Volume 178 Issue 11

Crohn's disease is an important cause of morbidity in Australia, with a prevalence of about 50 per 100 000 population. The disease is most common in adolescents and young adults, but can occur at any age. The cause is still unknown, but research towards finding the cause is proceeding apace, along with improvements in diagnosis and advances in therapy. The development of Crohn's disease depends upon an ...

Warwick S Selby MB BS MD FRACP

In this issue of the Journal, Priest and colleagues report a further study showing the lack of effectiveness of "debriefing" after a traumatic event in preventing psychological disorders — in this case, in women after childbirth.1 Their use of debriefing for this purpose indicates how widely the enthusiasm for this intervention has spread in the past decade. On superficial examination, early interventions are an appealing ...

Alexander C McFarlane MD, DipPsychother, FRANZCP

This issue of the Journal (page 575) features the last article of the EBM in action series,1 conceived to show how clinicians can effectively look for the best available evidence to answer clinical questions. In the current medical climate, clinicians clearly need systems to obtain the best available evidence, and the responsibility for creating these systems falls on both individual clinicians and the organisations for ...

Christopher B Del Mar MD FRACGP · Jeremy N Anderson MD FRANZCP

Objectives: To determine the utility of capsule endoscopy in patients referred for investigation of suspected disease of the small intestine.Design and setting: Single centre, prospective, cohort study from 4 July 2001 to 8 September 2002.Patients: Sixty consecutive patients who underwent capsule endoscopy for investigation of suspected disease of the small intestine.Main outcome measures: Abnormal findings at capsule endoscopy.Results: ...

André K H Chong FRACP · Andrew C F Taylor MD, FRACP · Ashley M Miller PhD, FRACP · Paul V Desmond FRACP

Objective: To test whether critical incident stress debriefing after childbirth reduces the incidence of postnatal psychological disorders.Design: Randomised single-blind controlled trial stratified for parity and delivery mode.Setting: Two large maternity hospitals in Perth.Participants: 1745 women who delivered healthy term infants between April 1996 and December 1997 (875 allocated to intervention and 870 to control group).Intervention: An individual, ...

Susan R Priest M Psych, PhD · Jenni Henderson BSc, MPH · Sharon F Evans MSc, PhD · Ronald Hagan MB BCh, MBA

Objectives: To determine whether infection with human immunodeficiency virus (HIV), hepatitis B virus (HBV) or hepatitis C virus (HCV) occurred after two potential episodes of exposure through needle- and syringe-sharing in Australian prisons, and to examine use of post-exposure prophylaxis (PEP) against HIV infection in the prison setting.Design: Cohort study of potential contacts of two prisoners infected with HIV, HBV and HCV ...

Belinda G O'Sullivan MPH, GradDipAppEpi · Michael H Levy MB MS, MPH · Sharon G Barton DipApplSc · Kate A Dolan PhD · John M Kaldor PhD · Andrew E Grulich PhD · Jeffrey J Post FRACP · Dominic E Dwyer MD, FRACP, FRCPA

Objective: To investigate the effect of incontinence on clinical outcomes and costs for patients in subacute care.Design: Retrospective analysis of data collected over a 3-month period in 1996.Setting: 54 medical facilities in Australia and New Zealand providing subacute care in an inpatient setting.Patients: 6773 episodes of care provided to 6455 rehabilitation and geriatric evaluation and management patients.Main ...

Janette P Green MStat · Irenie Smoker MEc · Maria Theresa Ho MD, MRACMA · Kate H Moore MD, FRANZCOG, CU

Clinical record At 11: 30 on 8 April 2003, a 64-year-old man presented to the National University Hospital emergency department (ED) complaining of light headedness for 3 days, and dry cough and body aches for 2 days. His general practitioner had recorded a temperature of 37.7°C. On further enquiry in the ED, he described mild dyspnoea and palpitations. For over 40 years, he had smoked 25 cigarettes a day, ...

Dale A Fisher MB BS, FRACP, DTMH · Madeleine H L Chew MB BS · Yean-Teng Lim MRCP, FRCP · Paul A Tambyah MB BS

Objectives: To conduct a systematic review of how short-stay observation units (SOUs) affect the efficiency of healthcare delivery and the quality of services provided.Data sources: MEDLINE, CINAHL, Best Evidence and The Cochrane Library were searched for the period 1 January 1960 to 31 July 2000.Study selection: Studies were eligible if published in English and rated at National Health and Medical ...

Sue Daly RN, MN, FRCNA · Donald A Campbell MD, FRACP · Peter A Cameron MB BS, FACEM

Pulmonary arterial hypertension (PAH) is a heterogeneous condition with a wide range of causes. The diagnosis is often delayed or missed. PAH is covert in its early stages, when its detection and treatment should have the most impact. Access in Australia to effective PAH therapies has lagged behind that in other affluent countries. New agents for PAH, now becoming available, improve ...

Anne M Keogh MD, FRACP · Keith D McNeil MB BS, FRACP · Trevor Williams MB BS, FRACP · Eli Gabbay MB BS, FRACP · Leslie G Cleland MD, FRACP

Antiplatelet drugs protect against myocardial infarction, stroke, cardiovascular death and other serious vascular events in patients with a history of previous vascular events or known risk factors for cardiovascular disease. Aspirin reduces the risk of serious vascular events in patients at high risk of such an event by about a quarter and is recommended as the first-line antiplatelet drug. Clopidogrel reduces the risk ...

Graeme J Hankey MD, FRACP · John W Eikelboom MB BS, FRACP

Clinical questionA 43-year-old woman sought advice about the treatment of her sea-sickness. A sea-kayaking enthusiast, she suffers disturbing motion sickness in big seas. The usual remedies have either been ineffective or made her drowsy. A scuba-diving instructor recommended that she try taking phenytoin the night before going kayaking, and she wonders whether there is any evidence to support this recommendation. Search questionThe primary search question was ...

Edi G Albert MSc FRACGP

Trial: Lipozencic J, Skerlev M, Orofino-Costa R, et al, and the Tinea Capitis Study Group. 2002; 146: 816-823.

Chris Commens FACD

Maintaining adequate and consistent accrual of patients is important for small clinical trials and crucial to large multicentre, multinational clinical trials, in which participants often number in the thousands. Trial recruitment that is slower than expected can result in prolonged trial durations, increased costs, uneven workload, and morale problems, both for trial participants and trialists.1 Furthermore, when recruitment is so poor that it needs to ...

Wendy E Hague MBA, MB BS · Val J Gebski BA, MStat · Anthony C Keech MscEpid, FRACP

Although uniquely personal, the information from gene analyses impacts on parents, siblings, children and even entire ethnic groups. Doctors need to carefully balance the right of a patient to privacy against the wider family and society interests, consistent with ethical standards and their legal obligations. Doctors also need to be in a position to advise their patients of potential risks that may result ...

Margaret F A Otlowski LLB(Hons), PhD · Robert Williamson FRS, FAA

To the Editor: Spilsbury et al argue that "improved education for physicians, and perhaps parents, with regard to foreskin development and management is required."1 However, updating of textbooks and medical curricula is required to accomplish this objective. Articles by Caldamone et al2 and Cendron et al3 are two examples of incorrect data in text books. Gairdner was the first to provide data on the normal development ...

George Hill

To the Editor: The study by Spilsbury and colleagues provides new data on rates of phimosis, balanoposthitis, and lichen sclerosus.1 However, it does cite sources — Øster2 and Shankar and Rickwood3 — that indicate very low rates of phimosis. Øster was a school medical officer who followed up his subjects for several years, making frequent penile inspections and giving them continual instruction on prepuce care. ...

Stefan A Bailis

To the Editor: In the recent article by Spilsbury and her colleagues on circumcision for phimosis, a key part of their argument hinged on probable rates of phimosis among boys.1 I take no stance for or against circumcision, but I have published on evolutionary aspects of the human foreskin and the origins of circumcision,2 for which I surveyed the literature on the occurrence of phimosis. Spilsbury ...

Guy Cox

To the Editor: The article by Spilsbury et al starts well by acknowledging at least some of the serious health consequences of not circumcising,1 but then digresses into a study of whether a particular medical reason for circumcision — namely phimosis early in life — has been overstated in medical records. So what! Circumcision is a simple procedure that conveys significant lifetime health benefits. Like immunisation, ...

Brian J Morris

In reply: We support Hill in his call for improving the dissemination of information and data about foreskin development and management. Circumcision is a highly emotive issue. Our study on phimosis1 was carried out under the Western Australian Safety and Quality of Surgical Care Project, established in 1996, to assess the safety, quality, appropriateness and outcomes of surgical care in the state. The purpose of our ...

James B Semmens

To the Editor: While I generally applaud the comments on phimosis in Dewan's recent editorial,1 there are two points on which I would take issue with him — one historical, one ethical. Firstly, the incidence of circumcision in Britain never reached anything like 95%, and most of the decline in the practice occurred in the 1940s. According to surveys in the 1940s and 1950s,2 even at ...

Robert JL Darby

In reply: I thank Darby for his correction of the historical facts, and for raising for further discussion the ethics of circumcision. While I concur that removal of the prepuce for cosmetic reasons may not be in the interests of the child, we do need to allow for the parents' perceptions, and for their willingness and ability to care for the prepuce appropriately, if ...

Paddy A Dewan

To the Editor: Metformin is a commonly prescribed oral hypoglycaemic agent used to treat type 2 diabetes mellitus. Its major effect is on hepatic glucose production and thereby fasting blood glucose level (f-BGL). Metformin does not commonly cause weight gain, and may be associated with significant weight loss.1 Over the past year, we have prescribed metformin as adjunctive therapy for five patients with type 1 diabetes (T1DM). ...

Jenny E Gunton · Stephen M Twigg

To the Editor: I concluded my recent article with a hope that the "recommendations of the Dawson Committee will provide much needed amendment to the Trade Practices Act".1 In the article, I argued that medical rosters ran the risk of illegality as exclusionary provisions under the Trade Practices Act 1974 (Cwlth) because of either a drafting deficiency in the Act or a policy non-appreciation of ...

Warren Pengilley

Re: the 5 May 2003 supplement to the Journal, Comprehensive care for people with schizophrenia living in the community (Med J Aust 2003; 178: S41-S80). In some articles, authors referred, in the text or reference list, to other articles in the same supplement. In a few instances, the page numbers of the cited articles were omitted in the printed version. The web version published simultaneously ...

Re: "The SARS epidemic: lessons for Australia", by Cameron PA, Rainer TH, De Villiers Smit P, in the 2 June 2003 issue of the Journal. The Box with the World Health Organization case definitions of "suspected" and "probable" SARS (severe acute respiratory syndrome) was omitted from the print version of this editorial (Med J Aust 2003; 178: 478-479), but was included with the rapid ...

Peter A Cameron MB BS, FACEM, MD · Timothy H Rainer MB BCh, FHKCEM, MD, FHKAM · Pieter De Villiers Smit MB ChB, FACEM

The medical profession comprises a few men ... who are constantly seeking to extend our knowledge of the human body and its ailments, and a very large number who apply this knowledge without contributing to it. ... the material in our medical schools is far from ideal ... because the majority of the teachers are either incapable of including research into their daily lives or unwilling ...

SARS: the genetics . . . As this epidemic continues, scientists in Singapore have sequenced the viral genome of isolates from the local index patient and four contacts.1 Comparing the genotypes of these isolates with those from Canada, Hong Kong, Vietnam and China, it is emerging that they show genetic "signatures", allowing us to track their geographic origins. These findings on the newly dubbed SARS ...