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In This Issue, 15 April 2002

Med J Aust 2002; 176 (8): 358.
Published online: 15 April 2002
  Mostly mainstream
Spinal manipulation is practised by many health professionals, including chiropractors, physiotherapists and doctors. Chiropractic itself can no longer be considered a “fringe” therapy: in the United States, 11% of the general population have reported using chiropractic, while 69% of Australian GPs have referred patients to a chiropractor. A systematic review by Ernst of adverse events after neck manipulation (page 376) shows that cerebrovascular events head the list. Is this true cause-and-effect? Let’s gather more rigorous evidence before we start casting stones, argues Breen (page 364).
   
  Elderly but independent
Some of Australia’s Medical Colleges are well into old age, but, rather than looking to retire, many are enthusiastically embracing new roles and challenges. Phelan (page 360) looks at some of the strengths inherent in our mature professional organisations as they interact with a changing society.
   
  New weapon, old enemy
One in five of Australia’s over-65 population have type 2 diabetes and, as you may have heard, there’s a new drug group to add to our armamentarium of weapons against this disease! The thiazolidinediones act by improving insulin sensitivity. They’re effective, but trial data are limited, and these drugs are certainly not for everyone. O’Moore-Sullivan and Prins detail what is known so far in New Drugs, Old Drugs, (page 381).
   
  Handled with care
In the past decade there has been an enormous effort to manage the hepatitis C epidemic in Australia. Recently, even such bodies as the Anti-Discrimination Board of NSW have become involved in improving the lot of sufferers. On page 361 Batey sums up of what has been achieved and makes suggestions for improvement.

 

Double-checking
While the debate on the best method of screening average-risk patients for colorectal cancer continues, Platell et al have offered a sigmoidoscopy screening program in Perth since 1995. In their latest report (page 371) they examine the important issue of the screening interval.

   
  Stress leave
The scenario presented by Russell and Roach to their GP survey subjects may sound familiar — a patient with significant work-related anxiety symptoms requests time off. Should the GP comply, and indeed is it time to reach for a WorkCover form? Read how a group of Western Australian GPs tackled these and other questions on page 367. Meanwhile, on page 363, Steven and Shanahan present some cold, hard facts on work-related stress claims and discuss some of the systemic issues that need improvement.
   
  Out-of-body success
Extracorporeal membrane oxygenation (ECMO) has come a long way from its initial application in neonates with respiratory failure: many adults with acute cardiac insufficiency have now benefited from the technique. On page 374 Leung et al describe how they used ECMO as a “bridge to recovery” in a young woman with fulminant myocarditis.
   
  Extra, extra ...
MJA announces the year of the supplement! As the year unfolds we will be presenting several bodies of work from authoritative groups in several areas in medicine. First up (and included with this issue) is Preventing osteoporosis: outcomes of the Australian Fracture Prevention Summit, held late last year. [Available in print only.]
   
  Brain fever
Anyone with an acute, severe headache and fever has bacterial meningitis until proven otherwise, and most GPs carry benzylpenicillin in their emergency bags for just this scenario. But what if it’s not quite so clearcut? Beaman and Wesselingh (page 389) continue MJA Practice Essentials – Infectious Diseases with the diagnostic and therapeutic challenges of meningitis and encephalitis.
   
  More “medical detectives”
In this issue’s instalment of EBM in Action (page 387) Hender et al examine the evidence for using carbogen gas to treat idiopathic sudden sensorineural hearing loss (sudden deafness).
   
  Another time ... another place...
Chiropractors today are divided into two factions.
The “straights” are those who adhere to the original Palmer teaching that all disease can be eliminated by adjusting subluxated spinal vertebrae by hand.
The “mixers” are those who have departed to some extent from this doctrine. They prescribe diets and vitamins, give colonic washouts, and are becoming more and more involved in non-manipulative treatment.
MJA 1966; II: 1059-1060 [editorial]


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