Those of us who are “allergic” to dental appointments will feel particularly sympathetic towards the patient with an unusual (and real) allergy in this issue’s Snapshot (page 522).
Tackling sore throat
GPs are used to being bombarded by “experts” on the inappropriateness of antibiotics for most cases of sore throat. Yet, when might antibiotics actually help and are there clinical “pointers” to such instances? Danchin et al (page 512) offer some evidence-based strategies for clinicians.
Those heady days of being the regular recipients of leaky little jars from pregnant women may soon be over, if we choose to heed the findings of Murray et al (page 477). They followed about 1000 women throughout their pregnancies to see how much useful information the ubiquitous urinalysis provides. Meanwhile, Wallace and Oats (page 468) agree that conventional wisdom is worth questioning when it comes to antenatal care.
Current guidelines recommend that all pregnant women have a glucose tolerence test, but in practice not all do. Gestational diabetes and its sequelae have also been difficult to quantify, partly because there is no centralised register. Stone et al (page 486) linked two data sets to estimate the incidence of gestational diabetes and its associated risks in Victoria.
Palm Pilots and performance
Australians have embraced the personal digital assistant. Up to 500 000 units are currently in use here and more than a quarter of our doctors purportedly own one. Bent et al have studied their usefulness as a professional monitoring tool for anaesthetic trainees, with a program which allows users to quickly enter data about procedures performed and adverse events. They present their results on page 496.
Postcards from the edge
…or so it can seem when writing referral letters amidst the mayhem of general practice. Letters coming back from specialists can be disappointing as well. Tattersall et al take look at the art of written communication between doctors on page 516, and present some of their own letter-writing work with oncologists.
Emergency departments are not pleasant places to linger in, but patients needing urgent admission when there is a shortage of inpatient beds may not have much choice. Do such situations affect the outcome of the admission? Richardson’s study (page 492) looks at “access block” and the length of hospital stay.
What do you think?
There are now a large number of published studies exploring the topic of what doctors think of clinical guidelines. Farquhar et al believe this issue is so important that they’ve pooled the existing evidence into a systematic review, which you can read on page 502.
Global cardiology came to Australia in May this year, declares Freedman in his Conference Report on the 14th World Congress of Cardiology. Turn to page 473 for the latest on presymptomatic detection of atheroma, reversing coronary artery disease, drug-eluting stents utilising antibiotics, and much, much more.
If it suits your personal style, you’ll be relieved to learn that the concept of coordination may be overrated — when it comes to medical care, that is. Trials of coordinated care have been fraught with hazards, say Esterman and Ben-Tovim (page 469), including time restraints, patient selection and suboptimal outcome measures. On page 481 Smith et al present the results of a subset of the South Australian trial which encountered some of these hazards.
Research ethics committees can be extremely cautious about approving studies involving sensitive issues. However, according to a study by Scott and colleagues (page 507), people suffering bereavement are often eager to participate in research and may actually find the experience helpful. Braunack-Mayer’s editorial (page 471) argues that consideration of the complex risks, as well as the benefits, experienced by research participants requires more from ethics committees than the usual skills and knowledge they bring to the job.
Another time ... another place...
If you see your face in her Water, if she hath not a Fever, she is with Child.
Parson Swift, [fl. 18th Century]
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