Letters

Does a formulaic approach based on traditional risk factors measure up?

Constantine N Aroney

Does a formulaic approach based on traditional risk factors measure up?

Mark R Nelson · Jennifer A Doust

Many doctors do not appreciate the significance of the Code

Ian R Gough

Study highlights a need to examine BCG vaccination program delivery across Australia

Frank H Beard · Kristine K Macartney

Study highlights a need to examine BCG vaccination program delivery across Australia

Amanda Gwee · Ranmali Rodrigo · Dan Casalaz · Nicole Ritz · Nigel Curtis

Bisphosphonates aren’t known to cause myocardial injury, but zoledronic acid may be an exception

Monique R Watts · Andris H Ellims · David S Eccleston

Those addicted to OTC codeine often do not fit stereotypes of illicit drug users and may present as well groomed professionals

Jennifer L Pilgrim · Olaf H Drummer

We need a better understanding of the effects of policy levers on general practice before adjusting Medicare further

Michael J Taylor

A doctor who is an effective follower will also be a much better clinical leader

Erwin Loh

Meeting the mental health needs of people with intellectual disability is often challenging

Niki S Edwards · William Alexander · Allyson Mutch

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: 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: 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