Past its peak?
Asthma is a big issue for Australian children: ask any teacher and she'll show you the "puffers" to prove it. But there’s good news from Robertson et al (→ Asthma prevalence in Melbourne schoolchildren: have we reached the peak?), whose study joins an emerging body of overseas research in showing that, after increasing for 40 years, asthma prevalence seems to have stabilised or even decreased. In response, Crane wonders whether asthma is in the eye of the beholder (→ Asthma prevalence: mysterious enigmatic riddle or time-expired illusion?).
Revving up rehab
Despite good evidence that it substantially reduces mortality after heart attack, a cohort study from Victoria reveals that not everyone is offered cardiac rehabilitation (Sundararajan et al, → Attendance rates and outcomes of cardiac rehabilitation in Victoria, 1998). Does the study tell us anything else? Jelinek’s editorial points out that there is a subgroup of patients who might stand to benefit from alternative models of cardiac rehabilitation (→ Database support for cardiac rehabilitation).
Coeliac or souvenir?
A middle-aged woman returns from Bali with diarrhoea. Heard it all before? Maybe, but the cause proved elusive in this case reported by Pingé-Suttor et al (→ Cyclospora infection masquerading as coeliac disease).
NICS for nix
The role of the National Institute of Clinical Studies (NICS) is to encourage the use of best evidence in clinical practice. What gaps have they identified and how might these be bridged? The Supplement with this issue is a rich source of ideas and information from Australian and overseas experts (→ Adopting best evidence in practice).
Walk right up
Conventional wisdom holds that children with newly diagnosed type 1 diabetes need several days in hospital for stabilisation and education, but overseas programs and the Diabetes Day Care Program at the Children’s Hospital at Westmead have adopted alternative models. Srinivasan et al compare their current outpatient program with their previous inpatient treatment (→ An ambulatory stabilisation program for children with newly diagnosed type 1 diabetes).
Postcard . . .
. . . or report card? Going where angels fear to tread, our expatriate spies, Jamrozik et al (→ The UK smoking time-warp: roll on 1989!), take the opportunity to put the boot into tobacco-control legislation in the UK.
Trials on trial
A recent trial comparing cardiac revascularisation strategies found that, although overall survival rates were similar after angioplasty and coronary artery bypass surgery, people with diabetes were at increased risk of death after angioplasty. This is an example of subgroup analysis at work. In → Subgroup analysis in clinical trials, Cook et al explain how and when to use this important tool. Meanwhile, Wilson and McGuire bring their clinical perspective to another cardiology trial that used subgroup analysis (→ Should patients with severely impaired left ventricular function following myocardial infarction receive an implantable defibrillator?).
Let it rain
Recent reports that astronauts living on the proposed lunar base will have to drink recycled urine have put paid to many an aspiration for space travel. Yet, even here on earth we are starting to realise that water recycling is inevitable. Mitakakis et al explain why national guidelines on water recycling are being developed (→ Alternative water sources and reuse: what are the public health issues?).
Reviving a dying art
In an era of precision diagnosis, when the cause of death is usually known, is there any need for routine autopsy? Judging from the falling rates described by the Royal College of Pathologists of Australasia Autopsy Working Party, many doctors believe not. The authors of the report provide compelling reasons and practical tips for reversing this trend (→ The decline of the hospital autopsy: a safety and quality issue for healthcare in Australia).
The myth of a moral malady
It’s Hepatitis C Awareness Week (March 15-19), and this year the website of the Hepatitis C Council of Victoria carries the reminder Hepatitis C is a virus. Discrimination is a judgement — both can make you sick! Waller has experienced both. She shares her story in (→ Living with hepatitis C: from self-loathing to advocacy).
Osteoporosis stripped bare
There are now some excellent treatments for osteoporosis, and in some cases the need for medication is clear-cut. But what if your patient is a 55-year-old woman with osteoporosis and no fracture, or a 65-year-old with osteopenia plus a fracture? Seeman and Eisman’s contribution to our MJA Practice Essentials: Endocrinology series has the answers (→ 7: Treatment of osteoporosis: why, whom, when and how to treat).
Another time ... another place...
I believe it is only a matter of time before physicians as well as hospitals will be rated by the percentage of autopsies they do or see in their practices.
R C Giles, J Natl Med Assoc 1932; 24: 22-25
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