Article Types
Perspectives
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
Barriers to “appropriate care” in general practice
Clinical practice guidelines are useful, but there is much more to delivering optimal care in the primary care settingThe CareTrack study reported by Runciman and colleagues in this issue of the Journal raises serious concerns about the delivery of appropriate health care in Australia.1 Yet we have some of the strongest benchmarks internationally,2 and Australia is one of the world’s healthiest countries.3 How can this ...
Evan Ackermann MB BS, FRACGP
Towards the delivery of appropriate health care in Australia
For decades, there have been concerns about the extent to which the health system provides the right care to those who need it in a cost-effective, timely manner. In Australia, there has been much discussion and marked improvements in some areas, but the provision of highly ...
William B Runciman MB BCh, FANZCA, PhD · Enrico W Coiera MB BS, PhD, FACMI · Richard O Day MD, FRACP, MB BS · Natalie A Hannaford DipAppSc(Nursing), MPH · Peter D Hibbert BAppSc(Physio), GradDipComp, GradDipEcon · Tamara D Hunt BAppSc(Nursing), CritCareCert · Johanna I Westbrook PhD, GradDipAppEpid, MHA · Jeffrey Braithwaite PhD, MBA, FCHSM
Medicine and science must oppose intolerance and censorship
Friends of Science in Medicine should avoid threatening their own valuesScience has always been — and should be — a battleground for contending views on what is true. Because of the close connection between knowledge and power, however, the risk is always present that those who command the dominant theories or ideologies will rely on their positions of influence to overcome those who oppose them. ...
Paul A Komesaroff MB BS, PhD, FRACP · Amber Moore BChineseMed(Hons), BA(Hons) · Ian H Kerridge MPhil, FRACP, FRCPA
International medical graduates in Australia: a historical perspective (1930–1950s)
The postwar arrival of refugee doctors heralded changes to the Australian health workforce that we are still adjusting to todayInternational medical graduates (IMGs) are an important part of Australia’s health workforce, accounting for about 23.5% (n = 16 186) of all doctors in Australia today.1 The recruitment and placement of IMGs in rural areas is particularly vital to the provision of health services in rural Australia, where there ...
Daniel R Terry BNurs, MInternatHlth · Jessica J Woodroffe BA(Hons), PhD · Quynh Le PhD, MAppComp, MEdStud · Kathryn J Ogden MB BS(Hons), MPH, FRACGP
Is it too late to prevent a decline in mental health care for older Australians?
Action is required now for future older Australians to receive adequate mental health careOver the next 20 years, the number of Australians aged 65 years and over is projected to nearly double from around 3.2 million to about 6.2 million people.1 Individuals with lifelong mental illness will be joined by those with new mental disorders, such as mood disorders, late-life psychoses and anxiety disorders that are often associated with ...
Roderick G McKay BSc, MB BS, FRANZCP · Brian M Draper MB BS, MD, FRANZCP
Can we educate out of racism?
Dennis McDermott argues that educating doctors about the health consequences of everyday racism towards Indigenous Australians challenges all involvedAgenuine engagement with Indigenous health issues challenges medical students and doctors alike. When participants in medical education analyse racism as a social determinant of health, the challenge deepens. The experience can range from disquieting to profoundly disturbing. For educators, the experience can be stressful, even daunting. Analysing racism ...
Dennis R McDermott BEc, BA(Hons)(Psych), MA
Ten principles relevant to health research among Indigenous Australian populations
Working with Indigenous communities towards research that is relevant, effective and culturally respectful. Writing in the Journal about Indigenous health in 2011, Sir Michael Marmot suggested that the challenge was to conduct research, and to ultimately apply findings from that research, to enable Indigenous Australians to lead more flourishing lives that they would have reason to value. As committed Indigenous health researchers in Australia, we reflect ...
Lisa M Jamieson PhD · Yin C Paradies PhD · Sandra Eades PhD · Alwin Chong MPH · Louise Maple-Brown PhD · Peter Morris PhD · Ross Bailie PhD · Alan Cass PhD · Kaye Roberts-Thomson MPH · Alex Brown PhD
Genetic research in Indigenous health: significant progress, substantial challenges
Genomics is a powerful research tool, but it must be handled with careOf all the measurements and biological samples used in health research, it is the extraction and analysis of genetic material that has caused the most controversy in indigenous health research across the globe. No other kind of research has a specific inter- national non-governmental organisation dedicated to opposing it — the Indigenous People’s ...
Emma E Kowal MB BS, BA(Hons), PhD
