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In reply: We thank Fielke for his interest in our article.1 Our study used the 20th centile method of the Australasian clinical indicator report on obstetrics, conducted by the Australian Council on Healthcare Standards (ACHS).2 The ACHS defines the 20th centile as a “best practice rate” that is potentially achievable and uses it to identify and prioritise clinical areas in which research and quality improvement ...

Yuen Yi (Cathy) Lee · Christine L Roberts · Jillian A Patterson

A 35% drop in invasive pneumococcal disease has been found in older people after 6-7 years of vaccine use

Robert I Menzies BAppSc, MPH, PhD · Sanjay H Jayasinghe MB BS, MSc · Vicki L Krause MD, DTM · Clayton K Chiu MB BS, MPH · Peter B McIntyre MB BS, PhD, FRACP

We offer an alphabetical guide into the opaque and mystical world of researchMany are called to do research, but few are chosen. How is this possible in an era of improved gender equality, educational access and global connectivity? The answer lies in the secret “Da Vinci Code” of research: the unwritten interpretation of the alphabet of research that touches us all through serial rejection of ...

Dominic A Fitzgerald MB BS, PhD, FRACP · David Isaacs MB BChir, MD, FRACP · Steve Isaacs MB BChir, MRCP, MRCPsych

Weather-related natural disasters in Queensland in recent years have damaged not only property, but also the mental condition of those affected.

Susan L Clemens MPH · Helen L Berry PhD · Brett M McDermott MD, FRANZCP · Catherine M Harper MPH

Comparing caesarean rates between hospitals and groups of women with differing pregnancy characteristics showed persistent variation after adjusting for casemix. Reducing variation in practice has potential to reduce the concerningly high caesarean rate in Australia.

Yuen Yi (Cathy) Lee BMathAdv(Hons), MBiostat · Christine L Roberts MB BS, DrPH · Jillian A Patterson BScAdv(Hons), MBiostat · Judy M Simpson BSc(Hons), PhD, CStat · Michael C Nicholl MB BS, FRCOG, FRANZCOG · Jonathan M Morris MB ChB, FRANZCOG, PhD · Jane B Ford BA(Hons), PhD

A “real world” audit comparing patient characteristics, patterns of investigation, treatment and patient outcomes can highlight variations in care and areas for improvement

Peter S MacDonald MB BS, MD, PhD · Phillip J Newton RN, BN(Hons), PhD · Patricia M Davidson RN, BA, PhD

This first decision-impact study of the Oncotype DX breast cancer assay in Australia provides evidence that recurrence score information influences treatment recommendations for hormone receptor-positive early-stage invasive breast cancer in the multidisciplinary meeting setting

Richard H de Boer MB BS, FRACP · Caroline Baker MB BS, FRACS · David Speakman MB BS, FRACS · Calvin Y Chao MD · Carl Yoshizawa PhD · G Bruce Mann MB BS, PhD, FRACS

The problem of excessive psychotropic drug use in Australian nursing homes is well known, but where are the solutions?

Juanita L Westbury · Gregory M Peterson

To the Editor: The article by Hilmer and Gnjidic1 raises issues about the management of behavioural and psychological symptoms of dementia (BPSD)2 in residential aged care facilities (RACFs). It is important to remember the context in which RACF residents’ care is provided. The federally managed aged care system is politically and organisationally perceived as supported accommodation, which is geared toward supporting or substituting for residents’ performance ...

Ludomyr J Mykyta

In reply: We thank Westbury and Peterson, and Mykyta for highlighting some of the issues raised in our article.1 While we acknowledge the important contribution of providing education programs to existing staff, staff education alone is insufficient to address the complex issues affecting psychotropic drug use in nursing homes.1 Better access to appropriately trained staff in nursing homes, including general practitioners, geriatricians, psychogeriatricians, psychologists, pharmacists, nurses ...

Sarah N Hilmer · Danijela Gnjidic

When considering this controversial procedure, how do we weigh the results of patient satisfaction surveys with those of clinical trials?

Wayne Adams

In reply: We thank Adams for providing private health insurance data that confirm the continued use of arthroscopic surgery for patients with osteoarthritis. We agree that the patient’s view of the benefits of the procedure is fundamental to assessing treatment success. We do not doubt that many patients are happy with the results of arthroscopic knee surgery, but this does not necessarily imply that the surgery ...

Rachelle Buchbinder · Ian A Harris

While the quality of data in the peer-reviewed literature has improved over time, there are still some important gaps in the evidence. The findings of this study provide a framework to allow Indigenous communities, researchers, funding bodies and the NHMRC to consider priorities for future research.

Peter S Azzopardi MB BS, MEpi, FRACP · Elissa C Kennedy MPH, MB BS · George C Patton MB BS, MD, FRANZCP · Robert Power BSc(Econ), PhD, PGCE · Robert D Roseby MB BS(Hons), FRACP · Susan M Sawyer MB BS, MD, FRACP · Alex D Brown BMed, MPH, PhD

Linked records for patients who died from primary advanced oesophageal carcinoma reveal an unfortunate trend in access to palliative care — greater socioeconomic disadvantage is significantly associated with decreasing odds of stent insertion for palliation of symptoms such as dysphagia and odynophagia

Jason P Bentley · David E Goldsbury · Guy D Eslick · Michael R Cox · Dianne L O’Connell

With human papillomavirus vaccination for boys now on Australia’s National Immunisation Schedule, this study determined background rates of potential adverse events, assuming temporal association with vaccination but no other association. The findings will help to determine whether adverse event reports represent real safety flags that require urgent investigation.

Hazel J Clothier FIBMS, MSc, MAppEpid · Katherine J Lee BSc, MSc, PhD · Vijaya Sundararajan MD, MPH · Jim P Buttery FRACP, MD, MSc · Nigel W Crawford BM BS, MPH, PhD