Letters

To the Editor: We note Ahmed and colleagues’ extensive case series of patients with severe vestibulopathy due to aminoglycosides. We attempted to develop a hospital-based screening program to detect vestibulopathy in inpatients that may be informative for others considering similar programs. We established a pilot project involving student pharmacists. Patients who received more than a single dose of any aminoglycoside antibiotic were identified by therapeutic drug ...

Maryam Teimoori · Gina Mistry · Carmela Corallo · Allen C Cheng

To the Editor: Influenza is a common respiratory infection that is infrequently associated with severe disease requiring hospitalisation. We have conducted hospital-based surveillance in the Influenza Complications Alert Network (FluCAN) since 20091 and report on our findings in 2010 and 2011. In 2010, 15 hospitals based in capital cities or large regional centres were involved, as previously described.1,2 In 2011, eight hospitals in Victoria, South Australia, Western Australia ...

on behalf of the FluCAN Investigators

To the Editor: There have been claims that the non-medical use of prescription stimulants is widespread and increasing in the United States and other developed countries, particularly among university students.1 In the context of rising education and general living costs, economic uncertainty and high rates of anxiety and depression among young people,2 it is plausible that some students may cope with study demands by using ...

Jayne C Lucke · Wayne D Hall

To the Editor: On a similar topic to the recent series by McNamara on the length of medical education, a provocative piece published earlier in the Journal of the American Medical Association suggested that medical training could be shortened by 30% in the United States, without detriment to clinical skills. The reality is that there is a paucity of evidence for the ideal duration of ...

Matthew H Anstey

To the Editor: The 2 April issue of the Journal contained several articles on pain, but no mention of patients who suffer with head pain. Headache is one of the commonest acute and chronic pain conditions. Studies have shown that episodic migraine affects 18% of women and 8% of men.1 Daily headache afflicts 4% of people worldwide, and half have chronic migraine.2 According to data from ...

Alessandro S Zagami

To the Editor: In their letter, Spencer, Howe and Manolios call for investment in fracture liaison services.1 Our own business plan showed that for an investment of $55 000 to hire a nurse, the dividend is $1.5 million in second surgeries prevented. This plan has failed to impress successive chief executive officers or their finance managers, and for good reason. The obstacle is a financial paradox. If a chief ...

Nikolai Bogduk

To the Editor: In Australia, cancer, heart disease, stroke and diabetes mellitus contribute to 56% of all deaths,1 and have a significant nutrition-related lifestyle component. In 2008, 68% of men and 55% women were classified as overweight or obese,1 and of those in residential aged care, 50% were moderately or severely malnourished.2 Accreditation standards for medical schools (currently under review) specify that medical graduates have ...

Caryl Nowson · Marjo Roshier-Taks · Brendan Crotty

To the Editor: I refer to Geelhoed and de Klerk’s article1 and related correspondence.2,3 While concerned with the rise in the overall rate of emergency department (ED) presentations, I am alarmed by the disproportionate increase in the ED admission rate (24% increase, from 3960 admissions per 10 000 ED presentations in July 2007 to June 2008, to 4910 admissions per 10 000 ED presentations in July 2010 to June 2011) since the introduction of ...

Shyan L Goh

To the Editor: Murray Valley encephalitis virus (MVEV) is rarely seen in south-eastern Australia, as described in the recent review in the Journal by Knox and colleagues.1 During the MVEV transmission period in early 2011, there was extensive flooding, and high notification rates were reported for other mosquito-transmitted infections, including flavivirus infection among horses. MVEV seroconversion was detected in sentinel chicken flocks. However, despite concerns ...

Joseph S Doyle · Suellen Nicholson · Jennifer A Leydon · Rodney J Moran · Michael G Catton

To the Editor: Patients who survive subarachnoid haemorrhage (SAH) are at significant risk of visual impairment, further complicating their recovery. This may arise as a result of Terson syndrome,1 which is the phenomenon of intraocular haemorrhage associated with any intracranial bleed and raised intracranial pressure. We report a case of missed Terson syndrome at a tertiary referral centre. A 36-year-old previously well woman presented with a ...

Akbar N Ashrafi · Rahul Chakrabarti · John Laidlaw

To the Editor: The United States medical education system is not a valid comparator in arguing for the shortening of training times for specialist doctors in Australia,1 whose training experience is already less than desirable. I was recently a medical observer at a major US training hospital, and there are significant differences in specialist training between the two countries. The Australian Medical Association Safe Hours campaign ...

David Ku

To the Editor: There are challenging ethical, legal and clinical issues associated with resuscitation and end-of-life care for older people. When an elderly patient with comorbidities and limited independence deteriorates, and is unable to participate in decision making, is it good medical practice to subject that person to invasive and traumatic resuscitation when the survival rate is less than 3.4%?1 Currently, many older patients will be ...

Campbell H Thompson · Margaret Brown

To the Editor: A rising awareness of the prevalence of 25-hydroxyvitamin D (25OHD) deficiency over the past decade is likely to have led to a surge in the number of individuals who undergo 25OHD testing.1 United States data indicate that testing for 25OHD has increased by 80%–90% annually,2 yet there are no reports that investigate the cost of 25OHD testing in Australia. We analysed the ...

Kellie L Bilinski · Steven C Boyages

To the Editor: The South Australian Institute of Medical Education and Training (SA IMET) recently conducted a review of internships in South Australia and proposed three potential changes.1 First, new prevocational training networks would rotate individual interns between more than one major teaching hospital. Under the existing system, most interns remain exclusively at one location, although there is an established southern network incorporating the Flinders ...

Thomas D Crowhurst · John Floridis · Lisa M Raven

To the Editor: A 23-year-old woman presented to the emergency department with bilateral pain, swelling and loss of power in her upper arms, which had started that morning. She had no history of significant trauma. Her medical history was significant for Wolff–Parkinson–White syndrome, diagnosed 3 weeks earlier at the same institution, and mild depression, diagnosed 8 months earlier, for which she had been taking desvenlafaxine (50 mg daily ...

Maximilian Stephens · Jeffrey T J Rowland · Anis Zand Irani

To the Editor: A 38-year-old HIV-positive Somalian refugee with a past history of pulmonary tuberculosis (TB) and poor compliance with antiretroviral therapy (ART) presented with fever, lethargy and mediastinal lymphadenopathy. He was diagnosed with fully drug-sensitive lymph node TB. The CD4 lymphocyte count at TB diagnosis was 20/µL (reference interval, 350–2630/µL), and the HIV RNA viral load was 99 000 copies/µL. Standard anti-TB treatment was commenced, and ART ...

Sarah L McGuinness · Joseph S Doyle · Alan C Street

To the Editor: Monshat and Castle have summarised the current state of play of mindfulness as an important component of the integrated management of chronic disease. So too medical students experience significant acute and chronic psychological disturbance, which impacts on their professional performance and personal life, as well as increasing their risk of substance misuse and suicidality.2 Strangely, in this respect, students and doctors have much ...

Jonathan P Page

Comment: In the 4 June issue of the Journal, I responded1 to an enquiry from McBryde2 as to why the Medical Journal of Australia decided not to publish an article by Haines and Lowenthal regarding the importance of a histological diagnosis when managing advanced cancer. I would like to clarify that the prime reason for rejecting the manuscript was that the patient in the case it reported ...

Annette G Katelaris

To the Editor: It has been estimated that “levelling the playing field” in terms of cardiovascular health alone could narrow the life-expectancy gap between Indigenous and non-Indigenous Australians by 6.5 years.1 While there has been a particular (and important) focus on risk factor modification, and prevention and management of chronic disease, it is worth noting that, compared with other Australians, Aboriginal and Torres Strait Islander people have: three ...

Robert D Grenfell · Vicki Wade · Eleanor Clune · Kelley O’Donohue · Prue Power

To the Editor: Woods and colleagues provide a timely and descriptive reminder of cyclone Yasi and the 2010–2011 summer.1 The evacuation of the hospitals on the Cairns foreshore, a decision made by the Queensland Premier, was the largest hospital evacuation in Australian history. The capability to successfully aeromedically transport 297 patients 1800 km, in a window of 22 hours, without loss of life or reported adverse clinical incident, was ...

Jeannette R Young · Mark S Elcock · Peter J Aitken

To the Editor: George,1 who has received a research grant from Pfizer on smoking cessation, makes the manifestly incorrect statement that “there is no evidence for the effectiveness of cold turkey cessation, especially in moderate to heavy smokers”. In fact, it has always been the case that the most common method used by ex-smokers in their final successful attempt to quit is cold turkey.2 Those promoting ...

Simon Chapman