General medicine

Objectives: To measure the frequency and content of electronic handover before and after implementation of the Blue BARRWUE handover system, and to measure its effect on patient safety and hospital efficiency over weekends.Design, setting and participants: Point-prevalence study comparing outcomes for general medical inpatients present over weekends before implementation (1 May 2008 to 30 April 2009) and after implementation (1 May 2009 to 30 April 2010) of ...

Boloor S Rao MB BS, DNB · Gail O Lowe RN, BN, MHA · Andrew J Hughes MB BS, FRACP

In 2009, Don Berwick, former president of the US-based Institute for Healthcare Improvement, gave an impassioned speech at the International Forum on Quality and Safety in Healthcare about why he was afraid of becoming a patient. It wasn’t, as one might expect from a prominent researcher of medical error, the danger of adverse events. When it came to safety, he said, he would have ...

Ruth Armstrong · Ann Gregory

Objective: To assess the effect of “hospital in the home” (HITH) services that significantly substitute for inhospital time on mortality, readmission rates, patient and carer satisfaction, and costs.Data sources: MEDLINE, Embase, Social Sciences Citation Index, CINAHL, EconLit, PsycINFO and the Cochrane Database of Systematic Reviews, from the earliest date in each database to 1 February 2012.Study selection: Randomised controlled trials (RCTs) comparing HITH care with ...

Gideon A Caplan MB BS, MD, FRACP · Nur S Sulaiman MB BS · Dee A Mangin MB ChB · Nicoletta Aimonino Ricauda MD · Andrew D Wilson MD, FRCGP · Louise Barclay BN

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

We support the recommendation of Runciman and colleagues for national agreement on clinical standards of health care, and highlight the importance of including routine health promotion activities as a core part of quality care in clinical practice. The indicators used by Runciman et al fail to consider core aspects of preventive care, such as screening and evidence-based behavioural interventions for lifestyle risk ...

Annemarie Wright · Bruce Bolam

To the Editor: The closet is a common lesbian response to prejudice, discrimination and stigma. Many rural lesbians choose to “pass” as heterosexual and keep their sexuality secret.1,2 Research shows that this secrecy is fuelled by the fear of violence, including harassment, ostracism and rejection,2 and it is unlikely that a lesbian will disclose her sexuality to a doctor unless she feels safe. Without full ...

Cathy Wheel

After a spectacular arrival in the early 1990s (JAMA 1992; 268: 2420-2425), evidence-based medicine quickly evolved beyond generating the best research evidence, to acknowledging a need to integrate this evidence with clinical expertise and patient values — to weave the science with the art of medicine. Several of the articles in this issue of the MJA highlight that, in Australian clinical practice, the resulting fabric ...

Ann Gregory · Ruth Armstrong

Two studies testing interventions that made little difference to patient outcomes demonstrate the importance of translational researchGeneral practitioners are often expected to implement findings of clinical trials done in hospitals or academia. Health policymakers also develop and implement primary health care system changes without proper evaluation or being informed by translational research studies. Two clinical trials reported in this issue of the Journal give us ...

Mark R Nelson MB BS(Hons), FRACGP, PhD

The central role for Australian general practice in providing high-quality affordable health care for all Australians has been underlined repeatedly by national health bodies including the National Health and Hospitals Reform Commission (NHHRC), the Council of Australian Governments Reform Council, the National Primary Health Care Strategy, the National E-Health Transition Authority and Health Workforce Australia. The Australian Health Practitioner Regulation Agency has recognised general practice ...

Claire L Jackson MB BS, MD, FRACGP

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

In Australia, chronic vascular diseases such as heart disease and diabetes are the leading causes of death and disability. Intensive lifestyle interventions have been shown to prevent vascular disease and diabetes in high-risk patients ...

Mark F Harris MB BS, MD, FRACGP · Mahnaz Fanaian BSc, MSc, PhD · Upali W Jayasinghe GradDipAppStat, MSc, PhD · Megan E Passey BMed, MPH, MSc · Suzanne H McKenzie MB BS, MMedSci, FRACGP · Gawaine Powell Davies BA(Hons), MHP · David M Lyle MB BS, PhD, FAFPHM · Rachel A Laws BSc(Nutrition), MSc(Nutrition · Heike Schütze BSc, MPH · Qing Wan MB BS, MPH, PhD

Objective: To evaluate a partnership model of care for patients with a diagnosis of chronic obstructive pulmonary disease (COPD).Design, setting and participants: Cluster randomised controlled trial with blinded outcome assessment of 44 general practices in south-western Sydney comprising 451 people with a diagnosis of COPD, conducted between 2006 and 2009.Intervention: Participants from intervention group practices were visited at their home by a ...

Nicholas A Zwar MPH, PhD, FRACGP · Oshana Hermiz MB BS · Elizabeth Comino BVSc, PhD · Sandy Middleton PhD · Sanjyot Vagholkar MB BS, MPH · Wei Xuan PhD · Stephen F Wilson PhD, FRACGP, FAFRM · Guy B Marks MB BS, PhD, FRACP

International and Australian studies show that well structured approaches to diabetes care can improve short-term and intermediate patient outcomes ...

Julia V Marley PgDipSc, PgDipPolSt, PhD · Carmel Nelson MPHandTM, FACRRM, FRACGP · Vicki O’Donnell DipBusMgt · David Atkinson MB BS, MPH

Long-term continuity of care and community engagement mean a lot to a doctor. When we pulled up in the driveway of our first rented house in Camperdown, south-west Victoria, a woman’s face appeared over the fence. “Hello”, she said, “Who are you? What are you doing here?” I explained that we were doctors and would be working in the town. “Oh, you got any family here?” ...

Ruth A Stewart MB BS, FACRRM, DRANZCOG

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

Appropriate assessment and management of diabetes-related foot ulcers (DRFUs) is essential to reduce amputation risk. Management requires debridement, wound dressing, pressure off-loading, good glycaemic control and potentially antibiotic therapy and vascular intervention. As a minimum, all DRFUs should be managed by a doctor and a podiatrist and/or wound care nurse. Health professionals unable to provide appropriate care for people with DRFUs should ...

Shan M Bergin BAppSci(Pod), PhD · Joel M Gurr BSc(Pod), MBA · Bernard P Allard MB BS, FRACS(Vasc) · Emma L Holland RN, CDE, MA(Ed) · Mark W Horsley MB BS, FRACS(Ortho) · Maarten C Kamp FRACP, MHA, GAICD · Peter A Lazzarini BAppSci(Pod) · Vanessa L Nube DipAppSci(Pod), MSc(Med) · Ashim K Sinha MB BS, MD, FRACP · Jason T Warnock DipAppSc(Chir), GradCertDiabEd · Jan B Alford RN, MEd(AdEd), CDE · Paul R Wraight MB BS, FRACP, PhD

Traumatic injury accounts for 9% of global mortality, and imposes significant physical and psychological disability on people of all age groups. It remains the leading cause of death in those under 45 years of age. Trauma systems facilitate the timely treatment of patients with major trauma at a trauma centre. This approach has reduced mortality in patients with trauma in Australia and internationally.

Kate A Curtis PhD, RN · Rebecca J Mitchell MA (Psych), MOHS, PhD · Shanley S Chong PhD · Zsolt J Balogh MD, PhD, FRACS · Duncan J Reed MB BS, FACEM · Peter T Clark FACEM, FCICM, FANZCA · Scott D’Amours MDCM, FRCS(C), FRACS · Deborah A Black PhD, MStat, BSc · Mary E Langcake BM BS, BSc(Hons), FRACS · Colman B Taylor MND · Patricia McDougall RN, Cert Hlth Economics · Peter A Cameron MB BS, MD, FACEM

Objective: To compare the Better Access to Psychiatrists, Psychologists and General Practitioners through the MBS initiative with the Better Outcomes in Mental Health Care initiative, to test contentions that Better Access is used more often by advantaged major city patients and that the role of GPs has been reduced to that of referrers.Design and setting: Analysis of Bettering the Evaluation and ...

Christopher M Harrison BPsych(Hons), MSocHlth · Helena C Britt BA, PhD · Janice Charles BA, MSc(Med)

Sir Keith Jones, who died on 2 March 2012 in his 101st year, had a long and distinguished medical career, during which he gave service to the medical profession through the British Medical Association in Australia and, later, in various capacities, the Australian Medical Association (AMA) after its formation in 1962. He was President of the AMA from 1973 to 1976 and Chairman of the Board of the Australasian ...

George D Repin

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

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