Topics

The epidemiology of bloodstream infections has changed during the early 21st century, and our understanding of complex host–pathogen relationships continues to evolve. Enterococci have emerged as major community and health care pathogens; the association of colorectal neoplasia with enterococcal infections has recently been reported, particularly with community‐acquired Enterococcus faecalis bacteraemia of unknown source.1,2

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1 Barwon Health, Geelong, VIC
2 Deakin University, Melbourne
3 University Hospital Geelong, Geelong, VIC
4 Swinburne University of Technology, Melbourne, VIC

Correspondence: eugene@barwonhealth.org.au

Competing interests:

No relevant disclosures.

1. Correidoira J, García‐País MJ, Coira A, et al. Differences between endocarditis caused by Streptococcus bovis and Enterococcus spp. and their association with colorectal cancer. Eur J Clin Microbiol Infect Dis 2015; 34: 1657–1665.
2. Pericàs JM, Corredoira J, Moreno A, et al. Relationship between Enterococcus faecalis infective endocarditis and colorectal neoplasm: preliminary results from a cohort of 154 patients. Rev Esp Cardiol (Engl Ed) 2017; 70: 451–458.
3. Murray HW, Roberts RB: Streptococcus bovis bacteremia and underlying gastrointestinal disease. Arch Intern Med 1978; 138: 1097–1099.
4. Reynolds JG, Silva E, McCormack WM. Association of Streptococcus bovis bacteremia with bowel disease. J Clin Microbiol 1983; 17: 696–697.
5. Leport C, Bure A, Leport J, Vilde JL. Incidence of colonic lesions in Streptococcus bovis and enterococcal endocarditis. Lancet 1987; 1: 748.
6. Corredoira J, Alonso MP, Coira A, et al. Characteristics of Streptococcus bovis endocarditis and its differences with Streptococcus viridans endocarditis. Eur J Clin Microbiol Infect Dis 2008; 27: 285–291.

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Editorials

High intensity lipid‐lowering therapy after acute coronary syndromes: room for improvement

Karam Kostner

Med J Aust 2019; 210 (2): . || doi: 10.5694/mja2.12055
Published online: 4 February 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Anatomy and physiology

Health services administration

Effective therapies are available, but too few patients are receiving them

There is a significant amount of evidence that intensive statin therapy reduces the likelihood of cardiovascular events in people who have had an acute coronary syndrome (ACS), and such therapy is given the highest grade of recommendation in Australian clinical practice guidelines.1 Post hoc analyses of randomised trials of treatment with statins, statins and ezetimibe, or, more recently, proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors indicate that patients who achieve very low low‐density lipoprotein cholesterol (LDL‐C) levels are at very low risk of cardiovascular events after an ACS, and that the rates of adverse events related to attaining such levels are not increased.2,3 In the Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE‐IT), the combination of simvastatin and a non‐statin LDL‐lowering treatment (ezetimibe) reduced LDL‐C levels to a median 1.4 mmol/L, and this was associated with reduced numbers of clinical events.4 In the Odyssey Outcomes trial, a combination of statins and alirocumab (a PCSK9 inhibitor) reduced LDL‐C levels to below 1.0 mmol/L and this was associated with reduced numbers of major adverse cardiovascular events.3 These trials provide further support for the LDL‐C hypothesis of cardiovascular risk, which suggests that the risk of a cardiovascular event is reduced by about 22% for each 1.0 mmol/L reduction in LDL‐C levels.2

Mater Hospital, Brisbane, QLD

Correspondence: k.kostner@uq.edu.au

Competing interests:

No relevant disclosures.

1. Chew DP, Scott IA, Cullen L, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of acute coronary syndromes 2016. Heart Lung Circ 2016; 25: 895–951.
2. Shepherd J, Barter P, Carmena R, et al. Effect of lowering LDL cholesterol substantially below currently recommended levels in patients with coronary heart disease and diabetes: the Treating to New Targets (TNT) study. Diabetes Care 2006; 29: 1220–1226.
3. Schwartz GG, Steg PG, Szarek M, et al. Alirocumab and cardiovascular outcomes after acute coronary syndrome. N Engl J Med 2018; 379: 2097–2107
4. Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015; 372: 2387–2397.
5. De Vera MA, Bhole V, Burns LC, Lacaille D. Impact of statin adherence on cardiovascular disease and mortality outcomes: a systematic review. Br J Clin Pharmacol 2014; 78: 684–698.
6. Brieger D, D'Souza M, Huyn K, et al. Intensive lipid‐lowering therapy in the 12 months after an acute coronary syndrome in Australia: an observational analysis. Med J Aust 2019; 210: 000–000.
7. Jackevicius CA, Mamdani M, Tu JV. Adherence with statin therapy in elderly patients with and without acute coronary syndromes. JAMA 2002; 288: 462–467.
8. Wouters H, Van Dijk L, Geers HC, et al. Understanding statin non‐adherence: knowing which perceptions and experiences matter to different patients. PLoS One 2016; 11: e0146272.73.
9. Wu JY, Leung WY, Chang S, et al. Effectiveness of telephone counselling by a pharmacist in reducing mortality in patients receiving polypharmacy: randomised controlled trial. BMJ 2006; 333: 522.

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Editorials

Pregabalin misuse: the next wave of prescription medication problems

Bridin Murnion and Katherine M Conigrave

Med J Aust 2019; 210 (2): . || doi: 10.5694/mja2.12056
Published online: 4 February 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Mental disorders

Poisoning

Pharmaceutical preparations

Overseas experience need not portend the future of prescription drug misuse in Australia

Dispensing data indicate that pregabalin prescribing in Australia is rising rapidly, and the numbers of self‐poisonings and deaths are also increasing.1 This mirrors the European and North American experience of escalating misuse and harms.2,3 Although Australian guidelines recommend it only as second line treatment for neuropathic pain,4 pregabalin is now the seventh most expensive drug in terms of Pharmaceutical Benefits Scheme (PBS) expenditure.5

1 Drug and Alcohol Services, Wyong Hospital, Wyong, NSW
2 University of Sydney, Sydney, NSW
3 Drug Health Services, Royal Prince Alfred Hospital, Sydney, NSW

Correspondence: bridin.murnion@sydney.edu.au

Competing interests:

No relevant disclosures.

1. Cairns R, Schaffer AL, Ryan N, et al. Rising pregabalin use and misuse in Australia: trends in utilization and intentional poisonings. Addiction 2018; https://doi.org/10.1111/add.14412.
2. Lyndon A, Audrey S, Wells C, et al. Risk to heroin users of polydrug use of pregabalin or gabapentin. Addiction 2017; 112: 1580–1589.
3. Gomes T, Greaves S, van den Brink W, et al. Pregabalin and the risk for opioid‐related death: a nested case‐control study. Ann Int Med 2018; 169: 732–734.
4. Siddall P, Hall A. Neuropathic pain: diagnosis and treatment today. Medicinewise News [online]. Mar 2018. https://cdn0.scrvt.com/08ab3606b0b7a8ea53fd0b40b1c44f86/07f7c27169bb23c8/1d249d6217dd/NPS1992_MW_News_NP_v2.pdf (viewed Oct 2018).
5. Australian Government Department of Health. PBS Expenditure and prescriptions, twelve months to 30 June 2017. http://www.pbs.gov.au/statistics/expenditure-prescriptions/2016-2017/expenditure-and-prescriptions-twelve-months-to-30-june-2017.pdf (viewed Oct 2018).
6. Crossin R, Scott D, Arunogiri S, et al. Pregabalin misuse‐related ambulance attendances in Victoria, 2012–2017: characteristics of patients and attendances. Med J Aust 2019; 210: 000–000.
7. Morrison EE, Sandilands EA, Webb DJ. Gabapentin and pregabalin: do the benefits outweigh the harms? J R Coll Physicians Edinb 2017; 47: 310–313.
8. Australian Institute of Health and Welfare. Impacts of chronic back problems (AIHW Bulletin 137). Aug 2016. https://www.aihw.gov.au/getmedia/9018da61-cdf0-4e3a-bd98-2508f515290d/19839.pdf.aspx?inline=true (viewed Oct 2018).
9. Shanthanna H, Gilron I, Rajarathinam M, et al. Benefits and safety of gabapentinoids in chronic low back pain: a systematic review and meta‐analysis of randomized controlled trials. PLoS Med 2017; 14: e1002369.
10. Mathieson S, Maher CG, McLachlan AJ, et al. Trial of pregabalin for acute and chronic sciatica. N Engl J Med 2017; 376: 1111–1120.
11. Hayes C, West C, Egger G. Rethinking chronic pain in a lifestyle medicine context. In: Egger G, Binns A, Rössner S, Sagner M, editors. Lifestyle medicine. Lifestyle, the environment and preventive medicine in health and disease. Third edition. London: Academic Press, 2017; pp. 339–353.

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Perspectives

International vascularised composite allotransplantation activity: implications for Australia

Karen M Dwyer, James D Burt and Tim Bennett

Med J Aust 2019; 210 (2): . || doi: 10.5694/mja2.12068
Published online: 4 February 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Surgical procedures, operative

Although hand transplantation has the potential to transform lives, the procedure is not without risk

March 2018 heralded 7 years since the only Australian to date received a hand transplant. The recipient has physically and psychologically integrated the transplanted hand and reports significantly improved quality of life;1 motor and sensory functions continue to improve incrementally with ongoing hand therapy. The Transplantation Society of Australia and New Zealand (TSANZ) Vascular Composite Allograft (VCA) Advisory Committee met during the TSANZ annual scientific meeting held in Melbourne in April 2018. Transplant physicians and surgeons and reconstructive microsurgeons comprise the advisory committee, with scope to co‐opt expert members (eg, in bioethics) as required. Despite the success of the seminal hand transplant in Australia, no further patients have progressed to the transplant waiting list. In light of this, the Advisory Committee reflects in this article on the status of hand transplantation internationally and considers its relevance for Australia.

1 Deakin University, Geelong, VIC
2 St Vincent's Hospital Melbourne, Melbourne, VIC

Correspondence: karen.dwyer@deakin.edu.au

Acknowledgements:

The views expressed in this manuscript reflect those of the TSANZ VCA Advisory Committee — Karen Dwyer (Chair), Jamie Burt, Tim Bennett, Frank Ierino, Sharon Ford, Kate Wyburn and Richard Allen — and have been ratified by the TSANZ Council — Stephen Alexander (President) and Toby Coates (President elect).

Competing interests:

No relevant disclosures.

1. Dwyer KM, Webb AR, Furniss HS, et al. First hand transplant procedure in Australia: outcome at 2 years. Med J Aust 2013; 199: 285–287. https://www.mja.com.au/journal/2013/199/4/first-hand-transplant-procedure-australia-outcome-2-years
2. Shores JT, Brandacher G, Lee WP. Hand and upper extremity transplantation: an update of outcomes in the worldwide experience. Plast Reconstr Surg 2015; 135: 351e–360e.
3. Burloux G. Hand transplant and body image. In: Lanzetta M, Dubernard JM, Petruzzo P, editors. Hand transplantation. Milan, Italy: Springer Milano, 2007; pp. 375–379.
4. Kanitakis J, Jullien D, Petruzzo P, et al. Clinicopathologic features of graft rejection of the first human hand allograft. Transplantation 2003; 76: 688–693.
5. Bhaskaranand K, Bhat AK, Acharya KN. Prosthetic rehabilitation in traumatic upper limb amputees (an Indian perspective). Arch Orthop Trauma Surg 2003; 123: 363–366.
6. Salminger S, Sturma A, Roche AD, et al. Functional and psychosocial outcomes of hand transplantation compared with prosthetic fitting in below‐elbow amputees: a multicenter cohort study. PLoS One 2016; 11: e0162507.
7. Petruzzo P, Lanzetta M, Dubernard J. International Registry on Hand and Composite Tissue Transplantation. Transplantation 2014; 98: 44.
8. Weissenbacher A, Hautz T, Zelger B, et al. Antibody‐mediated rejection in hand transplantation. Transpl Int 2014; 27: e13–e17.
9. Dwyer KM, Carroll R, Hill P, et al. Refractory vascular rejection in a hand allograft in the presence of antibodies against angiotensin II (type 1) receptor. Transplantation 2017; 101: e344–e345.
10. Kanitakis J, Petruzzo P, Badet L, et al. Chronic rejection in human vascularized composite allotransplantation (hand and face recipients): an update. Transplantation 2016; 100: 2053–2061.
11. Krezdorn N, Tasigiorgos S, Wo L, et al. Kidney dysfunction after vascularized composite allotransplantation. Transplant Direct 2018; 4: e362.
12. Pei G, Xiang D, Gu L, et al. A report of 15 hand allotransplantations in 12 patients and their outcomes in China. Transplantation 2012; 94: 1052–1059.
13. Dillon MP, Fortington LV, Akram M, et al. Geographic variation of the incidence rate of lower limb amputation in Australia from 2007–12. PLoS One 2017; 12: e0170705.
14. Lantieri L, Grimbert P, Ortonne N, et al. Face transplant: long‐term follow‐up and results of a prospective open study. Lancet 2016; 388: 1398–1407.
15. Aycart MA, Kiwanuka H, Krezdorn N, et al. Quality of life after face transplantation: outcomes, assessment tools, and future directions. Plast Reconstr Surg 2017; 139: 194–203.

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Research

Recruiting general practice patients for large clinical trials: lessons from the Aspirin in Reducing Events in the Elderly (ASPREE) study

Jessica E Lockery, Taya A Collyer, Walter P Abhayaratna, Sharyn M Fitzgerald, John J McNeil, Mark R Nelson, Suzanne G Orchard, Christopher Reid, Nigel P Stocks, Ruth E Trevaks and Robyn Woods

Med J Aust 2019; 210 (4): . || doi: 10.5694/mja2.12060
Published online: 28 January 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Health occupations

Statistics, epidemiology and research design

Abstract

Objective: To assess the factors that contributed to the successful completion of recruitment for the largest clinical trial ever conducted in Australia, the Aspirin in Reducing Events in the Elderly (ASPREE) study.

Design: Enrolment of GPs; identification of potential participants in general practice databases; screening of participants.

Setting, participants: Selected general practices across southeast Australia (Tasmania, Victoria, Australian Capital Territory, New South Wales, South Australia).

Major outcomes: Numbers of patients per GP screened and randomised to participation; geographic and demographic factors that influenced screening and randomising of patients.

Results: 2717 of 5833 GPs approached (47%) enrolled to recruit patients for the study; 2053 (76%) recruited at least one randomised participant. The highest randomised participant rate per GP was for Tasmania (median, 5; IQR, 1–11), driven by the high rate of participant inclusion at phone screening. GPs in inner regional (adjusted odds ratio [aOR], 1.45; 95% CI, 1.14–1.84) and outer regional areas (aOR, 1.86; 95% CI, 1.19–2.88) were more likely than GPs in major cities to recruit at least one randomised participant. GPs in areas with a high proportion of people aged 70 years or more were more likely to randomise at least one participant (per percentage point increase: aOR, 1.10; 95% CI, 1.05–1.15). The number of randomised patients declined with time from GP enrolment to first randomisation.

Conclusion: General practice can be a rich environment for research when barriers to recruitment are overcome. Including regional GPs and focusing efforts in areas with the highest proportions of potentially eligible participants improves recruitment. The success of ASPREE attests to the clinical importance of its research question for Australian GPs.

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1 Monash University, Melbourne, VIC
2 College of Health and Medicine, Australian National University School of Clinical Medicine, Canberra, ACT
3 Canberra Hospital, Canberra, ACT
4 University of Tasmania, Hobart, TAS
5 Curtin University, Perth, WA
6 University of Adelaide, Adelaide, SA

Correspondence: jessica.lockery@monash.edu

Acknowledgements:

The ASPREE study, including the design and implementation of the recruitment strategy, was supported by the National Institute on Aging and the National Cancer Institute at the National Institutes of Health in the United States (U01AG029824), the National Health and Medical Research Council (334047 and 1127060), Monash University, and the Victorian Cancer Agency. Bayer provided aspirin and the matching placebo. We acknowledge the dedicated and skilled staff in Australia and the Unites States who undertook the ASPREE trial. We are also most grateful to the ASPREE participants who so willingly volunteered for this study, and the general practitioners and medical clinics who supported the participants in the ASPREE study., (ASPREE): International Standard Randomized Controlled Trial Number Register (ISRCTN83772183) and clinicaltrials.gov (NCT01038583).

Competing interests:

No relevant disclosures.

1. Foster JM, Sawyer SM, Smith L, et al. Barriers and facilitators to patient recruitment to a cluster randomized controlled trial in primary care: lessons for future trials. BMC Med Res Methodol 2015; 15: 18.
2. Australian Bureau of Statistics. 4839.0. Patient experiences in Australia: summary of findings, 2015–16. Nov 2017. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4839.0 (viewed Oct 2017).
3. Newington L, Metcalfe A. Factors influencing recruitment to research: qualitative study of the experiences and perceptions of research teams. BMC Med Res Methodol 2014; 14: 10.
4. Wing LMH, Reid CM, Ryan P, et al. A comparison of outcomes with angiotensin‐converting‐enzyme inhibitors and diuretics for hypertension in the elderly. N Engl J Med 2003; 348: 583–592.
5. Reid CM, Ryan P, Nelson M, et al. General practitioner participation in the second Australian national blood pressure study (ANBP2). Clin Exp Pharmacol Physiol 2001; 28: 663–667.
6. Hunt CJ, Shepherd LM, Andrews G. Do doctors know best? Comments on a failed trial. Med J Aust 2001; 174: 144–146. https://www.mja.com.au/journal/2001/174/3/do-doctors-know-best-comments-failed-trial
7. Goodyear‐Smith F, York D, Petousis‐Harris H, et al. Recruitment of practices in primary care research: the long and the short of it. Fam Pract 2009; 26: 128–136.
8. Page MJ, French SD, McKenzie JE, et al. Recruitment difficulties in a primary care cluster randomised trial: investigating factors contributing to general practitioners’ recruitment of patients. BMC Med Res Methodol 2011; 11: 35.
9. Paul CL, Piterman L, Shaw JE, et al. Poor uptake of an online intervention in a cluster randomised controlled trial of online diabetes education for rural general practitioners. Trials 2017; 18: 137.
10. Yallop JJ, McAvoy BR, Croucher JL, et al. Primary health care research — essential but disadvantaged. Med J Aust 2006; 185: 118–120. https://www.mja.com.au/journal/2006/185/2/primary-health-care-research-essential-disadvantaged
11. Askew DA, Clavarino AM, Glasziou PP, Del Mar CB. General practice research: attitudes and involvement of Queensland general practitioners. Med J Aust 2002; 177: 74–77. https://www.mja.com.au/journal/2002/177/2/general-practice-research-attitudes-and-involvement-queensland-general
12. Zwar NA, Weller DP, McCloughan L, Traynor VJ. Supporting research in primary care: are practice‐based research networks the missing link? Med J Aust 2006; 185: 110–113. https://www.mja.com.au/journal/2006/185/2/supporting-research-primary-care-are-practice-based-research-networks-missing
13. Winzenberg TM, Gill GF. Prioritising general practice research. Med J Aust 2016; 205: 55–57. https://www.mja.com.au/journal/2016/205/2/prioritising-general-practice-research
14. McNeil JJ, Woods RL, Nelson MR, et al. Baseline characteristics of participants in the ASPREE (ASPirin in Reducing Events in the Elderly) study. J Gerontol A Biol Sci Med Sci 2017; 72: 1586–1593.
15. McNeil JJ, Woods RL, Nelson MR, et al. Effect of aspirin on disability‐free survival in the healthy elderly. N Engl J Med 2018; 379: 1499–1508.
16. Williams CM, Maher CG, Hancock MJ, et al. Recruitment rate for a clinical trial was associated with particular operational procedures and clinician characteristics. J Clin Epidemiol 2014; 67: 169–175.
17. Silagy CA, Carson NE. Factors affecting the level of interest and activity in primary care research among general practitioners. Fam Pract 1989; 6: 173–176.
18. Nelson MR, Reid CM, Ames D, et al. Feasibility of conducting a primary prevention trial of low‐dose aspirin for major adverse cardiovascular events in older people in Australia: results from the ASPirin in Reducing Events in the Elderly (ASPREE) pilot study. Med J Aust 2008; 189: 105–109. https://www.mja.com.au/journal/2008/189/2/feasibility-conducting-primary-prevention-trial-low-dose-aspirin-major-adverse
19. Australian Bureau of Statistics. 2033.0.55.001. Census of population and housing: Socio‐Economic Indexes for Areas (SEIFA), Australia, 2016. IRSAD. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/2033.0.55.001=2016=Main%20Features=IRSAD=20 (viewed Oct 2018).
20. Australian Bureau of Statistics. 1270.0.55.005. Australian Statistical Geography Standard (ASGS): Volume 5 — remoteness structure, July 2016. Mar 2018. http://www.abs.gov.au/ausstats/abs@.nsf/Latestproducts/1270.0.55.005Main%20Features15July%202016?opendocument&tabname=Summary&prodno=1270.0.55.005&issue=July%202016&num=&view (viewed Oct 2018).
21. Williamson MK, Pirkis J, Pfaff JJ, et al. Recruiting and retaining GPs and patients in intervention studies: the DEPS‐GP project as a case study. BMC Med Res Methodol 2007; 7: 42.
22. Borgiel AEM, Dunn EV, Lamont CT, et al. Recruiting family physicians as participants in research. Fam Pract 1989; 6: 168–172.
23. Freedman B. Equipoise and the ethics of clinical research. N Engl J Med 1987; 317: 141–145.
24. Nuttall J, Hood K, Verheij TJ, et al. Building an international network for a primary care research program: reflections on challenges and solutions in the set‐up and delivery of a prospective observational study of acute cough in 13 European countries. BMC Fam Pract 2011; 12: 78.
25. Peterson KA, Lipman PD, Lange CJ, et al. Supporting better science in primary care: a description of practice‐based research networks (PBRNs) in 2011. J Am Board Fam Med 2012; 25: 565–571.
26. Gunn JM. Should Australia develop primary care research networks? Med J Aust 2002; 177: 63–66. https://www.mja.com.au/journal/2002/177/2/should-australia-develop-primary-care-research-networks

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Research Letter

Exposures to e‐cigarettes and their refills: calls to Australian Poisons Information Centres, 2009–2016

Carol Wylie, Aaron Heffernan, Jared A Brown, Rose Cairns, Ann‐Maree Lynch and Jeff Robinson

Med J Aust 2019; 210 (3): . || doi: 10.5694/mja2.12032
Published online: 28 January 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Emergency medicine

Environment and public health

Poisoning

The popularity of e‐cigarettes has increased in Australia since they first became available as smoking cessation tools; an estimated 1.3% of the New South Wales population used them in 2015, and as many as 8.4% had experimented with them.1 E‐cigarettes have been recommended by Public Health England and the Royal College of Physicians as safe smoking cessation tools.2,3 In Australia, a prescription is required for legally importing nicotine‐containing e‐cigarettes.4 The safety of these products for users and the risks for members of their households have not been established. Imported products may not conform to Australian standards, including having child‐resistant closures and appropriate labelling, and refill bottles containing highly concentrated nicotine solutions — one millilitre of which can be lethal if ingested by a child — can be purchased online.

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1 Queensland Poisons Information Centre, Lady Cilento Children's Hospital, Brisbane, QLD
2 Griffith University, Gold Coast, QLD
3 New South Wales Poisons Information Centre, The Children's Hospital at Westmead, Sydney, NSW
4 University of Sydney, Sydney, NSW
5 Western Australian Poisons Information Centre, Sir Charles Gairdner Hospital, Perth, WA
6 Victorian Poisons Information Centre, Austin Health, Melbourne, VIC

Correspondence: Carol.Wylie@health.qld.gov.au

Acknowledgements:

We thank the poisons information specialists from the Queensland, New South Wales, Victorian and Western Australian centres.

Competing interests:

Jared Brown has received consultancy fees from GlaxoSmithKline Consumer for sitting on an advisory board regarding paracetamol.

1. Harrold TC, Maag AK, Thackway S, et al. Prevalence of e‐cigarette users in New South Wales. Med J Aust 2015; 203: 326. https://www.mja.com.au/journal/2015/203/8/prevalence-e-cigarette-users-new-south-wales
2. McNeill A, Brose LS, Calder R, et al. E‐cigarettes: an evidence update. A report commissioned by Public Health England (PHE No. 2015260). Aug 2015. https://www.gov.uk/government/publications/e-cigarettes-an-evidence-update (viewed Dec 2018).
3. Royal College of Physicians. Nicotine without smoke: tobacco harm reduction. London: RCP, 2016. https://www.rcplondon.ac.uk/projects/outputs/nicotine-without-smoke-tobacco-harm-reduction-0 (viewed Aug 2018).
4. Douglas H, Hall W, Gartner C. E‐cigarettes and the law in Australia. Aust Fam Physician 2015; 44: 415–418.
5. Noble MJ, Longstreet B, Hendrickson RG, Gerona R. Unintentional pediatric ingestion of electronic cigarette nicotine refill liquid necessitating intubation. Ann Emerg Med 2017; 69: 94–97.

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Letters

Medical assistance in dying: a disruption of therapeutic relationships

Douglas T Bridge, Sinead M Donnelly and Frank P Brennan

Med J Aust 2019; 210 (4): . || doi: 10.5694/mja2.12105
Published online: 21 January 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Ethics and law

Palliative care

General medicine

To the Editor: We commend William1 for his perceptive review of the complex issues involved in euthanasia and assisted suicide (EAS).1 In contrast to the euphemisms in the popular media, he confronts us with some uncomfortable realities: EAS is the intentional taking of a person's life (E) or facilitating suicide (AS); doctors considering EAS may be (unconsciously) demonstrating “countertransference of their helplessness onto the patient;” and relief of all suffering is a fantasy beyond the ability of doctors, politicians and lawyers.

1 Royal Perth Hospital, Perth, WA.
2 Capital and Coast District Health Board, Wellington, New Zealand.
3 Calvary Hospital, Sydney, NSW.

Correspondence: dtbridge@iinet.net.au

Competing interests:

No relevant disclosures.

1. Leeroy William. Medical assistance in dying: a disruption of therapeutic relationships. Med J Aust 2018 209: 286–287. https://www.mja.com.au/journal/2018/209/7/medical-assistance-dying-disruption-therapeutic-relationships
2. Leiva R, Cottle M, Ferrier C, et al. Euthanasia in Canada: a Cautionary tale. World Medical Journal 2018: 17–23.
3. Sulmasy DP, Finlay I, Fitzgerald F, et al. Physician‐assisted suicide: why neutrality by organized medicine is neither neutral nor appropriate. J Gen Intern Med 2018; 33: 1394–1399.
4. Australian and New Zealand Society for Palliative Medicine. Position statement: the practice of euthanasia and physician assisted suicide. ANZSPM; 2014. http://www.anzspm.org.au/c/anzspm?a=da&did=1005077 (viewed Oct 2018).
5. Australian and New Zealand Society for Geriatric Medicine. ANZSGM. Euthanasia, physician‐assisted suicide and end of life care — position statement. http://www.anzsgm.org/documents/FinalEuthanasiaDiscussionPointsAugust2014_final.pdf (viewed Oct 2018).

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Letters

Medical assistance in dying: a disruption of therapeutic relationships

Peter G Beahan

Med J Aust 2019; 210 (4): . || doi: 10.5694/mja2.12104
Published online: 21 January 2019

ARTICLE
AUTHORS
REFERENCES

Topics

Ethics and law

Palliative care

General medicine

To the Editor: The Perspectives article by William1 states that medical assistance in dying may disrupt therapeutic relationships and will challenge beliefs.

Perth, WA

Correspondence: pbeahan@optusnet.com.au

Competing interests:

No relevant disclosures.

1. Leeroy William. Medical assistance in dying: a disruption of therapeutic relationships. Med J Aust 2018 209: 286–287. https://www.mja.com.au/journal/2018/209/7/medical-assistance-dying-disruption-therapeutic-relationships
2. Callinan K. Allow modern medicine to relieve agonizing end‐of‐life experiences. The Hill 2017; 25 Dec. https://thehill.com/opinion/healthcare/366374-allow-modern-medicine-to-relieve-agonizing-end-of-life-experiences (viewed Oct 2018).

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Silent but deadly: patients with enterococcal bacteraemia should be assessed for colorectal neoplasia

Topics

Author

High intensity lipid‐lowering therapy after acute coronary syndromes: room for improvement

Topics

Author

Pregabalin misuse: the next wave of prescription medication problems

Topics

Author

International vascularised composite allotransplantation activity: implications for Australia

Topics

Author

Recruiting general practice patients for large clinical trials: lessons from the Aspirin in Reducing Events in the Elderly (ASPREE) study

Topics

Abstract

Author

Exposures to e‐cigarettes and their refills: calls to Australian Poisons Information Centres, 2009–2016

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Author

Medical assistance in dying: a disruption of therapeutic relationships

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Author

Medical assistance in dying: a disruption of therapeutic relationships

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Author

Increased incidence of community‐associated Staphylococcus aureus bloodstream infections in Victoria and Western Australia, 2011–2016

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Author

Nicotine and other potentially harmful compounds in “nicotine‐free” e‐cigarette liquids in Australia

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Author

Silent but deadly: patients with enterococcal bacteraemia should be assessed for colorectal neoplasia

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Comment

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High intensity lipid‐lowering therapy after acute coronary syndromes: room for improvement

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Pregabalin misuse: the next wave of prescription medication problems

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International vascularised composite allotransplantation activity: implications for Australia

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Recruiting general practice patients for large clinical trials: lessons from the Aspirin in Reducing Events in the Elderly (ASPREE) study

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Abstract

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Comment

Do you have any competing interests to declare? *

Exposures to e‐cigarettes and their refills: calls to Australian Poisons Information Centres, 2009–2016

Topics

Author

Comment

Do you have any competing interests to declare? *

Medical assistance in dying: a disruption of therapeutic relationships

Topics

Author

Comment

Do you have any competing interests to declare? *

Medical assistance in dying: a disruption of therapeutic relationships

Topics

Author

Comment

Do you have any competing interests to declare? *

Increased incidence of community‐associated Staphylococcus aureus bloodstream infections in Victoria and Western Australia, 2011–2016

Topics

Author

Comment

Do you have any competing interests to declare? *

Nicotine and other potentially harmful compounds in “nicotine‐free” e‐cigarette liquids in Australia

Topics

Author

Comment

Do you have any competing interests to declare? *

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