The scene is a busy Casualty: people talking, phoning, writing, gazing at computers; pagers bleeping, phones ringing . . . How can such exchanges be measured? Coiera and colleagues (page 415) “shadowed” staff to build a unique picture of communication in two emergency departments.
Can the interruptions and multitasking they recorded cause clinical error? Vincent and Wears (page 409) discuss the issues raised and the solutions possible with some input from psychologists and engineers.
|Stranger than fiction
When the Report on maternal deaths in Australia, 1994–96 was released late last year, the media speculated that the rise in pregnancy-related deaths was due to rising caesarean rates. The truth is likely to be far more complex, and frankly is not yet clear, say Walters et al (page 413).
Not so strange, however, is the possibility of a future shortage of practising obstetricians, partly due to the rising costs of medical indemnity and the fear of litigation. MacLennan and Spencer surveyed Australian obstetricians about their intentions to cease practice, with some disturbing findings (page 425).
|“There’s no place like home”
. . . says Dorothy after a surreal trip to the land of Oz. Hospital inpatients (and staff), similarly dazed by their hospital experience, might well echo these sentiments. For some patients, the hospital-in-the-home program offers the best of both worlds. In our continuing MJA Practice Essentials – Infectious Diseases series, Howden and Grayson (page 440) describe its usefulness in the treatment of some infections.
|Fit for surgery
Neurosurgery is now an effective treatment option for some patients with epilepsy refractory to drug therapy. Fabinyi’s editorial (page 410) describes who would be suitable and the various procedures available.
Spectrum of suffering
Waging war with biological agents is unfortunately not new. In the 14th century, bodies of plague victims were catapulted into a besieged city to spread disease. In the 21st century, we publish the first of a two-part series on bioterrorism (page 431). In this Clinical Update, Whitby et al examine smallpox and botulism. Co-authors include Frank Fenner, who was instrumental in the global eradication of smallpox.
|Bench to bedside . . .
. . . is our new category of articles which will describe advances in basic science with imminent clinical applications. The impetus for the research in the first of these articles (page 434) arose from vaccination programs in developing countries, which are limited by cost and difficulties in maintaining the cold chain. Enter Australian researchers Webster et al, who are working to develop an edible vaccine.
If you’ve ever received a graph from the Health Insurance Commission comparing your prescribing rates with those of others, Robertson et al have news for you (page 419). They developed a list of desirable and undesirable prescribing profiles and tested how well HIC prescribing data could reflect quality prescribing.
|Not to be sneezed at
This issue’s Notable Case (page 429) begins as a woman whose twin died suddenly, presumably from a cardiac arrhythmia, has an automatic defibrillator implanted. All goes well until her first dose of a non-sedating antihistamine leads to an episode of ventricular tachycardia. Kuchar and colleagues advise caution with the drug in a particularly susceptible group of people.
The supplement accompanying this issue has the latest on best practice in the diagnosis and management of chronic fatigue syndrome — a must for GPs and all others dealing with those who have this condition.
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