Letters

To the Editor: In 2009, the RE-LY (Randomized Evaluation of Long-Term Anticoagulant Therapy) trial compared dabigatran etexilate with warfarin for prevention of stroke and systemic embolism in 18 113 patients with non-valvular atrial fibrillation (AF) and at least one additional risk factor for stroke.1 In April 2011, it became accessible in Australia (Pradaxa; Boehringer Ingelheim) under a product familiarisation program funded by the manufacturer; however, the Pharmaceutical ...

Sueh-li A Lim · Ellen Maxwell

To the Editor: The Australian Government’s recently completed Review of anticoagulation therapies in atrial fibrillation (AF) identified that the quality of international normalised ratio (INR) control was one of a number of factors creating uncertainty regarding the cost-effectiveness of novel anticoagulants in the Australian setting.1 INR control, usually expressed as the percentage of time in the therapeutic range (TTR), is critical in determining the relative efficacy, ...

Luke R E Bereznicki · Alexandra R Madden · Gregory M Peterson

Funding such a recommendation would lead to little overall cost but would possibly save several Australian lives each year

D Ashley R Watson

To the Editor: We commend the clinical update of Bergin and colleagues on the management of diabetes-related foot ulceration.1 We agree that a multidisciplinary approach is the best way to manage these complex wounds. However, we believe that the use of hyperbaric oxygen treatment (HBOT) for ulcers which have failed to respond to 3 months’ standard treatment justifies more prominent consideration. The actions of HBOT are diverse, ...

Glen C Hawkins · Michael H Bennett · David R Smart

To the Editor: Following two articles in the Journal,1,2 I wish to provide an update on the pricing of statins in Australia and the implications for Pharmaceutical Benefits Scheme (PBS) expenditure. I was prompted to do so by a recent review by the Pharmaceutical Benefits Advisory Committee (PBAC), which was instigated by the Senate when it passed legislation enabling the current pharmaceutical pricing arrangements.3 The ...

Philip M Clarke

To the Editor: Neovascular age-related macular degeneration (NVAMD) is the most common cause of blindness in Australia.1 Current treatment to prevent further deterioration in vision, and an improvement in some, involves the antivascular endothelial growth factor (anti-VEGF) agents ranibizumab (Lucentis, listed on the Pharmaceutical Benefits Scheme [PBS] since August 2007) or bevacizumab (Avastin, used off-label for NVAMD).2 The Australian Macular Degeneration Foundation estimated the annual number ...

Robert P Finger · Robyn H Guymer

Do the CSL snake venom detection kit dose recommendations need updating?

Alan Paul

In reply: A low-volume, polyvalent antivenom for brown and tiger snake envenoming would make treatment simpler and safer. Since 2001, when information cited by Paul was published, there have been over 15 peer-reviewed research publications addressing the issue of antivenom dosing.1-3 There is now consistent evidence that one vial is equivalent to larger doses, and there have been no cases of active venom being present after one ...

Geoffrey K Isbister · Nicholas A Buckley · Simon GA Brown

To the Editor: Caplan et al1 include in their meta-analysis a trial by Mather et al that compared home care with intensive care management of patients with acute myocardial infarction (AMI) between 1966 and 1968.2 A joint working party of the Royal College of Physicians and British Cardiac Society dismissed the results of this study because of design defects.3,4 Kalra et al5 performed a randomised trial with ...

Hugh G Dickson

In reply: Dickson argues for exclusion of randomised controlled trials (RCTs) if treatments have changed, but treatments are constantly changing so, following this rule, meta-analysis would be impossible. Similarly, diagnosis has changed — stroke was a clinical diagnosis, then computed tomography was required, and now magnetic resonance imaging is needed. Equipoise is not a requirement for inclusion in a meta-analysis. Complaints about research being simplistic because ...

Gideon A Caplan

A common injury in a popular sport that requires early referral and management

Mohammed Baba · Jason N Harvey · Anthony J Beard · Richard D Lawson

To the Editor: The impact of population ageing on health care expenditure was a hot topic in the late 1990s in Australia.1 Previous studies have adopted various modelling approaches to estimate age- and sex-specific health care costs to inform population health care expenditure projections.2-4 Medicare funds about 3800 medical services, including consultations provided by general practitioners and specialists, medical diagnostic services (such as medical imaging and ...

Catherine L Keating

To the Editor: The most common cause of difficult-to-treat depression may be a failure to diagnose bipolar II depression.

Andrew R Robertson · Greg M de Moore · Philip M Boyce

In Reply: Treatment recommendations for bipolar II depression differ minimally from those for bipolar I.

Michael Berk · Seetal Dodd · Lesley Berk

Information on refugee background and country of birth provides important pointers to possible health needs.

Melanie E Gibson-Helm · Andrew A Block · Helena J Teede

To the Editor: I read with great interest the recent article by Knox and Marshall.1 Chromoblastomycosis may result in a number of rare systemic complications that may be associated with significant morbidity. For instance, chromoblastomycosis may affect the cornea. This usually follows cataract surgery. Cladophialophora carrionii is the aetiological agent involved in corneal chromoblastomycosis.2 Keratitis occurs, resulting in ocular pain and decreased visual acuity. Topical and ...

Shailendra Kapoor

Accidental carbon monoxide poisoning as a result of burning charcoal briquettes has continued despite the introduction of mandatory warnings.

Jared A Brown · Nick A Buckley

To the Editor: Clozapine therapy is a recognised risk factor for myocarditis and cardiomyopathy; however, there are no national guidelines for cardiac monitoring. Similar to many centres in Australia, and consistent with the consensus view from major psychiatric facilities in Victoria,1 our institution’s policy is to monitor patients with a baseline echocardiogram before starting treatment with clozapine, at 6 months and 12 months after starting treatment, and ...

Stuart D Murch · David L Prior · David J Castle

To the Editor: The donation after cardiac death (DCD) procedure used by Coulson and colleagues is ethically problematic and is not, as claimed, re-implementation of the practice followed before brain-death organ donation protocols were introduced. First reported in 1992, the more precise term is controlled donation after cardiac death or controlled non-heart-beating organ donation.2 What is controlled is the timing, mode and criteria of death, ...

Judith R Kennedy · Michael C Kennedy

To the Editor: We congratulate Coulson and colleagues for sharing their single-centre experience of donation after cardiac death (DCD).1 Our recently published Queensland DCD data2 reflect their experience and highlight the efficacy of DCD in augmenting the pool of donors with organs available for transplantation. The number of Australian DCD organ donors is increasing. There were 19 in 2007 and 86 in 2009. In 2011, of the 337 total ...

Raj Kumar · Kiran Shekar · John F Fraser

In reply: The Alfred Hospital’s donation after cardiac death (DCD) program was developed in full knowledge of ethical concerns such as those raised by Kennedy and Kennedy. All are covered under “DCD guideline development and implementation” in the methods section of our article.1 Specifically, no patient was denied a chance of survival, because all would have undergone withdrawal of cardiorespiratory support even if donation were ...

Tim G Coulson · David Pilcher

Is activity-based funding stifling the use of new technologies in the public sector?

Michael D Coory · Bridie S Thompson · Susan J Jordan

Never let the truth get in the way of a tidy timesheet.

Rosalind J McDougall

To the Editor: Weisbrot and Breen’s proposal1 for a no-fault compensation system for medical injuries should extend to all injuries in Australia, including those from motor vehicle accidents and in the workplace. It should also apply to recreational injuries that may lead to common law compensation cases. After 40 years of clinical experience in the rehabilitation of patients with severe neurological injury, I argue that such ...

David C Burke

To the Editor: We read with great interest the article by Burns and Belton regarding the deficiencies in knowledge and attitudes of health professionals towards understanding legal considerations of photographic ownership, storage and disposal.1 This article is timely, given the escalation of smartphone use among clinicians in daily practice. However, we feel that no practical advice was offered to clinicians. The advent of smartphones capable of ...

Rahul Chakrabarti · Chandrashan M Perera