Letters

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

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

To provide quality health services, we need to collect meaningful data and invest in embedded research and development

Julie A Halton

To the Editor: I would like to commend Penington for his insightful opinion piece regarding the challenges facing the Australian health system over the next decade.1 I, and I am sure many others, share his warranted concern regarding the future of quality and safety in health care in a politically charged, target-based funding system. As highlighted by Penington, the recently published McKeon report provides a suggested ...

Justin M Nazareth

To the Editor: The response of Sievert and colleagues for the Gastroenterological Society of Australia1 to an article on iron deficiency anaemia in a young woman2 missed the point. In the absence of menorrhagia, dietary deficiency of iron is extraordinarily rare unless the individual is a vegan. The young woman presented with a haemoglobin level of 61 g/L and was treated with iron supplements over a ...

Terry D Bolin

To the Editor: The Gastroenterological Society of Australia (GESA) response1 to the anonymous father’s heartfelt account of the suffering and ultimate death of his daughter, misdiagnosed on a number of occasions by general practitioners and medical specialists, was, in my view, inadequate. The young woman certainly warranted a colonoscopy, if not at presentation then certainly after 6 months of unsuccessful iron replacement therapy. Sievert and colleagues should ...

Randolph S Williams

In reply: We appreciate the interest of Bolin and Williams regarding our article.1 We agree that further investigation of iron deficiency anaemia was indicated in this patient, as her clinical presentation of severe, unexplained anaemia is clearly articulated in the Gastroenterological Society of Australia recommendations as requiring such diagnostic investigation, as stated in our article. Colonoscopy would have been the most appropriate investigation. Williams states ...

William Sievert · Barbara A Leggett · Finlay A Macrae