Australian Doctor Australia Doctor 18th August 2017 | Page 3

MICHAEL WOODHEAD
ANTIBIOTICS appear to
be justified for children with
bulging of the eardrum in
acute otitis media (AOM),
new research suggests.
The Finnish study reveals
just two children with severe
bulging of the tympanic
membrane need to be treated
with antibiotics to prevent
one case of worsening ear
pain or perforation.
The findings contradict the
most recent Cochrane review
that says only one in 20 chil-
dren with AOM benefit from
antibiotics.
The latest randomised con-
trolled trial published in the
jounral of Pediatrics involved
319 children aged six to 35
months.
It found that withholding
antibiotics led to worsening
of AOM in 64% of children,
compared with 11% of those
who received amoxicillin-cla-
vulanate for seven days.
The benefit of antibiot-
ics in AOM was greatest in
children under two years of
Mediscan/Alamy
Antibiotic benefit in bulging eardrum
age and was seen regardless
of other markers of severity,
such as fever and ear pain.
The
researchers
said
they were aiming to iden-
tify subgroups of children
who might benefit from
antibiotics, which were not
recommended for AOM
in guidelines since most
children recovered without
treatment.
“The Number Needed to
Treat among children with
severe bulging of the tym-
panic membrane was 1.9,
indicating that two children
need to be treated with anti-
microbial agents to prevent
treatment failure in one
child,” they noted.
Patients want their test results via text,
survey finds, and doctors agree
JOCELYN WRIGHT
MOST patients would prefer
to receive their test results
by text message or mobile
phone call rather than in per-
son, a survey suggests.
Asked how they would
like to receive results of
skin biopsies, blood tests or
skin swabs, almost 80% of
patients preferred a quicker
method
than
speaking
directly to the doctor.
The survey of 78 Queens-
land patients attending an
outpatient
dermatology
clinic showed that, for nor-
mal results, the most popular
methods of communication
were text message (59%) or
email (17%).
For abnormal results, the
most popular methods were
by mobile phone call (55%)
and appointment with a doc-
tor (15%).
Patients over 60 were less
likely to prefer texts and
more likely to opt for other
disclosure methods, such as
a landline call, postal mail
or even a ‘no news is good
news’ policy.
Younger people expressed
strong preferences for text
message or mobile phone
call.
Fewer than one-third of
patients (and none of the
younger patients) had con-
cerns with confidentiality
in receiving results via text
message.
Junior doctors surveyed
in the study said they spent
several hours a day ringing
patients with their results.
More than 80% said they
would prefer using text mes-
sage or email for normal
results and a mobile phone
call for abnormal results.
They authors said deliver-
ing results electronically was
not only faster but also a
better use of staff time, while
expediting the nervous wait
that patients often experi-
ence.
“Both patients and doc-
tors favour text messages
and email notification for
benign results and a mobile
phone call for abnormal
results,” the researchers con-
cluded.
Australasian Journal of
Dermatology 2017; online.
Row over ‘Mcworry med school’
RACHEL WORSLEY
THE dean of Australia’s
newest full-fee-paying medical
school, where students will
be charged $250,000, has
rejected claims graduating
more medical students is
irresponsible.
“The world isn’t going to
end because Macquarie Uni
is going to graduate an extra
40 doc tors,” said Professor
Patrick McNeil, Macquarie
University’s executive dean of
medicine and health sciences.
The Macquarie MD program
in Sydney, will take in 60
full-fee-paying postgraduate
students from next year: 40
domestic and 20 international.
The full course fee for
domestic students will be
$256,000 over four years,
cheaper than the $361,900
medical degree offered by

the private Bond University in
Queensland.
The announcement has
enraged medical students,
with Australian Medical
Students’ Association (AMSA)
dubbing it the ‘Mcworry
med school’. President Rob
Thomas called the move
“irresponsible”, saying there
was no guarantee graduates
would get jobs.
“Workforce projections
show an expected surplus of
7000 doctors already by 2030.
In a state with seven medical
There is no guarantee of jobs, says AMSA president Rob Thomas.
schools already, Macquarie
will only exacerbate this.”
Professor McNeil
said the school will be
complemented by training
spots at Macquarie University
Hospital, which the university
owns and operates.
“We want to be part of the
solution to the bottleneck of
specialty training,” he said.
All medical students
graduating from the school
would be ranked highly in
the intern priority system
within NSW, Professor McNeil
added, but stopped short of
guaranteeing all graduates
intern places.
He said the school had
taken an “innovative”
approach by offering extended
clinical placements in a
hospital in Hyderabad, India,
as part of the medical degree.
www.australiandoctor.com.au
The benefit of antibiotics in
AOM is greatest in children
under two.
“Severe bulging is … a sign
that is difficult to miss, even
for a less experienced oto-
scopist, and therefore, this
prognostic factor as an indi-
cation for antimicrobial treat-
ment could be easily applied
into clinical practice,” they
suggested.
However, the Cochrane
review on AOM, published
in 2013, concluded that
observation was the best
approach for most children
because antibiotics had only
a modest effect.
It concluded that about 20
children would need to be
treated to prevent one from
experiencing ear pain at 2-7
days.
And 33 children would
need to be treated to prevent
tympanic membrane perfora-
tions.
Antibiotics appeared to be
most useful in children under
two with bilateral AOM or
with both AOM and otor-
rhoea, the review found.
“[However] for every 14
children treated with antibi-
otics, one child experienced
an adverse event (such as
vomiting, diarrhoea or rash)
that would not have occurred
if antibiotics had been with-
held,” it noted.
Pediatrics 2017; online.
In Brief
Staff writers
New penalties for fake
doctors fast-tracked
FAKE doctors could soon face
up to three years jail under new
penalties agreed by federal
and state health ministers. The
reforms, which will have to
be passed by every state, are
being fast-tracked and are set
to be introduced in Queensland
next year. The change comes
after it was revealed that authorities were unable to force
fake doctor Shyam Acharya to return to Australia to face
charges because the maximum penalty of $30,000 fell
below the minimum required for extradition. Acharya fled to
India last year after working in NSW hospitals for more than
a decade under the stolen identity of a real doctor.
‘Out-of-hospital’ GP incentive proposed
GPs could be given bonus
payments if their chronic
disease patients stay out of
hospital. Federal Minister for
Health Greg Hunt floated the
idea of incentive payments
at the COAG Health Council
meeting this month. In return
for diverting federal money
to primary care, the states
would be offered 10-year
agreements on funding for their
health budgets — double the length of the usual deals.
But Mr Hunt is yet to release any details of the plan, and
experts are warning that measuring its success or failure
could be close to impossible without better data on patient
outcomes.
Prisons fail on mental health
PRISONS have become de-facto mental health institutions,
with at least half of adult prisoners and 90% of young
people in custody diagnosed with a mental health disorder,
a report from the NSW Mental Health Commission says.
Failure to provide appropriate health services for people in
custody with mental illness or cognitive impairment means
the majority will reoffend, concludes the report.
18 August 2017 | Australian Doctor |
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