2 February 2004

Wakley winners

For the first time, two essayists have shared The Lancet’s Wakley Prize. The prize, named for Dr Thomas Wakley who founded The Lancet in 1823, is given annually for the best essay on a clinical topic of international health importance. Writing from the Antipodes, Dr Amanda Kvalsvig wrote of how being a deaf doctor has helped her determine how to (and how not to) respond to people with disabilities — without assumption or blithe reassurance, but rather by letting them "tell how it is". Remembering time spent in the Andes, Dr J Jaime Miranda recounted the stories of three patients battling tuberculosis. He asked: is it acceptable for money (or the lack of it) to draw the line between life and death?

Lancet 2003; 362: 2038, 2079-2082.

Arrests at the dentist’s

Australian researchers say that if a patient has a cardiac arrest while in the dentist’s chair, the dentist should administer CPR with the patient lying flat in the dental chair rather than move them onto the floor. Their small study compared the effectiveness of CPR performed by three health professionals on a resuscitation mannikin lying supine on a dental chair with CPR on the mannikin when lying on the floor nearby; two types of chairs in three different settings were involved. CPR was effective in both positions; study participants reported that CPR was easier to perform with the mannikin in the chair (especially in a cramped setting).

Aust Dent J 2003; 48: 244-247

Long-life partnerships

The Swiss HIV Cohort Study Group has reported that in patients with HIV receiving highly active antiretroviral therapy (HAART) those with a stable partner have a slower rate of disease progression to AIDS or death. Conversely, HIV-positive patients without a stable partner may be expected to progress more rapidly through clinical latency. The link between partnership status and disease progression was shown at all stages of disease, from early to advanced.

BMJ 2004; 328: 15-18

The first time

Compared with previous generations, today’s young Australians are not only younger at the time of their first experience of sexual intercourse they are also more likely to use contraception, including condoms. This augurs well for their future health and social wellbeing, say Boyle and colleagues. They surveyed nearly 1800 people across Australia aged 18-59 years, asking about early heterosexual experiences. Among other findings, women in the youngest age group were more likely than women in the oldest age group to have had first sex with a non-steady partner (about 30% compared with 15%). Both women and men were now much less likely to have had sex for the first time with a marriage partner (23% v 3% for women and 12% v 1% for men).

Int J STD AIDS 2003; 14: 745-752

Chest pain belief challenged

Do you share the common belief that acute chest pain relieved by glyceryl trinitrate is probably due to active coronary artery disease? US researchers would have us dispel this notion: in a study of 459 patients admitted with chest pain who received 400 mg of spray or sublingual nitroglycerin, relief from pain at 5 minutes after the first dose of this treatment did not predict active coronary artery disease.1 Further, at 4 months after admission, clinical outcomes were similar whether or not patients had responded to glyceryl trinitrate.

Although an editorialist agreed that nitrate responsiveness is not helpful in diagnosing the cause of acute chest pain, he maintained that it has a place in diagnosing chronic stable chest pain.2

1. Ann Intern Med 2003; 139: 979-986

2. Ann Intern Med 2003; 139: 1036-1037

Doctoring nursery rhymes

In recent years, some traditional fairy tales have come under fire for being politically incorrect. Now, Canadian authors have raised concerns about the medically inaccurate, or at least inadequate, nature of nursery rhymes. Giles and Shea critically appraised six rhymes in which head injury was mentioned, including "Humpty Dumpty", "Jack and Jill" and "Ring around the Rosie". All fell far short of best practice in terms of responding to injury appropriately, seeking a medical opinion, giving a clear history and using precise medical terminology. For example, the authors questioned whether "all the king’s horses and all the king’s men" were capable of launching an appropriate medical intervention after Mr Dumpty’s unfortunate accident. In an attempt to remedy this "sad situation", the authors present a new, medically sound nursery rhyme about Little Johnny’s head injury, featuring a neurosurgeon, no less!

CMAJ 2003; 169: 1294-1296

— Dr Ann Gregory, MJA