Article Types
Letters
Gestational diabetes needs to be managed
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
Controversy grows over redefinition of gestational diabetes
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
Over 150 potentially low-value health care practices: an Australian study
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
Over 150 potentially low-value health care practices: an Australian study
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
Over 150 potentially low-value health care practices: an Australian study
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
Burns from motorcycle exhausts among children in New South Wales: a continuing problem
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
Clinical software on personal mobile devices needs regulation
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
Clinical software on personal mobile devices needs regulation
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
Stent insertion for palliation of advanced oesophageal carcinoma symptoms by level of socioeconomic disadvantage in urban New South Wales
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
Attitudes of a private hospital community to medical student teaching
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
It’s time to examine the status of our undergraduate mental health curricula
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
Where is the next generation of medical educators?
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
Where is the next generation of medical educators?
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
Where is the next generation of medical educators?
In reply: We thank Hart and Pearce for supporting the views raised in our editorial, noting the unmet demand for medical education expertise. We also thank Kandiah for his response, and agree that medical graduates should be “clinically competent, reliable, keen to learn and show compassion to patients and colleagues”. We believe this outcome is best achieved by strong collaborations among “skilled clinicians and excellent mentors” ...
Geoffrey J McColl · Jill E Thistlethwaite · Tim Wilkinson · Lambert W T Schuwirth · Wendy C Y Hu
Take a deep breath . . . and talk
To the Editor: We congratulate Nowak on her discussion surrounding communication in the emergency department (ED).1 This is certainly an issue that has an impact on both patient safety and satisfaction, and is an area in which all medical personnel can improve. The challenges in ED are manifold, and time-based targets tend to militate against effective communication.2 A strategy that we have employed in our ...
Alan E O’Connor · William G Lukin · Victoria A Brazil
Reviewing the revisions: what are the Australian Bureau of Statistics suicide figures really telling us?
To the Editor: For several years, the Australian Bureau of Statistics (ABS) has cautioned data users of likely underreporting of suicide statistics due to delays in coronial processes and (since 2006) exclusive reliance on the National Coronial Information System, which often contains incomplete information on cause of death.1 In 2009, the ABS introduced data revision processes that allowed additional information received to be added in ...
Jerneja Sveticic · Samara McPhedran · Diego De Leo
The extent of alcohol advertising in Australia: an audit of bus stop advertisements
To the Editor: There is significant concern about drinking patterns and alcohol-related harm among young people. A comprehensive approach to preventing harm from alcohol is needed, with population approaches including curbs on alcohol promotion.1 The National Preventative Health Taskforce has recommended phasing out alcohol promotions “from times and placements which have high exposure to young people”.1 Exposure to alcohol advertising influences young people; research consistently shows ...
Hannah L Pierce · Julia M Stafford · Mike Daube
Changes in smoking intensity among Aboriginal and Torres Strait Islander people, 1994–2008
To the Editor: The recent study by Thomas1 documents the change in smoking intensity of Australian Indigenous people between 1994 and 2008. A significant overall reduction in heavy smoking was observed with a corresponding increase in the proportion of light smoking. This is an interesting epidemiological observation but it should not be misinterpreted as a public health achievement or as a desirable goal in itself. As Thomas ...
Colin P Mendelsohn · Gillian S Gould
Changes in smoking intensity among Aboriginal and Torres Strait Islander people, 1994–2008
In reply: Nowhere in my article do I promote reducing the number of cigarettes patients smoke, rather than smoking cessation, as a goal for clinicians. Mendelsohn and Gould have created their own straw man with which to argue. I explain in the third paragraph of the Discussion that the population changes in smoking intensity may have been caused by previously heavy smokers cutting down (with only ...
David P Thomas
Better prepared next time: considering nutrition in an emergency response
To the Editor: Cyclones, floods and bushfires are experienced in Australia every year, and Australia’s management of natural disasters centres on prevention, preparedness, response and recovery.1 Although access to safe food is a basic human need, during the 2010–2011 Queensland floods there was minimal information available to guide household food preparedness and food supply to communities.2 To ensure that Queensland is better prepared for future natural ...
Elizabeth J Good · Amanda J Lee · Fiona L McKenzie Lewis
Injury trends and mortality in adult patients with major trauma in New South Wales
To the Editor: It is pleasing to see Curtis and colleagues report injury trends and mortality across New South Wales,1 but the data are old and precede major changes to the NSW trauma system. We are concerned that the conclusions of this study will be misapplied by policymakers, leading to unnecessary out-of-area transport of injured patients. The authors concluded that there is a survival benefit when ...
Stuart G Stapleton · Rod O Bishop · James L Mallows
Injury trends and mortality in adult patients with major trauma in New South Wales
In reply: In our study,1 we allocated the numbers and type of trauma centres according to New South Wales Department of Health terminology and the Royal Australasian College of Surgeons Trauma Verification Committee model resource criteria. The latter reflected the resource availability of 24-hour, 7-day per week specialty services such as plastic surgery, cardiothoracic surgery and neurosurgery at those centres during the study period,2,3 as ...
Kate A Curtis*
Palliative care is everyone’s business — is it yours, doctor?
In recognition of Palliative Care Week (19–25 May), we are reminded that, “Palliative care is everyone’s business”. It is a timely and relevant slogan.
Ian Maddocks · Yvonne Luxford
Philately and the Diagnostic and statistical manual of mental disorders
A fan of our “Stamps of greatness” series takes the connection between philately and medicine a step further, with an account of a chance moment in history.
Robert M Parker
Emergency surgery model improves outcomes for patients with acute cholecystitis
To the Editor: Reducing the time from presentation to cholecystectomy in patients with acute cholecystitis has been shown to benefit patients (eg, by reducing the duration of patient discomfort before surgery) and to be cost-effective.1-3 Benefits have also been shown for performing cholecystectomy during the index admission for gallstone pancreatitis.4 Geelong Hospital (in regional Victoria) introduced daily general surgery emergency theatre sessions in February 2011. We ...
Daniel P McGlade · David A Watters · Douglas A Stupart