Perspectives

Unless future well designed studies show an actual benefit for patients, hospitals and health care, policymakers should resist any attempts to enforce this potentially expensive and ineffective practice.

Adam M Deane MB BS, PhD, FCICM · Mary G White MB BCh, BAO, FFARCSI

To change practice, we should move beyond trial-based efficacy to real-world effectivenessMeaningful health care reform requires robust evidence about which interventions work best for whom and under what circumstances. The Institute of Medicine in the United States has estimated that less than 50% of current treatments are supported by evidence and 30% of health care expenditure reflects care that is of uncertain value.1 In studies ...

Ian A Scott FRACP, MHA, MEd

Public reporting of hospital performance is welcome, but we need to understand the limitations of the data and report the most meaningful outcomes.

Leon J Worth MB BS, FRACP, PhD · Ann L Bull PhD · Michael J Richards MB BS, FRACP, MD

Researchers need an umbrella group to advocate on their behalf, identify the research gaps and provide a way to share ideas and infrustructure.

Ian N Olver AM, MD, PhD · Anthony C Keech FRACP, MSc(Epid)

Today, sex-based inequalities and inequities shape how individuals are disproportionately exposed to adverse determinants of health. Our sex can determine how well or ill we become, and if or how our health care needs are acknowledged and met.1 The underlying reasons for this disparity are complex and diverse, shaped by how sex and sexual customs interact within varying political and social contexts. Discriminatory values, norms ...

Izzeldin M M Abuelaish MD, MPH

How can the current health care system accommodate, integrate and implement the strategies required for quality end-of-life care for people on a longer-term trajectory of disease?

Teresa A Burgess GradDipNursing Management, MPHC · Annette J Braunack Mayer BMSc(Hons), PhD · Gregory B Crawford MB BS, MD, FAChPM · Justin J Beilby MB BS, MD, FRACGP

Tasmania is the only Australian jurisdiction to operate a state-funded registry and to require registration of completed enduring guardianship forms, but uptake is low.

Michael A Ashby MD, FRACP, FAChPM · Robert N Thornton BEd, MHPEd, PhD · Robyn L Thomas MB BS, FRACGP, FAChPM

People who are suffering and who will continue to suffer should have the right to request assistance to die gently and, if possible, at a time they choose, say the Doctors for Voluntary Euthanasia Choice.

on behalf of Doctors for Voluntary Euthanasia Choice

The barriers to conduct of clinical research will require solutions if we are to implement evidence-based health care reformReforms in the funding of health services, such as “activity-based” funding initiatives, seek to facilitate changes in how health care is delivered, leading to greater efficiency while maintaining effectiveness. However, often these changes in treatment strategies and service provision evolve without evidence demonstrating effectiveness in terms of ...

Ian D Davis MB BS, PhD, FRACP · Derek P B Chew MB BS, MPH, FRACP

Why is performance reporting necessary? Is there any evidence of benefit? And how can it help busy doctors, nurses and allied health clinicians?

Diane Watson PhD

Clinical registries are at a crossroads. Will we continue the current patchwork approach or will we make the changes that are needed to improve the efficiency and effectiveness of data collection and drive the quality of care?

Sue M Evans MClinEpi, PhD · Bebe Loff BA LLB, MA(MedLaw · Peter A Cameron MB BS, MD

Delays in a uniform approach to detecting gestational diabetes mellitus and providing adequate management represent a missed opportunity to improve pregnancy outcomes and maternal health.

H David McIntyre MD, FRACP · Jeremy J N Oats DM, FRCOG, FRANZCOG

A real-time reporting system for controlled drugs may improve the safety of Schedule 8 medicinesOver the past decade, increased prescribing of pharmaceutical opioids in a number of countries has raised professional and public concern about iatrogenic opioid dependence and fatal opioid overdoses. Most fatal drug overdoses in the United States are now from opioids.1 Although not as high as in the US in absolute terms, the ...

Fiona L Shand BSc(Hons)(Psych), MClinPsych, PhD · Gabrielle Campbell BA(Psych), MCrim · Wayne Hall BSc(Hons) (Applied Psych), PhD · Nicholas Lintzeris BMedSci, MB BS, PhD · Milton Cohen MD, FRACP, FFPMANZCA · Louisa Degenhardt BScHon, MClinPsych, PhD

Complex reforms and increasing financial strains on the UK National Health Service make it almost inevitable that patient care will suffer.

Tony Kirby BSc(Biological Chemistry)

Greater emphasis is needed on behavioural and psychosocial aspects in research and clinical practiceWednesday 14 November marks World Diabetes Day, the birthday of Sir Frederick Banting, whose research led to the discovery of insulin in 1922. In the 90 years since, there have been other significant landmarks. The Diabetes Control and Complications Trial (DCCT)1 and United Kingdom Prospective Diabetes Study (UKPDS)2 showed that the devastating complications of ...

Jane Speight PhD, CPsychol, AFBPsS

Participant engagement and careful planning are key to a successful cohort studyIn the beginning there was an idea ... and funding. The project might never have started if not for a serendipitous meeting between an accountant for the Raine Medical Research Foundation and a young obstetrician. The Foundation had been established 30 years earlier by the bequest of Mary Raine (Box 1), a successful businesswoman who ...

Charlotte M McKnight MB BS · John P Newnham MB BS, MD, FRANZCOG · Fiona J Stanley MB BS, MD, MSc · Jenny A Mountain MBA, MClinEpi · Louis I Landau MB BS, MD, FRACP · Lawrence J Beilin MB BS, MD, FRACP · Ian B Puddey MB BS, MD, FRACP · Craig E Pennell MB BS, PhD, FRANZCOG · David A Mackey MB BS, MD, FRANZCO

Less harmful forms of nicotine have harm reduction potential that is worth investigatingConcern has been expressed about the possible increased use of smokeless forms of tobacco, such as low-nitrosamine smokeless tobacco (SLT) and electronic nicotine delivery systems (ENDS), also known as e-cigarettes (Box).1 Domestic sale of SLT was banned pre-emptively in 1991 in response to overseas marketing of these products to youth. Currently, Australians are permitted ...

Coral E Gartner PhD · Wayne D Hall PhD · Ron Borland PhD

Indigenous Australians have six times more blindness than the national average, but 94% of the vision loss is preventable with eye examinations and timely access to treatment. The Roadmap emphasises regional needs-based planning for service delivery and accountability.

Hugh R Taylor MD, FRANZCO, AC · Andrea I Boudville MIH · Mitchell D Anjou MScOptom

Good working relationships with journalists are needed during public health crises but many journalists believe that health departments could do a better job of meeting their information needs, both in content and timeliness.

Melissa A Sweet BA, MA · Kate E Holland PhD · R Warwick Blood PhD