Letters

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

To the Editor: Burns and Belton1 are to be commended for their reminder that informed consent is required before taking patient photographs. They warn that many clinicians are unaware of copyright issues, fail to meet required hospital standards for clinical photographs and/or store images in unacceptable ways. These are important messages. Interestingly, their article did not mention the core reason for medical photography. They state that ...

Rod Phillips

In reply: We are grateful for the interest in our article on medical photography. We plan to publish a more comprehensive article on our research results shortly, to provide a better understanding of the issue in one Australian tertiary hospital. Medical photographs aid diagnosis by becoming part of the patient file, providing a highly useful visual record for case management. Among 167 clinicians surveyed in our research, ...

Kara Burns · Suzanne Belton

To the Editor: Scott and colleagues address the vexed issue of using highly sensitive (hs) cardiac troponin (cTn) assays to detect myocardial infarction (MI) and likely increases in hospitalisations.1 Greater numbers of MIs detected by hs-cTn assays also confound population surveillance of MI trends and our understanding of disease prevention. The initial introduction of cTn assays resulted in predictions of marked increases in MI rates, based ...

Lee J Nedkoff · Michael S T Hobbs · Tom G Briffa

To the Editor: We comment on practical aspects of the approach to maternal Indigenous smoking raised in the study by Eades and colleagues.1 Pregnant smokers face barriers to quitting; however, we believe some additional barriers are systemic,2 including excessive caution in prescribing nicotine replacement therapy (NRT). Guidelines for maternal smoking cessation recommend an unassisted attempt before considering NRT.3 There is no agreed definition of a “failed ...

Gillian S Gould · Andy McEwen

In reply: Although our trial1 did not decrease quit rates with an intensive intervention, health professionals should continue to deliver appropriate intensive smoking interventions to pregnant Indigenous women.2 Guidelines advise the exercise of caution with the use of nicotine replacement therapy (NRT) in pregnancy,3 given the lack of trial data supporting its use.4 A recent trial of NRT in pregnancy found similar rates of adverse ...

Sandra J Eades · Rob W Sanson-Fisher · Katie Panaretto

To the Editor: We refer to the article by Leslie and colleagues1 and seek to clarify some comments regarding emergency medicine in New South Wales. The Australasian College for Emergency Medicine (ACEM) unreservedly supports the spread of specialist emergency medical services across all hospitals and does not limit vocational trainee numbers. In 2011, 286 Fellows of the ACEM and 191 advanced trainees were working across at least 472 ...

Alana M Killen · Sally M McCarthy · Anthony P Joseph · Andrew D Gosbell

In reply: The Hospital Skills Program (HSP) is a lifelong self-directed education process, across three levels of expertise. It aims to support the individual learning needs of all non-specialist doctors, wherever and however they practise. This includes facilitating access to quality local, college and university programs when relevant to need. The HSP thus applauds and is appreciative of all Australasian learned colleges in the provision of ...

Simon D Leslie · Mary Webber · Michael Boyd

A survey of students and parents shows that bedside teaching is viewed positively in paediatric wards.

Kathryn L Connelly · Michael S Gordon

To the Editor: In their article, Head and colleagues stated that “white coat hypertension carries minimal actual CVD [cardiovascular disease] risk”.1 However, a failure to identify white coat hypertension, and to misdiagnose it as true hypertension, can lead to inappropriate prescription of antihypertensive medications, with associated financial costs and adverse effects such as falls and acute kidney injury, which are unrelated to CVD risk. Although the ...

Patrick Coleman

In reply: The cardiovascular risk associated with white coat hypertension itself is quite separate from the risk of treating white coat hypertension inappropriately. We agree that there are considerable issues associated with treating elderly patients for hypertension and possibly inappropriately treating white coat hypertensive patients. However, although white coat hypertension is more common among elderly patients, the condition needs to be considered in a broader context ...

Geoffrey A Head · Barry P McGrath · Mark R Nelson · Michael Stowasser

To the Editor: Scott and Glasziou’s recent article about the challenges of integrating best research evidence into practice had excellent examples of the 20%–30% of treatments that remain widely used despite being shown to be ineffective or harmful.1 We also note the National Health and Medical Research Council initiative in creating a Research Translation Faculty to improve research relevance and its uptake into practice. A recent ...

Robert G Fassett · Bill Lancashire · Anne Rasmussen