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Incontinence in hiding
Faecal incontinence is not just a cause for embarrassment. It can
also be disabling, isolating and costly. Kalantar
and colleagues report their findings on the Australian prevalence
of this largely unrecognised problem, debunking myths that those most
affected are the elderly. Kamm's
editorial highlights the common causes of faecal incontinence and
updates us on the latest treatment innovations. |
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Deadlocked
So-called
heroin trials, using injectable heroin as part of a maintenance program,
have been a bone of contention in Australia, where they have been
advocated as a possible form of treatment, but strongly vetoed by
the Federal Government. Hall
et al propose an alternative For Debate: a trial of hydromorphone,
an injectable opioid with similar effects to heroin. Will this break
the policy deadlock? |
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Death
lessons
Many of today's medical students may complete their studies without
spending too much time inhaling formalin in the anatomy laboratory.
They may also avoid the grisly trips to the morgue to witness autopsies.
Parker
wonders whether this is a good thing, and discusses the pros and cons
of familiarity with the dead body. Meanwhile, Ward
et al are concerned about falling autopsy rates in their hospital
— and forthcoming changes in legislation may exacerbate matters. |
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Feeling
liverish?
The post-festive season is probably not a bad time to contemplate
the organ responsible for processing some of our (imbibed and ingested)
excesses. Pokorny
and Waterland evaluated liver biopsies performed under radiological
guidance and out of hospital. Their findings prompt Griffiths
et al to comment on where and why liver biopsies should be performed,
and by whom. Read their conclusions on the role of liver biopsy in
an era of revolutionary imaging and laboratory techniques. |
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Different
strokes
Indigenous Australians
are admitted to hospital more often than their non-Indigenous compatriots.
But what happens to them as inpatients? Cunningham
examined national data on use of diagnostic and therapeutic procedures.
In response, Fisher
and Weeramanthri do some soul-searching as to why we treat Indigenous
people differently. |
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What
does it all mean?
According to Neuwirth
many doctors are so overwhelmed by the pressures of the "real world"
of medicine that we have lost touch with the meaning of why we are
there. He gives some tips for reclaiming meaning so that we can all
be more effective doctors. |
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Rocking
the boat
The articles on the health of asylum seekers in Australia, published
in our recent Christmas issue, have provoked a number of responses,
including a critical letter from the Minister for Immigration. Click
here for some of these letters and replies. |
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The
end?
A young woman
with a young family and an advanced cancer deteriorates suddenly at
home. Her husband and parents are in conflict as to what to do next.
What does the ethical GP do? For a practical yet thoughtful discussion
of the decision-making process, turn to the latest instalment of our
Clinical Ethics series, by Glare
and Tobin. |
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Bleeding
conundrum
When do you refer a patient who is bleeding in early pregnancy? When
do you order an ultrasound, proceed to surgery, or offer anti-D prophylaxis?
These and other questions on the management of early-pregnancy bleeding
were put to GPs, whose responses led McLaren
and Shelley to identify deficiencies in the literature. |
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A
sickle-y story
This issue's Notable
Case is the first report of the sickle-cell gene in a Papua New
Guinean. A pale, four-year-old boy admitted to hospital in Papua New
Guinea with left upper quadrant pain is found to have sickle-cell/ +-thalassaemia.
The sickle-cell gene is later traced as the genetic legacy of a great-grandmother who had come to PNG as a missionary and married into the local community. |
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Another time ... another place...
The impartial knife of the pathologist is a certain antidote for conceit.
Without autopsies, the natural tendency is to develop a blind confidence
in one's habitual methods . . .
W F Putnam, N Engl J Med 1941; 224:
324-328 |
