Article Types
Perspectives
The media and public health: complexity, controversy and combat
The overt role of journalists is to provide information to an interested or concerned public. But journalists also have a shadow role — generating entertainment value to enhance advertising and shareholder revenue. Likewise the overt role of public health officials is to disseminate accurate, timely information to inform an interested populace; but health officials too have a shadow role — to minimise the political risks of the elected branch of government
Craig B Dalton BMed, MMSc, FAFPHM
Can we feel it in our waters? Antimicrobials in aquaculture
Eating fish once or twice a week is promoted as good for your health — but is there a downside as well? With the global decline in wild fish stocks, there is an ever-increasing demand for aquaculture-produced fish and other aquatic foods. The aquaculture industry is relatively new but is growing rapidly in ...
Mary D Barton BVSc, PhD, FACVS · Olasumbo L Ndi BSc, MSc, PhD
Exploring the economics of helicopter rescue in Australia
Helicopter emergency medical services (HEMS) have a considerable history in Australia, with operations in Sydney dating back to 1973. HEMS have evolved from their original use in water-based search and rescue to become an established mode of medical transport in the local health system, helping to alleviate the “tyranny of distance” that restricts equitable access to health ...
Colman B Taylor BPhEd, MND · Stephen Jan BEc, MEc, PhD · John A Myburgh PhD, FCICM, FAICD
Take a deep breath . . . and talk
Eighty fewer deaths were recorded in the year following the adoption of the 4-hour rule by the emergency departments (EDs) of three tertiary hospitals in Western Australia1 — equivalent to almost half the state road toll. This remarkable result is regarded by some as preliminary. But if it stands the test of time, it will be testament to what is achievable with good up-front resourcing from a health department, plus improved communication — in this case, between the ED and the wards ...
Rachel E Nowak BSc, MA, PhD
The definite health risks from cutting power outweigh possible bushfire prevention benefits
On 2 January 2012, during a period of extremely hot weather, a South Australian electricity distributor deliberately cut power to several thousand homes because it was concerned that its electricity assets might cause a bushfire. Its action raises an important question: when does the risk of electricity assets causing a bushfire outweigh the benefits of having a power supply? ...
Richard A Broome MA, MB BS, MSc · Wayne T Smith MPH, FAFPHM, PhD
It’s not about choice: the supermarket and obesity
Supermarket design and strategy encourages shoppers to buy large quantities of high-profit-margin products. The emergence of supermarkets as a form of retailing and increasing reliance on manufactured foods have paralleled the increase in the rate and severity of obesity. So, it makes sense to examine supermarkets and how they successfully market these now widely used goods to the community. Supermarkets have an almost universal captive market — ...
Molly E Bond BBiotech(Hons), DipLang · Brad R Crammond MA(Hons), LLM · Bebe Loff LLB, MA, PhD
Automated office blood pressure measurement for routine clinical practice
Good correlation with out-of-office readings, virtual elimination of white-coat effectAn accurate blood pressure (BP) reading can be obtained if measurement guidelines are followed properly. However, BP readings recorded in routine clinical practice are often inaccurate and much higher than mean awake ambulatory BP values and readings obtained by home measurement. In studies that have included data on office BP readings that were recorded manually in ...
Martin G Myers MD, FRCPC · Mark R Nelson MB BS(Hons), PhD, FRACGP · Geoffrey A Head BSc(Hons), PhD
Improving effectiveness of clinical medicine: the need for better translation of science into practice
Published research evidence does not automatically diffuse into clinical practice but requires active processes of translation that start with clinicians’ awareness of the science and end with patient adherence to the recommended care. Many barriers thwart the uptake of valid and clinically important research into practice, with cognitive, motivational and sociological factors on the part of health professionals being among the most important. ...
Ian A Scott FRACP, MHA, MEd · Paul P Glasziou MB BS, FRACGP, PhD
Overactive bladder in men as a marker of cardiometabolic risk
Overactive bladder may be a marker of obstructive sleep apnoea or cardiometabolic riskThe lower urinary tract symptoms (LUTS) nocturia, urgency and frequency are grouped as “storage symptoms”. When troublesome, the presence of urgency plus one other symptom constitute overactive bladder (OAB).1 Dysfunction or irritability of the detrusor muscle of the urinary bladder is a primary cause of these symptoms, although coexistent prostatic disorders may be ...
Gary A Wittert MB Bch, MD, FRACP · Sean Martin BSc(Hons) · Peter Sutherland MB BS, FRACS · Susan Hall PhD · Varant Kupelian PhD · Andre Araujo PhD
e-Health records: beware of assumed benefit
Ray Moynihan rings some notes of caution coming from experiences elsewhereChange is perennial in health care, but some changes are more significant than others, like the personally controlled electronic health record (PCEHR) currently being rolled out across Australia. An ambitious reform, its much-touted benefits are safer and more effective care, less duplication of unnecessary tests — and, of course, enhanced datasets for researchers. As with ...
Ray N Moynihan BA
Highly sensitive troponin assays — a two-edged sword?
Lower specificity and lower positive predictive value necessitate a cautious approach. The advent of cardiac troponin (cTn) assays has redefined acute myocardial infarction (AMI) and revolutionised the care of patients with suspected AMI presenting to emergency departments (EDs). So central has cTn measurement become to the diagnosis of AMI that, since 2000, the formal criteria start with detection of rise and/or fall in serum troponin levels ...
Ian A Scott FRACP, MHA, MEd · Louise Cullen MB BS, FACEM · Jillian R Tate MSc, FFSc(RCPA) · William Parsonage BM BS, BMedSci, FRACP
What the public learns about screening and diagnostic tests through the media
Better journalistic standards for reporting on medical tests will mean better informed health care consumersScreening of healthy groups in the population and diagnostic testing on suspicion of disease are fundamental components of health care delivery and disease prevention. As the general media are important sources of health information for consumers, accurate and balanced reporting is essential. Media reporting of diagnostic tests is skewed towards screening ...
Amanda J Wilson PhD · Jane Robertson PhD · Benjamin D Ewald BMed, MMS, PhD · David Henry FRCP
A journalist’s view of reporting medical tests
Reporters need to balance real-world writing pressures against idealised reporting standards. When doctors and academics critique mainstream media health coverage, they typically suggest that this is to educate reporters about their failings, and/or to sound the alert generally about the media’s tendency to mislead a naive public into believing dangerous falsehoods about risks of disease, side effects of medicines, miracle cures and so on. The article by ...
Julie C Robotham MA
“Click first, care second” photography
Policies to prevent medical photography being performed unethically and unlawfully are critical in the digital ageIn the era of easily obtainable, easy-to-use digital cameras, any owner of a camera can be a “medical photographer”. Yet professionalism in obtaining medical photographs is much more than the sum of one’s equipment. Digital cameras, especially the ones in smartphones, give clinicians a high degree of autonomy in taking ...
Kara Burns BSci(AppSci)(Hons) · Suzanne Belton PhD
Do available predictions of future medical workforce requirements provide a sensible basis for planning? Yes
Professor Peter Brooks advocates increasing productivity and reducing demand to prepare for what lies aheadIf future increased health care demand in Australia is simply met by increasing medical workforce capacity by the year 2025, our country will go bankrupt. However, recently released modelling shows us how we can meet this demand in other ways. The most recent Health Workforce Australia report provides an interesting model of ...
Peter M Brooks MD, FRACP, FAFPHM
Do available predictions of future medical workforce requirements provide a sensible basis for planning? No
Professor Richard Murray explains why action on generalism, regional training and service reform is a national policy emergencyIt might surprise some to know that among wealthy Organisation for Economic Co-operation and Development (OECD) countries, Australia has an average number of doctors for its population.1 Australia has more doctors per capita than ever before, more than New Zealand, Canada, the United States and the United Kingdom. With ...
Richard B Murray MB BS, MPHTM, FACRRM
New money for chronic diseases: can clinicians and entrepreneurs deliver outcomes eluding governments?
Could savings for governments from objective reductions in preventable hospitalisations create long-term incentives for evidence-based health care? It is to our collective shame that those with chronic conditions in Australia suffer “a miserable existence in trying to organise their health care and prevent further deterioration”. With more than 1 million adults with cardiovascular disease and at least 800 000 with diabetes, we are ill equipped for the looming “tsunami ...
Jeanette E Ward PhD, FAFPHM, FACHSM
Controversy grows over redefinition of gestational diabetes
Ray Moynihan reports on the bitter battle over blood sugar levels and pregnancy. One of the freshest fights over the definition of disease is happening with gestational diabetes. A recent redefinition more than doubles the patient pool and labels up to one in five pregnant women as unwell. The new criteria arose at a conference in California in 2008, were published in 2010, and are now ...
Ray N Moynihan BA
Drug policy at the margins: the case of growth hormone replacement for adults with severe growth hormone deficiency
Are current standards of evidence always appropriate when making the decision to subsidise treatment?
Wendy L Lipworth MB BS, MSc, PhD · Ken Ho MD, FRACP, FRCP · Ian H Kerridge BMed(Hons), MPhil, FRACP · Richard O Day AM, MD, FRACP
The case for a national intern allocation system in Australia
A single entry and exit point model would be more efficient for graduates and employers alike. Completion of a structured internship is a requirement for medical graduates seeking to progress from provisional to general registration in Australia. Despite minor historical variations between states and territories, there is increasing consistency among internship programs across the country. Driving forces behind this include the establishment of a national registration ...
Michael A Bonning MB BS, BAppSci(Hons) · Rick J Fielke MB BS, GradCertMed(PaedMed) · Rob D Mitchell MB BS(Hons), BMedSc(Hons)
The Hospital Skills Program: a professional development program for non-specialist doctors in New South Wales
Supporting a previously neglected group of doctors will improve the safety, efficiency and efficacy of patient careThe Hospital Skills Program (HSP) is a flexible training and professional development program for New South Wales career medical officer (CMO)-equivalent medical practitioners with needs that are not met by prevocational and specialist college training programs. The 510 enrolled doctors work in a range of public health services across NSW ...
Simon D Leslie MB BS · Peter Davy BEd · Michael Boyd MB BS · Mary Webber MB BS
The ethics of industry sponsorship of charities
Nathan Grills examines unhealthy alliances that highlight corporate social irresponsibilityIndustry sponsorship of charitable causes is increasingly promoted and practised across the corporate sector in Australia and overseas. But should such “corporate social responsibility” be limited in certain circumstances? Apart from tobacco companies, there are currently very few restrictions on which industries are allowed to support which charities. But there is a need to consider whether ...
Nathan J Grills MB BS, DPhil, MPH
Measuring performance and outcomes of acute coronary syndromes management in Australia
A national registry for acute coronary syndromes will improve patient care and clinical resultsAcute coronary syndromes (ACS) represent a substantial burden of morbidity and mortality within Australia.1 Modern treatment of these syndromes requires efficient risk stratification, timely angiography and revascularisation, and use of proven secondary prevention therapies.2-4 With a robust evidence base, it is a reasonable societal expectation that care be applied as completely as ...
Derek Chew MB BS, MPH, FRACP · David Brieger MB BS, PhD, FRACP · Carolyn M Astley RN, BN(Hons) · Andrew Georgiou PhD, FACHI, FCHSM
Importance of ambulatory blood pressure in hypertension management
Ambulatory monitoring is critical in accurately assessing blood pressure to calculate absolute cardiovascular risk. Recently, there has been debate about the need for ambulatory blood pressure monitoring (ABPM) in clinical decision making, promoting instead the use of an absolute cardiovascular disease (CVD) risk-based approach. While we fully endorse hypertension management based on absolute risk, inherent in this assessment is the accurate measurement of blood pressure (BP). ...
Geoffrey A Head BSc, PhD · Barry P McGrath MB BS, MD, FRACP · Mark R Nelson MB BS(Hons), PhD, FRACP · Michael Stowasser MB BS, MD, FRACP
Domestic violence: can doctors do more to help?
One of the centrepieces of this week’s Primary Health Care Research Conference in Canberra will be a presentation, billed as “best paper” at the conference, on how general practitioners respond to women who fear violence at the hands of their partners. Despite a long history of concern and policy action to reduce domestic violence, it remains ...
Ray N Moynihan BA
