Letters

To the Editor: The perspective of the Doctors for Voluntary Euthanasia Choice needs to be challenged.1 Firstly, irrespective of one’s views on the matter, it does not seem reasonable for euthanasia to be legalised so that doctors can avoid the scrutiny of the law. Secondly, the authors point out that “pain may not be a prominent symptom, making death by morphine legally unjustifiable”, therefore implying ...

Paul F Dunne

To the Editor: The Doctors for Voluntary Euthanasia Choice want Australia to have enlightened euthanasia laws similar to those of the Netherlands.1 But a recent review of Dutch physician-assisted death (PAD) suggests that such practices are extremely difficult to control.2 They state that there has been some improvement in the rate of reporting of cases of euthanasia (a legal requirement), although only 2% of deaths classifiable ...

Roger K Woodruff

In reply: We thank Dunne and Woodruff for comments on our Perspectives article.1 Both colleagues firmly expressed their opinions. However, we find it telling that neither mentioned consideration of their patients’ opinions and both referred to euthanasia, not voluntary euthanasia (VE), which was the subject of our article. We agree with Dunne that “it does not seem reasonable for euthanasia to be legalised so that doctors ...

John O Willoughby · Robert G Marr · Colin P Wendell-Smith

The problem of excessive psychotropic drug use in Australian nursing homes is well known, but where are the solutions?

Juanita L Westbury · Gregory M Peterson

To the Editor: The article by Hilmer and Gnjidic1 raises issues about the management of behavioural and psychological symptoms of dementia (BPSD)2 in residential aged care facilities (RACFs). It is important to remember the context in which RACF residents’ care is provided. The federally managed aged care system is politically and organisationally perceived as supported accommodation, which is geared toward supporting or substituting for residents’ performance ...

Ludomyr J Mykyta

In reply: We thank Westbury and Peterson, and Mykyta for highlighting some of the issues raised in our article.1 While we acknowledge the important contribution of providing education programs to existing staff, staff education alone is insufficient to address the complex issues affecting psychotropic drug use in nursing homes.1 Better access to appropriately trained staff in nursing homes, including general practitioners, geriatricians, psychogeriatricians, psychologists, pharmacists, nurses ...

Sarah N Hilmer · Danijela Gnjidic

Data from a tertiary paediatric refugee health clinic show that instances of post-traumatic stress disorder are on the rise in this population, particularly in children who have been held in detention.

Joshua R Francis · Sarah Cherian · David Forbes

When considering this controversial procedure, how do we weigh the results of patient satisfaction surveys with those of clinical trials?

Wayne Adams

In reply: We thank Adams for providing private health insurance data that confirm the continued use of arthroscopic surgery for patients with osteoarthritis. We agree that the patient’s view of the benefits of the procedure is fundamental to assessing treatment success. We do not doubt that many patients are happy with the results of arthroscopic knee surgery, but this does not necessarily imply that the surgery ...

Rachelle Buchbinder · Ian A Harris

To the Editor: This letter encourages timely preoperative recognition of restless legs syndrome (RLS), for patient wellbeing, as well as for practical management of incidental procedures. RLS is a neurological disorder found in many older patients of either sex and in those with a variety of conditions including iron deficiency, pregnancy, uraemia, diabetes and rheumatoid arthritis. It may also affect patients with other neurological disorders ...

Ivan Cher

To the Editor: We read with interest the viewpoint offered by Mitchell and colleagues, highlighting the need for improved integration of global health training in postgraduate medical education in Australia.1 This subject has garnered interest in Australia and overseas with reference to ophthalmology. In the United Kingdom, the case for structured global health training has been advocated in ophthalmology postgraduate education, where financial and bureaucratic ...

Jan Kokavec · Lauren Hodgson · Justin C Sherwin

To the Editor: Mitchell and colleagues have done medical education a service by outlining all the potential benefits and harms associated with global health training.1 They are right to state that sustainability is key — however, all too often in the past, it has been sustainability that has been lacking. According to Yikona, writing in 2003: “Case by case analysis of medical schools in sub-Saharan ...

Kieran Walsh

In reply: We thank Walsh for highlighting that sustainability is a critical challenge in global health training (GHT) programs and that technology is creating new options for international engagement. He has also articulated a vision of qualified specialists taking a greater role in the delivery of clinical education in resource-poor settings. We share this aspiration. One of the end points of GHT is a lifelong commitment ...

Rob D Mitchell · Jennifer C Jamieson · Jake Parker · Fred B Hersch · Zoe Wainer · A Rob Moodie

A case-note audit at a community-based sexual health clinic has shown that hepatitis C treatment outcomes among Indigenous Australians are similar to those among non-Indigenous Australians, which might be partly due to genetics.

Joshua S Davis · Anuja C Kulatunga · Krispin Hajkowicz

To the Editor: Telehealth is the umbrella term for the electronic and telecommunication-based expansion of health care services, both clinical and non-clinical, which include telemedicine (telehealth clinical services) and electronic health record (EHR) systems. A re-evaluation of health care in Australia is needed, including characterisation of new systems of care focused on improving health outcomes using mobile device-based telehealth (mHealth). This will be accelerated through ...

Sven-Erik Bursell · Alicia J Jenkins · Laima Brazionis · Kevin G Rowley · Alex D Brown

To the Editor: Interpreting coronial legislation can prove challenging for junior doctors at the bedside, with significant local variation in interpretation.1 The Victorian Coroners Act (Coroners Act 2008 [Vic]) has recently undergone changes that have coincided with a decline in numbers of reported cases,2 with the Coroners Court raising the question of whether there was “unintentional under-reporting of reportable deaths”.2 What constitutes a reportable death ...

Alison J Dwyer · Philip Visser · Lynette Russell

To the Editor: We report a case of severe Vibrio cholerae infection acquired in Sydney, likely due to ingestion of imported seafood. An 83-year-old man with Parkinson disease presented with a 3-day history of vomiting, large-volume watery diarrhoea and acute renal impairment necessitating admission to the intensive care unit. Blood cultures grew curved gram-negative bacilli, and intravenous piperacillin–clavulanic acid was commenced. Subsequent microbiological testing of blood ...

Chiao-Yun Hsu · Simon Pollett · Patricia Ferguson · Brenden J McMullan · Vicki Sheppeard · Suzanne E Mahady

A local case highlights the current worldwide resurgence of this disease among men who have sex with men and the need to consider it as a cause of genital ulceration.

Phillip J Read · Anna McNulty

To the Editor: Conflicting information about treatments is known to undermine compliance with the use of medications.1 The education of patients and caregivers that accompanies prescribing should therefore be as consistent as possible. Clients may conduct research on the internet into particular medicines and try to corroborate “what the doctor said”. In the case of the use of clonidine in children, publicly available information is ...

Klaus Martin Beckmann

A retrospective review among patients admitted to a Queensland palliative care unit showed that a large proportion was prescribed nine or more medications. Vigilance in review and appropriate cessation of drugs that are no longer needed is recommended.

Ross P Cruikshank · Bruce Stafford · Lee Jones

Punishing on-call and after-hours arrangements are threatening Australia’s rural medical workforce.

Chee S Koh

Removing the Medicare rebates for telehealth in outer metropolitan areas is a short-sighted policy.

Victoria A Wade

To the Editor: McIntyre and Oats promote the International Association of the Diabetes and Pregnancy Study Groups (IADPSG) criteria for gestational diabetes mellitus (GDM) as being well reasoned.1 Derived from observational data and mathematical modelling in an attempt to provide a worldwide definition and to improve outcomes, these criteria will significantly increase the number of women diagnosed with GDM2 in health care systems that have ...

Adrian V G Taylor

To the Editor: McIntyre and Oats1 suggest that Australian medical practitioners should adopt the new International Association of the Diabetes and Pregnancy Study Groups (IADPSG) diagnostic criteria for the management of gestational diabetes mellitus (GDM),2 mainly because of the findings of the Hyperglycemia and Adverse Pregnancy Outcome (HAPO) study.3 If adopted, a significant number of women will be diagnosed with GDM if their only blood ...

Michael C d’Emden · Narelle D Fagermo · Amanda J Love · Karin M C Lust