Kerry J Breen

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• MBBS, MD, FRACP
• Adjunct Professor at Monash University (Australia)

Over 600 international medical students commence training in Australian medical schools each year. Government funding policies are driving medical schools to recruit more international students. The need to lobby for intern positions for domestic graduates and for international students has placed Australia's medical schools in conflicted positions...

This chapter describes the human research ethics guidelines that have been issued by national government agencies in Australia between 1966 and the present time. The identity, statutory or formal authority to issue such guidelines of each of these agencies is described as is the composition of the committees and approval bodies of each of the issui...

The incidence of research misconduct appears to be increasing, drawing attention in the general media and academic literature. Concerns have been expressed about probable under‐reporting, harms arising, lack of an agreed international definition, welfare of whistleblowers and the adequacy of the investigation processes and any subsequent sanctions....

A national registration scheme for health professionals was introduced in Australia 5 years ago, replacing the long-standing state-based schemes. This review examines whether the scheme has delivered what it promised and makes recommendations for change. The available evidence indicates that the scheme’s design and its implementation were rushed an...

* The proposed introduction of a revalidation process as part of renewal of medical registration in Australia needs wide debate. * The revalidation process that began in the United Kingdom in 2012 is premised on a need to regain the trust of the community and to promote participation in continuing professional development. These alone are not justi...

The 2011 report of the Productivity Commission (PC) recommended the establishment of a no-fault national injury insurance scheme limited to "catastrophic" injury, including medical injury. The report is welcome, but represents a missed opportunity to establish simultaneously a much-needed no-fault scheme for all medical injuries. The existing indem...

Good Medical Practice: Professionalism, Ethics and Law brings together information that is central to the professional, ethical and legal requirements of being a doctor. It covers a core curriculum for medical students, doctors in training and international medical graduates preparing for the Australian Medical Council examinations. A useful guide...

The move to national registration of doctors presents both threats and opportunities for the manner in which doctors seek health care and for providing assistance to doctors who may be impaired by illness. The most striking threat is the regressive nature of the provisions for mandatory reporting of ill doctors. The new system should be grasped as...

Consultant physicians encounter patients, and families and carers of patients, who leave us feeling helpless, frustrated, irritated and even angry. There are limited opportunities for trainees and physicians to discuss how to recognize, manage, learn from and prevent these difficult physician–patient encounters. This paper addresses factors, includ...

The release for public consultation of the draft Health Practitioner Regulation National Law 2009 represents a once-in-a-generation opportunity to ensure best practice in medical regulation. The draft law fails to build on the best aspects of existing state and territory legislation, particularly in regard to how allegations of misconduct, poor per...

Comparison with a selected group of alcohol-using patients has allowed clear definition of the characteristic features of subjects with Wernicke's encephalopathy. The majority were unemployed Australian men with a very high alcohol intake, thiamin deficiency and abnormal liver function tests. Gross nutritional status ranged from obesity to protein-...

An intensive study of 39 alcoholic patients with liver disease indicated a wide range of nutritional status; severe malnutrition was uncommon. Normal values for all measurements of anthropometry and vitamin status were observed in 41 and 13% of 39 subjects respectively. Mild protein‐energy malnutrition (by anthropometry) was observed in 22%. The in...

A series of 51 patients with achalasia of the oesophagus treated by pneumatic dilatation between 1980 and 1988 is reported. Treatment was assessed as effective (no or minimal dysphagia) in 78% of patients, followed for a mean of 30 months. Thirty‐four patients required only one dilatation and only two patients had more than 3 dilatations. There wer...

Recent publications on medical professionalism have created an impression of a medical profession under siege in several countries. These publications recommend a new approach to medical professionalism to assist the profession to respond to new challenges. I suggest that the issue is not one of failed professionalism, but a shift in the balance of...

Esophageal atresia (EA) is the most common congenital anomaly of the esophagus. There are few long-term follow-up data on adults who had surgery for EA as infants. The primary aims were to evaluate the prevalence of esophageal symptoms and pathology and second to develop recommendations for follow-up. This is a descriptive study of individuals atte...

All stakeholders should contribute to enhancing Australia's guidelines for ethical research.

Australia has so far been spared serious mishaps in health research, but rising pressures on researchers, deemed to have contributed to two deaths of research participants in the United States, clearly also exist in Australia. Health research investment in our institutions is large and represents an often overlooked area of risk by boards of manage...

There is evidence that drug-marketing techniques affect doctors' prescribing practices. This has ethical implications for doctors, as it affects the trust required in the doctor-patient relationship. Doctors need to recognise they are affected by drug marketing, and take steps to maintain their independence from the pharmaceutical industry.

Examples of many types of misconduct in medical research continue to be reported. The true incidence is unknown because there is strong evidence of under‐reporting as well as suggestions of increased detection. Risks to research participants may also be increasing, with contributing factors such as increased pressure on researchers to publish and t...

In this response, the Australian Health Ethics Committee (AHEC) indicates that it shares, and has strategies in place to address, the majority of the concerns identified by Susan Dodds. AHEC believes it is too early to assess the full impact of the National Statement on Ethical Conduct in Research Involving Humans (1999) or to call for a major revi...

Data linkage research is being conducted in an evolving and complex environment. The National Health and Medical Research Council's Guidelines Under Section 95 of the Privacy Act 1988 and National Statement on Ethical Conduct of Research Involving Humans allow scope for such research to be legally and ethically acceptable, although conducted withou...

Data linkage research is being conducted in an evolving and complex environment. The National Health and Medical Research Council's Guidelines Under Section 95 of the Privacy Act 1988 and National Statement on Ethical Conduct of Research Involving Humans allow scope for such research to be legally and ethically acceptable, although conducted withou...

Although it has an important role in maintaining medical standards, little is known about the work of the Australian Medical Council (AMC) by members of the medical profession. A non‐statutory standards authority, the AMC accredits medical schools in Australia and New Zealand, examines overseas‐trained doctors for registration purposes and advises...

Doctors should be able to seek help with confidence that their colleagues will be supportive

Prophylactic antibiotics are used in an attempt to avoid the septic complications of endoscopic retrograde cholangiopancreatography (ERCP). We prospectively performed blood cultures and surveyed patients for complications. The aims were first, to determine the incidence of bacteraemia associated with ERCP, second, to assess the incidence of clinica...

Mitochondria of patients with alcoholic liver disease are morphologically abnormal, and mitochondria isolated from animals exposed to ethanol exhibit functional deficiencies in vitro. Because the functional consequences of the morphological alterations and the relevance of in vitro observations to mitochondrial function in alcoholic subjects are no...

A case is reported of a patient with symptomatic bacterial overgrowth and Vitamin B12 malabsorption secondary to two duodenal diverticula, treated successfully by surgical excision of the diverticula.

A case of acute hepatitis is reported in a 62 year old woman who had been treated for severe psoriasis with the aromatic retinoid, etretinate. Her clinical condition and liver function tests continued to deteriorate after cessation of the drug, but there was a marked initial response to therapy with prednisolone. Liver biopsy showed hepatitis with...

A 25-year-old woman with hypertension had three episodes of severe hepatitis, each following treatment with hydralazine. The case is compared with eight cases of hydralazine-induced hepatitis reported to the Australian Adverse Drug Reactions Advisory Committee, and ten cases reported in the world literature. After the second episode of hepatitis, a...

A planned pregnancy with a satisfactory outcome is reported in a 33-year-old woman who had received long-term home parenteral nutrition after a massive volvulus, with resection of almost the entire small intestine, six years previously. No obstetric complications were observed and a normal baby girl was delivered by caesarean section. The only nutr...

Seven patients demonstrating the difficulties in diagnosis and management of hepatic vein occlusion are presented. The syndrome may present in an acute form with upper abdominal pain, abdominal swelling, ascites and tender hepatomegaly or in a chronic form, mimicking cirrhotic ascites. The clinical features, predisposing factors, liver scan and liv...

Thirty-two cases of Wernicke's encephalopathy were admitted to hospital for treatment in a period of 33 months; this represented a relatively low incidence in total hospital admissions. Thiamin status was deficient, borderline and normal in 21 (66%), five (16%) and six (19%) patients, respectively, and responded immediately to treatment in those wh...

The pharmacokinetics of the newer 1, 4 benzodiazepine temazepam were evaluated in 16 healthy subjects aged 18-92 years and in 15 cirrhotic patients, to ascertain the effect of ageing and liver disease. The data were analysed both by classic two compartment and by non-compartmental methods. The mean elimination half-life in the control subjects was...

The jejunal uptake of 35S-thiamin hydrochloride was examined using an intestinal perfusion technique in six young students (group 1), 12 recently drinking alcoholic men (group 3) and in 6 non-drinking men age-matched with the alcoholic men (group 2). The acute effect of alcohol on thiamin uptake was also examined in the alcoholic subjects. At a per...

The disposition of intravenous glycofurol, a solvent for some drugs, was followed in nine male patients with hepatic cirrhosis. In comparison with age-matched controls, glycofurol clearance in the patients with cirrhosis was reduced 43% and terminal t 1/2 was prolonged 103%. There was no significant difference between the cirrhotic and control grou...

Oxidative metabolism inhibition of a number of drugs by Cimetidine has been attributed to its imidazole ring, a hypothesis that has been supported by reports that ranitidine does not affect drug metabolism despite being five times as potent as Cimetidine as an H2-receptor antagonist. In five healthy subjects ranitidine at 150 mg twice daily induced...

In this study the well-established interaction between cimetidine and theophylline has been demonstrated using only a single dose of cimetidine. Eleven healthy subjects were given a 30 min infusion of theophylline on two separate occasions and plasma levels were monitored at frequent intervals. During one of the studies, a single 400 mg oral dose o...

Phenacetin, a high-clearance drug, was labeled as [14C-ethyl]phenacetin and used in a breath test of hepatic function. 14CO2 appeared rapidly in breath such that more than 30% of the administered radioactivity was expired in 2 hr. For all means of expression used to describe the appearance of 14CO2 in breath, normal controls and hospitalized patien...

Twenty-five patients were studied in an eight-week randomized controlled comparison of cimetidine and placebo in the treatment of reflux oesophagitis. Therapy with cimetidine (1.0 g/day), compared with placebo, did not produce a statistically significant beneficial effect as assessed by relief of heartburn, reduction in antacid use, endoscopic evid...

Cimetidine has been shown to inhibit hepatic mixed-function oxidase activity and to lower hepatic blood flow. It is not known whether these effects are related to its H2-receptor antagonism or to its intrinsic structure. Ranitidine is a more potent H2-receptor antagonist and differs structurally from cimetidine. In our study, ranitidine, 150 mg twi...

Acutely administered ethanol has been shown to inhibit the hepatic metabolism of a number of drugs. Ethanol might be expected to decrease the first-pass extraction of chlormethiazole leading to higher blood levels of this high clearance sedative frequently used in the management of alcoholic patients. Chlormethiazole has a narrow therapeutic index...

Cimetidine has been shown to impair elimination of a number of drugs metabolized by the hepatic mixed-function oxidase enzymes. It is uncertain whether this is related to its histamine H2-receptor antagonism or to its intrinsic structure. Ranitidine is a more potent H2-receptor antagonist and has a completely different structure. Cimetidine (1 gm/d...

Over a four-year period, 103 patients presented to St Vincent's Hospital, Melbourne, after poisoning themselves with paracetamol. Most of them were young adults who suffered temporary emotional or social distress. There was severe liver damage in four patients who presented, or were recognised, 24 hours or more after the ingestion of paracetamol. T...

Cimetidine impairs the systemic clearance of a number of low extraction drugs and this study examines its effect on the oral clearance of the high extraction drug, chlormethiazole. Cimetidine (1 g/day for 7 days) caused the clearance of chlormethiazole to fall to 69% of pretreatment values. It also prolonged the elimination half-life by 60%. The fi...

This article critically examines the size of the problem of thiamine deficiency in Australia, and the proposal that alcoholic beverages be fortified with thiamine as a means of preventing brain damage in chronic alcoholics.

A double blind study of partial thiamin restriction was undertaken in 19 volunteer male medical students for a period of 4 to 5 weeks. Each day the subjects followed a diet supplying 500 micrograms thiamin and took 1 capsule randomly assigned to contain 5 mg thiamin hydrochloride or thiamin placebo. This capsule also supplied physiological doses of...

A double blind study ofpartial thiamin restriction was undertaken in 19 volunteer male medical students for a period of4 to 5 weeks. Each day the subjects followed a diet supplying 500 �g thiamin and took I capsule randomly assigned to contain 5 mg thiamin hydrochloride or thiamin placebo. This capsule also supplied physiological doses ofother vita...

Hepatitis B surface antigen (HBsAg) was sought over a six-month period in patients and staff members of the intensive care, cardiothoracic, and haematology/oncology units of a large general hospital. In addition, HBsAg was sought in all inpatients, outpatients and staff members at one point in time during August, 1977. A positive HBsAg state occurr...

The effects of tetracycline on the synthesis, outward transport, and accumulation of triglyglycerides from [1-14C]oleate were investigated using the isolated perfused rat liver. The effects of the antibiotic on production of CO2, and ketone bodies were studied also. Tetracycline either was added to the medium perfusing livers from normal fed male r...

Gradually accumulating data from many centres are helping to define the risk to hospital patients and staff members of contracting hepatitis. This paper briefly reviews current knowledge of viral hepatitis A and B, considers the risk to patients and staff members posed by the presence of hepatitis sufferers in general hospitals, and presents sugges...

Diet therapy is mandatory in only a very small number of GIT disorders. While the available evidence does not support its use in other conditions, many physicians will wish to make an individual decision regarding diet therapy according to the patient's symptoms, to the patient's attitudes and expectations and very importantly, to the financial and...

Five methods of diagnosis have been compared prospectively in 43 patients referred for suspected reflux oesophagitis. A final diagnosis of reflux oesophagitis, as defined by the presence of at least two of the three features of typical symptoms, abnormal endoscopic findings, and abnormal findings on oesophageal biopsy, was made in 27 patients. Obse...

:Thiamine status in alcoholism. Beverley Wood, Kerry J. Breen and D. G. Penington, Aust. N.Z. J. Med., 1977, 7, pp. 475–484. The erythrocyte transketolase assay was used to seek biochemical evidence of thiamine deficiency in 265 alcoholic persons attending an inner city Australian hospital. Fifty patients were found to have recent vitamin therapy a...

An existing intensive drug monitoring system was used to study the occurrence of pseudomembranous colitis and diarrhoea in 100 patients treated with lincomycin and clindamycin. In order to give perspective to the results an equal number of matched patients treated with ampicillin were also studied. The incidences of diarrhoea in both groups were si...