Letters

To the Editor: I would like to endorse the call for better health data standards across Australia.1 However, while standardisation is a long-term goal, we at NPS MedicineWise believe that more can be done now, even with current limitations. NPS MedicineWise has recently embarked on an ambitious program called MedicineInsight to gather anonymised patient data from 500 general practices (equating to about 2 million patients) on an ongoing ...

Lynn M Weekes

In reply: Weekes agrees that better health data standards are needed, and suggests that MedicineInsight can gather valid data from current general practice electronic health records, to provide meaningful information. We have gathered representative data on general practice patient management through the Bettering the Evaluation and Care of Health (BEACH) program and earlier surveys for 20 years.1,2 In parallel we have worked to develop data standards with ...

Helena C Britt · Graeme C Miller

With the growing prevalence of obesity (including morbid obesity) in Australia, especially in those living in areas of lower socioeconomic status, improving access should be a priority health commitment.

Alessandra Doolan · Anne Trimmer

To the Editor: Data from the tertiary paediatric hospitals in Brisbane (Royal Children’s and Mater Children’s Hospitals) support Claessen and colleagues’ letter.1 A total of 1091 children aged < 18 years were initially admitted from 1 January 2001 to 31 December 2011 with a new diagnosis of type 1 diabetes (T1D) (Box). Diabetic ketoacidosis (DKA) was defined as venous pH < 7.3 or serum bicarbonate level < 15 mmol/L in association with hyperglycaemia and ketoacidosis. Severity was defined ...

Carol M Willis · Jennifer A Batch · Mark Harris

First-line monoclonal antibody therapy to prevent bone loss in bone-metastatic breast and prostate cancers is delivered subcutaneously, often by general practitioners who need to be aware that this treatment in patients with low vitamin D levels, impaired renal function and poor calcium absorption (all often seen in older patients) can lead to serious hypocalcaemia.

Jennifer M McLachlan · Gavin M Marx · Margaret Bridgman

To the Editor: Guidelines for the management of absolute cardiovascular disease risk, published recently by the National Vascular Disease Prevention Alliance, contain the following evidence-based recommendations (EBRs) for choice of blood pressure-lowering therapy: EBR 11: Treatment should begin with any one of the following agents: · ACE [angiotensin-converting enzyme] inhibitor · Angiotensin receptor blocker · Calcium channel blocker · Low dose thiazide or thiazide-like diuretic. EBR 12: If monotherapy does not ...

Timothy Usherwood

In reply: On behalf of the National Vascular Disease Prevention Alliance, I thank Usherwood for raising concerns about the evidence-based recommendations (EBRs) within the Guidelines for the management of absolute cardiovascular disease risk.1 These guidelines inform a comprehensive, absolute risk approach to prevention of cardiovascular disease, and were approved by the National Health and Medical Research Council in 2012. Usherwood’s concerns are specific to treatment recommendations ...

Robert D Grenfell

To the Editor: Increased numbers of medical graduates in Australia over recent years are causing great concern about the capacity of current prevocational training systems to effectively absorb extra trainees.1 For example, in the Australian Capital Territory, 42 intern positions in 2007 increased to 96 in 2013 — an increase of 130%. ACT Health has seen this increase in intern and junior doctor numbers as an opportunity to improve current ...

Melanie Angstmann · Tobias J Angstmann · Tim McDonald

Lead is toxic at picomolar concentrations, but what is the best basis for determining the intervention level for its concentration in blood?

Ian H Wilson · Simon B Wilson

In reply: In epidemiology, the weight-of-evidence approach is useful for reaching general conclusions, whereas details from selected studies are useful for understanding nuances. This is particularly important when evidence from human and experimental research is consistent across multiple studies and in populations with different characteristics, including Australia.1-3 There will always be limitations and unmeasured confounders, but, ultimately, we can rely on controlled laboratory studies which ...

Mark P Taylor · Bruce P Lanphear · Chris Winder

To the Editor: BCG is an effective vaccine to prevent tuberculosis (TB) in young children travelling to countries with a high prevalence of TB.1 Although it does not completely mitigate the risk of developing TB, nor the need for preventive therapy after a significant TB exposure, it provides about 80% protection against the severe forms of TB that affect infants and young children.2 In Australia, ...

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

To the Editor: I commend de Costa and Rane1 for highlighting a matter that has been causing me increasing concern over the past few years; namely, the decline in undergraduate education in obstetrics and gynaecology. Coincidentally, a couple of weeks before their article was published, I was the consultant on call at a rural hospital and was asked to see a young woman who turned out ...

Graeme J Dennerstein

To the Editor: In his article on the German Medical Association’s apology for medical crimes under Nazism, Weisz states “One can but hope that it will be soon followed by an apology from the Austrian Medical Association”.1 Having been in Vienna on the 75th anniversary of the Anschluss (the annexation of Austria by Germany in March 1938), I would like to comment as to why ...

Peter M Winterton

In reply: I thank Winterton for providing important information about Austria’s attitude towards its participation in Nazi atrocities. Nazi crimes perpetrated in Austria include those at the Mauthausen-Gusen concentration camp, where over a quarter of a million inmates perished. The Austrian government has acknowledged this by establishing the Mauthausen Memorial. However, the Austrian Medical Association remains silent. Recall Irmfried Eberl, the Austrian doctor who was the ...

George M Weisz

Twitter is being used to promote alcohol, and this includes promoting it to people who are underage; putting an end to this practice requires political will and international cooperation.

Ann M Dadich · Suzan M Burton · Alena Soboleva

In Victoria, from 2001 to 2011, 115 deaths were identified with codeine and ibuprofen co-detected in postmortem toxicological analysis or with codeine–ibuprofen analgesic misuse described in the coroners’ findings.

Jennifer L Pilgrim · Malcolm Dobbin · Olaf H Drummer

A young boy’s painful encounter with a moth playing possum.

John J van Bockxmeer · Jennifer Green