Statistics

Consistent with studies from the United States, this study provides the first strong Australian evidence that areas of low socioeconomic status have a higher density of tobacco retail outlets. The findings have broad public health implications and raise the question of whether we should move to regulate the number of outlets licensed to sell tobacco products.

Lisa J Wood BCom, GradDipHlthProm, PhD, · Gavin Pereira PhD · Nick Middleton BSc(Hons) · Sarah Foster BSc, MPH, PhD

Damien Jolley was born in Melbourne on 23 March 1954. He graduated from the University of Melbourne in 1976 with a combined Bachelor of Science (Honours) and Diploma of Education. After a short period teaching mathematics, he moved to Papua New Guinea with Australian Volunteers International and began his epidemiological studies. Five years later, he returned to Melbourne and completed a Master of Science in statistics while ...

Judy A Lowthian · John J McNeil

This study suggests that recent media reports and public concern about concussion sustained during sport are valid, as the frequency of hospitalisation for concussed players in Victoria increased significantly between 2002–03 and 2010–11, with substantial associated economic costs.

Caroline F Finch BSc(Hons), MSc, PhD, · Angela J Clapperton M(Counsel), GradDipEdPsych, BSc(Behav) · Paul McCrory MB BS, PhD, FRACP

A NSW study found low rates of self-reported influenza vaccine uptake in pregnant women. Women who had received a recommendation to have the vaccine were 20 times more likely to have been vaccinated, but less than half recalled receiving such a recommendation. Most of the women who expressed safety concerns about the vaccine indicated they would have the vaccine if their doctor recommended it.

Kerrie E Wiley MScMed(ClinEpid) · Peter D Massey DrPH, GCPH, RN · Spring C Cooper BS, PhD · Nicholas J Wood MB BS, FRACP, PhD · Jane Ho BMed, FRACP, MPH · Helen E Quinn BSc(Hons), MAppEpid, PhD · Julie Leask PhD, MPH

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

An antibiotic stewardship program in a tertiary referral hospital immediately reduced use of broad-spectrum antibiotics but will it stand the test of time?

Kelly A Cairns BPharm, GradDipClinPharm · Adam W J Jenney MB BS, FRACP, FRCPA · Iain J Abbott MB BS · Matthew J Skinner MB BS, FRACP · Joseph S Doyle MB BS, MSc, FRACP · Michael Dooley BPharm · Allen C Cheng MPH, PhD, FRACP

Eight years after the first Bali bombing, a cross-sectional study of Australians who were directly affected by the attacks found that they tended to have good physical health but high rates of psychological distress.

Garry J Stevens BSc(Hons), MClinPsych, MAPS · Julie C Dunsmore BSc(Psych)(Hons), MPH, MAPS · Kingsley E Agho BSc(Hons), PhD, MPH · Melanie R Taylor BSc(Hons), PhD, CPsychol · Alison L Jones MD, FRCP, FRCPE · Jason J van Ritten BSc(Hons), GradCertSRM · Beverley Raphael MB BS, MD, FRANZCP

To the Editor: Caplan et al1 include in their meta-analysis a trial by Mather et al that compared home care with intensive care management of patients with acute myocardial infarction (AMI) between 1966 and 1968.2 A joint working party of the Royal College of Physicians and British Cardiac Society dismissed the results of this study because of design defects.3,4 Kalra et al5 performed a randomised trial with ...

Hugh G Dickson

In reply: Dickson argues for exclusion of randomised controlled trials (RCTs) if treatments have changed, but treatments are constantly changing so, following this rule, meta-analysis would be impossible. Similarly, diagnosis has changed — stroke was a clinical diagnosis, then computed tomography was required, and now magnetic resonance imaging is needed. Equipoise is not a requirement for inclusion in a meta-analysis. Complaints about research being simplistic because ...

Gideon A Caplan

CORRECTION Typographical errors in tables of birthweight percentiles: In “Australian national birthweight percentiles by sex and gestational age, 1998–2007”, in the 3 September 2012 issue of the Journal (Med J Aust 2012; 197: 291-294; doi: 10.5694/mja11.11331), there were two errors in Box 3 and one in Box 4 (page 293). In Box 3, the 25th percentile for boys with a gestational age of 34 weeks should be 2100 g, not 200 g, and ...

Timothy A Dobbins BMath, PhD · Elizabeth A Sullivan MD, MPH, FAFPHM · Christine L Roberts MB BS, DrPH, FAFPHM · Judy M Simpson BSc(Hons), PhD

Introducing a series of articles emerging from a summit convened by the MJA in 2012, to pave the way for high-quality, relevant and implementable health and health care research.

R John Simes MD, SM, FRACP · Steven A R Webb MB BS, PhD, FCICM

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

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

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

Using cases as their own controls potentially provides stronger evidence for analysing adverse events following vaccinationMMaintaining public confidence in vaccines requires having effective postmarketing vaccine safety surveillance systems in place to rapidly address emerging concerns about vaccine safety. However, conducting studies of vaccine safety presents several challenges for traditional observational study designs. Important differences may exist between vaccinated and unvaccinated individuals that could confound the ...

Steven Hawken MSc · Kumanan R Wilson MD

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

Tests for serum vitamin B12 and red cell folate levels are commonly requested in elderly inpatients to rule out reversible causes of cognitive impairment (eg, delirium). This imposes some cost on the community. The evidence for the association of cognitive impairment and vitamin B12 deficiency is inconclusive. It is also unclear whether other markers, such as elevated mean corpuscular volume (MCV) and ...

Celia S M Ting · John C Oldroyd · Michele R Levinson

These data show a sustained and substantial decline in severe rotavirus disease and all-cause AGE since the introduction of rotavirus vaccination, most pronounced in the target age group, but with evidence of herd immunity. The impact of rotavirus vaccination in Indigenous children in hyperendemic settings was less remarkable.

Aditi Dey MB BS, MPH, PhD · Han Wang MStats · Robert Menzies BAppSc, MPH, PhD · Kristine Macartney MB BS, MD, FRACP

Objective: To estimate the risk of active tuberculosis (TB) in immigrants to Victoria, Australia, as a function of time since arrival and stratified by age group and region of origin.Design, setting and subjects: Longitudinal study of the incidence of active TB in Victorian immigrants, excluding New Zealanders, who arrived in Australia between 1975 and 2007. Victorian immigration data were used to describe annual arrival ...

Emma S McBryde MB BS, PhD, FRACP · Justin T Denholm BMed, MPHTM, FRACP

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

Changing clinician beliefs and behaviour in response to credible evidence of lack of treatment efficacy remains highly challengingArthroscopy is commonly used to treat people with knee pain due to osteoarthritis. However, data collected from randomised controlled trials over the past two decades have provided compelling evidence that, in general, arthroscopic treatment comprising debridement and lavage is no more effective than placebo surgery or non-operative alternatives,1,2 ...

Rachelle Buchbinder MB BS(Hons), MSc, PhD · Ian A Harris MB BS, MMed(Clin Epi), PhD

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

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

Objective: To assess the use of elective knee arthroscopy procedures for all adults 20 years and older, and for adults with a concomitant diagnosis of osteoarthritis (OA) in Victoria.Design, setting and patients: Retrospective, longitudinal cohort study of 807 030 elective orthopaedic admissions using routinely collected public and private hospital data from 1 July 2000 to 30 June 2009.Main outcome measure: Trends in rates of elective ...

Megan A Bohensky PhD, MPH, BA · Vijaya Sundararajan MD, MPH · Nick Andrianopoulos MB BS, MBiostat · Richard N de Steiger MB BS, FRACS, FAOrthA · Andrew Bucknill MSc, MB BS, FRACS · Christos M Kondogiannis MB BS, FRACS · Geoffrey McColl MB BS, PhD, MEd · Caroline A Brand MB BS, MPH

To the Editor: A recent editorial in the Journal1 is another in a long line of articles arguing that national linkage of routine care-delivery data will enable us to improve the health care provided to Australian patients.2 However, over the past three decades, progress on national data linkage has been painfully slow. Anyone who has ventured down the path of obtaining national linked data can ...

Michael D Coory