issue 2

A prospective quality improvement register will reduce variations in outcomes and care following emergency laparotomy

Katherine J Broughton · Robert J Aitken

Suffering should not be hierarchical, and care should not be predicated on the prestige that a disease attracts

Louise Stone

Standard deviations (SDs) and standard errors are reported routinely in statistical analyses, but the distinction between them is not always well understood

Petra Macaskill

A 59-year-old woman presented with gas gangrene of the leg and no perception of light in her right eye

Ali S Haider · Harkiran Manku · Peter McCluskey

Psychiatric presentations in general practice: a guide to holistic management

Grant A Blashki

Helping patients help themselves works: but questions remain about what works and for whom

Nicholas A Zwar · Sarah M Dennis

We remain uncertain about which infants will benefit from surgical treatment

Jonathan Walsh · David E Tunkel

Some patients may derive greater benefit from such a program than from health education and positive attention

Richard L Reed · Leigh Roeger · Sara Howard · Jodie M Oliver-Baxter · Malcolm W Battersby · Malcolm Bond · Richard H Osborne

Further action to reduce salt consumption in Australia and robust monitoring of population salt intake are needed

Mary-Anne Land · Bruce C Neal · Claire Johnson · Caryl A Nowson · Claire Margerison · Kristina S Petersen

Idiopathic pulmonary fibrosis (IPF) is a fibrosing interstitial lung disease associated with debilitating symptoms of dyspnoea and cough

Helen E Jo* · Jyotika D Prasad* · Lauren K Troy · Annabelle Mahar · Jane Bleasel · Samantha J Ellis · Daniel C Chambers · Anne E Holland · Fiona R Lake · Gregory Keir · Nicole S Goh · Margaret Wilsher · Sally de Boer · Yuben Moodley · Christopher Grainge · Helen M Whitford · Sally A Chapman · Paul N Reynolds · David Beatson** · Leonie J Jones · Peter Hopkins · Heather M Allan · Ian Glaspole*** · Tamera J Corte***

The rates of surgical intervention are rising, but the evidence for benefit is limited

Vishal Kapoor · Pamela S Douglas · Peter S Hill · Laurence J Walsh · Marc Tennant

Management of abnormal uterine bleeding should be patient-focused

Annabelle Brennan · Martha Hickey

To the Editor:The recent tragic suicides of young doctors have highlighted concerns regarding the welfare of trainees in our profession. The Trainee Committee of the College of Intensive Care Medicine of Australian and New Zealand (CICM) met in Melbourne in March 2017, and the recent results of the survey1 into bullying and harassment, in addition to the deaths of several junior medical officers to suicide, provided for a solemn meeting. The committee wants to highlight the factors that adversely affect intensive care medicine trainees: bullying, discrimination and sexual harassment;1 staffing and intensity as, while patients’ needs are more complex, staffing has not increased with this intensity of practice; rapid response teams, which are often under-resourced, poorly trained and undersupported; and poor workforce planning and tenuous future job security, compelling junior doctors to pursue increased non-clinical commitments without an allocated time to do so. A consequence of these factors is burnout, which disproportionately affects intensivists and is an increasingly significant risk in trainees.2 Changes in work practices, severity of illness, increased demand for limited resources and increasing intensive care unit size — problems that have recently been addressed by Corke3 — have all played a part in burnout rates. The Trainee Committee welcomes the approach of the CICM to tackle these issues.4 The college is steadfast in its zero tolerance to bullying, discrimination and harassment, and remains committed to fair and equitable access to training. The college also values the need for a reasonable balance between provision of clinical services and time for professional development, and recognises the importance of work–life balance, including part-time training and the provision of parental and other forms of leave. However, the CICM has limited ability to enforce these needs at hospital level. Finally, the CICM embraces rapid response teams, recognising the importance of an appropriately supported service, but hospitals need to respond to this need, and lack of planning and matching training with lifetime workforce demands have to be a priority for the government at all levels. Our specialty will change significantly in the next decade or so. We chose intensive care because we enjoy the work we do and find the challenge it provides rewarding. We must ensure that the next generation of intensivists can meet this challenge too.

Alun T Ellis · Sandra Lussier · Sarah A Yong

To the Editor: I found the article by Kiely and colleagues1 very interesting. The authors concluded that “it should be noted that a relatively small number of imported ZIKV [Zika virus] infections have been reported in Australia, there have been no reported cases of local ZIKV transmission, and the geographical distribution of the potential ZIKV mosquito vector in Australia (Aedes aegypti) is limited to northern Queensland,” and that “at present, ZIKV represents a low risk to blood safety in Australia.”1 Indeed, Kiely and colleagues may be correct in their statement. Nevertheless, without supportive evidence, it seems too soon to draw a conclusion. The estimation of the risk or possibility of transfusion-transmitted ZIKV infection in each setting may be based on mathematical modelling with reference to risk of transmission of other arboviruses in that setting. A good example is the previous report on the estimated risk of transfusion-transmitted ZIKV infection in Thailand.2 However, the lack of reports on ZIKV transmission does not mean that the problem does not exist; many patients with ZIKV infection are asymptomatic and can be easily missed.3

Viroj Wiwanitkit

In reply

Philip Kiely · Erica M Wood · Allen C Cheng

To the Editor: Retinal screening is crucial to the prevention of vision loss from diabetic retinopathy. The recent National Eye Health Survey highlighted a gap in screening rates between Indigenous Australians (aged ≥ 40 years) and non-Indigenous Australians (aged ≥ 50 years),1 providing a foundation on which to target future eye health services. While acknowledging the budgetary and logistical constraints of such a large-scale study, we are concerned that another at-risk group — younger adults with type 2 diabetes who are aged 18–49 years — was not included in the National Eye Health Survey. The past two decades have seen a global increase in the incidence of type 2 diabetes in youth and young adults, with younger age being an independent risk factor for the development of diabetic retinopathy.2 In Australia, about 130 000 people with type 2 diabetes who are aged < 50 years are registered on the National Diabetes Services Scheme.3 However, there are no population-level data available regarding retinal screening rates in this age group. A decade ago, a survey of young Australian adults with type 2 diabetes (aged 16–35 years) reported a 55% retinal screening rate.4 Given the small, self-selected sample, this is likely an overestimate and compares unfavourably with the non-Indigenous rate of 78% reported for adults aged ≥ 50 years in the National Eye Health Survey.1Moreover, our qualitative research has shown that young adults aged 18–39 years who have type 2 diabetes face different psychosocial challenges and barriers to retinal screening compared with their older counterparts aged ≥ 40 years.5 Younger adults with type 2 diabetes require targeted, tailored intervention, which can only be provided if accurate, population-level data are available for this group. As Foreman and colleagues1 acknowledge, diabetic retinopathy is the leading cause of vision loss in working age adults — a situation with potential for considerable social and economic burden. The absence of current eye examination data for younger Australians with type 2 diabetes increases the risk that their needs will be neglected in future evidence-based policy and program delivery initiatives. We urge the Australian Government and other stakeholders to extend future population-level surveys (and other research and policy initiatives) to include all adults with diabetes.

Amelia J Lake · Jessica L Browne · Jane Speight

In reply

Joshua Foreman · Stuart Keel · Mohamed Dirani

Grant Blashki has a simple philosophy – learn from the best …

Cate Swannell

This calendar will be updated each month. If you have an event you would like to add, please include relevant details in an email to cswannell@mja.com.au

Cate Swannell