Costing (in)continence

Exactly how much does it cost to care for people who are incontinent of urine? Research is sparse, say Green and colleagues, who examine the data for over 6000 inpatients in subacute care in Australia and New Zealand (Urinary incontinence in subacute care — a retrospective analysis of clinical outcomes and costs).

Debunking debriefing

Recent studies have challenged the role of debriefing after traumatic incidents, but trauma (and indeed debriefing) can take many forms. Many women suffer from stress disorders or depression in the year after giving birth, with the trauma of labour and delivery playing a possible role in aetiology. Priest et al have conducted a randomised controlled trial of structured midwife-led stress debriefing after childbirth, and present their results in Stress debriefing after childbirth: a randomised controlled trial. In response, McFarlane takes a look at debriefing in general, exploring what can be learned from the failure of this seemingly good idea (Debriefing: care and sympathy are not enough).

Prisoners and PEP

Several reports have documented the spread of blood-borne diseases within Australian prisons. Two separate instances, in which an inmate infected with HIV and hepatitis B and C admitted to sharing needles and syringes with other inmates, afforded O'Sullivan and colleagues the opportunity to observe subsequent seroconversion. For the first time anywhere, they also offered post-exposure prophylaxis against HIV to prisoners at risk (Hepatitis C transmission and HIV post-exposure prophylaxis after needle- and syringe-sharing in Australian prisons).

Ethics, law and genes

If a genetic test were available to predict the time and cause of your final demise, would you have it? Would you want your family, employer or insurance company to have access to the results? Would you allow your children to be tested? Genetic advances don't change basic ethical and legal principles, but they do change the context in which they are applied. In Ethical and legal issues and the "new genetics", Otlowski and Williamson discuss some of the dilemmas of The New Genetics.

Pulmonary arterial hypertension

Contrary to popular belief, pulmonary arterial hypertension is fairly common, especially secondary to a range of other disease processes. Keogh et al discuss diagnosis and management in Pulmonary arterial hypertension: a new era in management.

Final round

If you're an alert and astute MJA reader (and you like a good brawl), you will have noticed that the articles in our EBM in Action series often raise readers' hackles. The series is at an end but the final article, Albert's investigation of the use of phenytoin to prevent motion sickness (Phenytoin for the prevention of motion sickness) will leave you begging for more. Why must the series finish? Del Mar and Anderson explains what it was designed to do in the first place, as well as why it will "go down fighting" (Epitaph for the EBM in action series).

Vascular saviours

In the fast-flowing tide of pharmacotherapy, few agents are moving at the rapid pace of the antiplatelet drugs. For the latest on this turbulent area see Hankey and Eikelboom's New Drugs, Old Drugs contribution on Antiplatelet drugs.

Singapore SARS advice

If you didn't catch Fisher and colleagues' article about the community spread of SARS in Singapore when it appeared on the eMJA website a couple of weeks ago, be sure to read it now (Preventing local transmission of SARS: lessons from Singapore). It was fast-tracked because it contains important public health messages for Australia.

Short and sweet?

The increasing pressure on hospitals all over the Western world calls for creative and practical solutions. One initiative, aimed at relieving access block while providing timely, cost-effective, quality care, is the short-stay observation unit. Do these wards achieve their aims? Daly et al present a systematic review of the published studies in Short-stay units and observation medicine: a systematic review.

Trials on trial: now recruiting

A trial comparing different treatment regimens for tinea capitis in children, described by Commens, found that the traditional treatment (griseofulvin) outperformed a newer drug (terbinafine). The study included 165 patients — an adequate number of participants to achieve meaningful results. This was no mean feat when you consider that the patients came from 22 centres in Europe and South America (see Which drug is most effective in treating childhood tinea capitis caused by Microsporum species?). Hague et al give the lowdown on recruitment in Recruitment to randomised studies.

Another time ... another place