Lactation for the nation How can we, as doctors, help to decrease the rates of gastroenteritis, obesity and asthma in Australian children? McVeagh (page 128) writes on the occasion of Breastfeeding Awareness Week (August 1–7), pointing out that we could be a healthier country if members of the medical profession took every opportunity to encourage and promote breastfeeding.
Taking control The 30-year "war" on cancer in the United States has recently been criticised for focusing too much on treatment and too little on strategies for early diagnosis and prevention. This is one war that Australia will not be joining, having instead established the National Cancer Control Initiative, which seeks to take a holistic approach. Elwood and Ireland (page 127) report on the NCCI's progress so far.
World on wheels Baby-walkers have been under a cloud for some time — as a cause of injury in small children, and more recently as a possible cause of delayed motor development. A total ban, however, has been deemed excessive, and Australian authorities are grappling with proposed new safety standards to warn users, improve stability and prevent the walkers from going down stairs. Thompson (page 147) used injury surveillance data to determine what proportion of serious injuries such standards would prevent.
Testing times Despite the limitless possibilities of medicine, resources are finite. We need to cut costs in some areas in order to fund others. Stuart et al targeted diagnostic testing in their hospital emergency department. Their simple intervention and before-and-after study (page 131) could be used to inform national efforts to combat inappropriate testing, say Hammett and Harris (page 124).
Another hazard of ordering too many tests is that it increases the chance of false-positive results. White (page 153) believes many clinicians are unfamiliar with the concept of uncertainty in pathology testing. He gives some examples and some advice for a smoother passage from bedside to lab and back again.
Licked by the giant Consider your shortlist of causes of a painful ulcerated tongue in an elderly woman before you turn to Lessons from Practice (Tweddle et al, page 156). The patient also had a frontal headache and blurred vision.
Picture this The general rule in impalement injuries is to leave the impaling object in situ while transporting the patient for surgery, so when Lederer et al went to retrieve a young man who had fallen onto metal reinforcement rods they cut the rods, not the patient. The wisdom of this approach can be appreciated by viewing the Snapshot on page 155.
Taking a stab at Parkinson's Recent advances in neurosurgery for Parkinson's disease show great promise in relieving symptoms such as severe, poorly controlled motor fluctuations. The first Australian report of bilateral deep brain stimulation of the subthalamic nucleus (Iansek et al, page 142) gives a glimpse of just how effective this treatment can be, plus some of its pitfalls. Fung and colleagues (page 125) review the available procedures.
What might have been According to Cass and colleagues' analysis of the Australia and New Zealand Dialysis and Transplant Registry (page 135), more than a quarter of the patients who start renal replacement therapy need to do so within three months of referral to a nephrologist. It is well known that such patients have greater early morbidity and mortality, but, if you take out those who are so sick that they die within the first year, are they at any disadvantage? The evidence is compelling for yet another disease for which vigilance, early diagnosis and timely expert intervention can make a difference.
Vitamin D matters The past few years have seen the re-emergence of rickets in some industrialised countries and the recognition that any degree of vitamin D deficiency causes bone loss. Even sunny countries like Australia are re-evaluating the role of diet and sunlight exposure. On page 149 Nowson and Margerison discuss the current dilemmas in optimising vitamin D status. Meanwhile, Diamond et al (page 139) report on a study of Muslim women in south-western Sydney, correlating vitamin D status with bone turnover.
time ... another place...
The most productive way to move forward in cancer research is to call off the war.
Richard Kausner, MD. US National Cancer Institute, 2001