eMJA: In Other Journals, 19 January 2009

CARE Study Group researchers based in the United Kingdom suggest that sensible advice for women contemplating pregnancy would be to reduce their caffeine intake from all sources before conception. Further, once pregnancy is confirmed, they should make every effort to stop or markedly reduce caffeine consumption.1 The researchers had conducted a prospective longitudinal observational study in 2635 pregnant women, finding that maternal caffeine consumption was associated with an increased risk of fetal growth restriction and that the risk increased with increasing amounts of caffeine consumption. The researchers said that although the overall size of the reduction in birthweight — for example, of about 60 – 70 g for caffeine consumption of more than 200 mg/day — may be seen as small, it could nevertheless affect perinatal morbidity and mortality in an already compromised fetus. More than 60% of the caffeine consumed by participants in the study was from tea, and only 14% from coffee.

The authors of an accompanying editorial concurred that pregnant women should be advised to reduce their intake of caffeine products during pregnancy; however, the women should not replace caffeine-containing beverages with drinks containing alcohol, or soft drinks loaded with sugar.2

Check-ups by the dozen

Group appointments are being trialled in general practices in the Canadian province of British Columbia in an effort to address a critical shortage of doctors. The groups typically involve 12 to 15 patients with a common condition (such as diabetes, heart disease, hypertension or arthritis), one doctor and one nurse, and last for about 90 minutes. The concept, developed in the early 1990s by Colorado physician Dr John Scott, is proving popular both with patients, who enjoy the support of others with similar health problems, and doctors, who are finding the experience professionally satisfying. Group appointments seem to be revenue-neutral, being neither a money-maker for doctors nor a money-saver for governments.

Whole ovary transplanted

A 38-year-old woman who had two children and normal ovarian function donated an ovary to her identical (monozygotic) twin sister who had undergone premature menopause at 15 years of age. The recipient’s first menstruation in 22 years occurred on Day 101 after transplantation, and after 11 regular menstrual cycles, the recipient fell pregnant. A healthy baby girl was born at term, and both mother and baby are doing well.

The ovary was transplanted intact using a microvascular technique, in which the donor’s ovarian veins (3 mm in diameter) were anastomosed to the recipient’s ovarian veins and the donor’s ovarian arteries (0.5 mm in diameter) were anastomosed to the recipient’s ovarian arteries. Whole-ovary microvascular transplantation is technically more challenging than the more usual ovarian cortical grafting, but could result in a longer duration of graft function.

N Engl J Med 2008; 359: 2617-2618

Beware of burnout in intensivists

Australian intensivists are at high risk of “burnout syndrome”, according to a recent survey. Shehabi and colleagues invited all 324 intensivists listed as practising in Australia on the Australian and New Zealand Intensive Care Society database to take part in a web-based survey about their work, workload and risk of burnout. The workload reported by the 115 survey respondents was high, with most managing more than two new admissions and an average of two lengthy family conferences per day; about one in four respondents managed more than nine ventilated patients at a time. Survey respondents also had considerable administrative and locum clinical duties. Although most intensivists reported high job satisfaction, 80% had signs of psychological stress and discomfort, 42% showed signs of emotional exhaustion and 32% experienced negative feelings and cynicism about their professional activities. The researchers said these emotions placed a large proportion of respondents at significant risk of both burnout syndrome and depressive illness. They called for leaders, managers and policymakers within intensive care to focus on the prevention, early identification and management of burnout among critical care practitioners.

Crit Care Resusc 2008; 10: 312-315

Dr Ann Gregory, MJA

mja.com.au | The Medical Journal of Australia

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