Letters

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

In reply: Taylor welcomes a strong evidence base for clinical practice, which is echoed by d’Emden and colleagues. However, their strong support for the current Australian diagnostic criteria for gestational diabetes mellitus (GDM) is surprising, given that these criteria are the product of an “Ad Hoc Working Party” report.1 This guideline, published in 1991, clearly acknowledged a lack of strong evidence and advocated criteria that ...

H David McIntyre · Jeremy J N Oats

To the Editor: Moynihan has recently suggested that gestational diabetes mellitus (GDM) is a “non-entity”1 and cited controversy regarding new diagnostic criteria, while McIntyre and Oats have defended the practice of screening for GDM.2 Robust data associate hyperglycaemia with adverse pregnancy outcomes;3 and randomised controlled trial data show a beneficial effect of screening and treatment on perinatal outcomes.4 However, it is short-sighted to consider only the ...

Mark McLean · Len D Moaven · Naswrin Moin · Jennifer A Bradford

To the Editor: We read the recent study by Elshaug and colleagues1 with interest, but were concerned by the inclusion of radiotherapy for spinal cord disease as a potentially low-value intervention. The lack of clinical review in the identification process appears to be the key driver in coming to this erroneous conclusion. Elshaug and colleagues recognise the need for clinical expertise in assessing trials demonstrating no ...

Andrej Bece · Christopher Hamilton · Brigid E Hickey

To the Editor: Elshaug and colleagues recently attempted to identify low-value health care practices.1 They further identified 13 services found by more than one of their search methods, implying that these services may be of particularly low value. One such practice identified is “radiotherapy for patients with metastatic spinal cord disease”.1 However, this terminology is loose at best, and the following quotes from Elshaug et al’s own ...

Graham Pitson

In reply: I thank Bece and colleagues and Pitson for engaging constructively with this quality improvement agenda. Bece et al challenge the inclusion of radiotherapy for spinal cord disease in our list of 150 candidate treatments potentially warranting further review under a quality improvement program.1 Pitson calls attention to “loose terminology” in the same example. This latter point, I concede. Precision of language in relation to ...

Adam G Elshaug

An audit of cases treated at a major children’s hospital reveals that significant burns from motorcycle exhausts still occur much too frequently

Ela J Hyland · Rachel A D’Cruz · John G Harvey

To the Editor: Fernando makes a valid statement on the need for regulation of clinical software on personal mobile devices (PMDs).1 Her timely comment regarding acting now before the “courts decide” is fair, given that many doctors, including a high percentage of specialist trainees, are now using PMDs.2 However, it is important for doctors to remember that the security risks highlighted by Fernando are not ...

Sulakshan Rasiah · Jonathan K Kam

In reply: I appreciate the interest in my article.1 More comprehensive research work is currently underway to evaluate the application of personal mobile devices (PMDs) in the context of security risks posed by their intrinsic functions. The importance of such research findings is borne out by emerging discussions.1-4 Many platforms already offer security or locking software applications to avoid information breaches on PMDs, and nascent moves ...

Juanita I Fernando

Linked records for patients who died from primary advanced oesophageal carcinoma reveal an unfortunate trend in access to palliative care — greater socioeconomic disadvantage is significantly associated with decreasing odds of stent insertion for palliation of symptoms such as dysphagia and odynophagia

Jason P Bentley · David E Goldsbury · Guy D Eslick · Michael R Cox · Dianne L O’Connell

To the Editor: A shortage of training opportunities for medical students in public hospitals has led to greater need for collaboration with the private sector.1-3 In 2011, Sydney Medical School established the first private hospital clinical school in New South Wales at the Sydney Adventist Hospital (SAH). Essential to its success is the support of the hospital’s patient and medical community. We conducted two cross-sectional surveys, ...

Stephanie Phillips · Linda A Klein

To the Editor: Review of undergraduate mental health education is timely, given the growing disease burden of mental disorders and the need to better equip doctors for their central role in treatment. Curricula should prepare all doctors with competencies in recognising and treating mental health problems,1 because these occur frequently in patients across all branches of medicine, leading to poorer outcomes.2 Curricula should also prepare ...

Susan J Thomas · Brahmavar N Pai · Kerry Dawes

To the Editor: The thought-provoking editorial by Hu and colleagues laments the “erratic supply of medical educators”.1 Curriculum design and review, course accreditation, and student teaching and assessment at all levels require specialist expertise in education. The 17th National Prevocational Medical Education Forum, held in Perth in November 2012, revealed pressures throughout the medical education and training pipeline. With an unprecedented increase in student numbers in ...

William G Hart · Robert Pearce

To the Editor: The arguments put forward by Hu and colleagues for recognition of medical education as a specialty are persuasive, especially considering current national requirements for accreditation to ensure delivery of high-quality programs.1 In recent decades, medical educationalists have flooded journals and other publications with articles (Box). Many have resulted from, and led to, innovative educational programs. Unlike other areas of scientific research, however, the ...

David A Kandiah