Following her husband’s death from colon cancer, a prison officer’s wife claimed and was awarded workers' compensation on the basis that work stress had contributed to his developing the disease. In strictly medical terms this doesn't make sense — there is no proof that stress causes cancer. However, as Spigelman and Dwyer explain (→ Is there a link between work-related stress and colorectal cancer?), "evidence" in the adversarial legal system is poles apart from the usual medical definition! Niselle says a better way to handle such claims is to use medical panels that flush out and contextualise all relevant information (→ Stress, colon cancer and workers' compensation).
As any parent (and doctor) knows, children don't always fall ill between nine and five, and it’s not always easy to tell how serious the illness is. What if they had access to phone advice from experienced paediatric nurses in such situations? Kidsnet (run by the Children’s Hospital at Westmead) is one such service. Read about its enormous popularity in “Paediatric telephone triage and advice: the demand continues”.
The Footy Show
Mention football and most will think scandal, wealth and adulation, not just the game. The Football Australasia conference, held during last year’s AFL grand final week, also linked football with injuries and controversies over injury management. Seward et al describe the practical and research issues that were raised, from career-ending injuries to autologous chondrocyte implants (→ Football Australasia: controversies in 2003).
We've heard the adage that all that wheezes is not asthma. This issue’s Lessons from Practice adds that all breathing that’s noisy isn't necessarily wheezing either . . . (Spencer et al, Biphasic stridor in infancy)
A previous MJA article — "Evidence-based obstetrics in Australia: can we put away the wooden spoon?" (Med J Aust 2001; 174: 588-589) — recounted the discipline’s admirable pursuit of best evidence and the pitfalls of doing so. In this issue, Giles et al report how obstetricians manage women who are (potentially) infected with blood-borne viruses (→ An audit of obstetricians' management of women potentially infected with blood-borne viruses). Does the wooden spoon still dangle overhead?
The ‘W’ word
Workforce planning is the subject of two articles reflecting current concerns about our shortage of doctors, particularly rural ones. Kamien’s editorial describes two recent ground-breaking reports with a practical blueprint for viable rural general practice (→ The viability of general practice in rural Australia). The Viewpoint by Joyce and colleagues argues that much of our current approach is piecemeal and narrow, proposing a more global "systems perspective" (→ Time for a new approach to medical workforce planning).
A controversial editorial by Peters and colleagues challenges us to consider whether smokers should be denied certain elective surgical procedures (→ Smoking cessation and elective surgery: the cleanest cut). The premise is simple: apart from the well known cardiorespiratory risks, smokers have higher rates of wound infection, thus incurring higher healthcare and personal costs. But what are the other issues to consider in such a discriminatory policy?
Riding on the sheep’s back
As part of the MJA’s evidence-based drive to boost Australian industry and export earnings, we publish a randomised controlled trial of a high-performance Australian medical sheepskin. Introduced by the CSIRO with certain technical specifications in 1998, the sheepskin was assessed for its effectiveness in preventing pressure ulcers. Jolley and colleagues shear — sorry, share — the good news in “Preventing pressure ulcers with the Australian Medical Sheepskin: an open-label randomised controlled trial”.
Stacey’s editorial reminds us that the answer doesn't lie in any one item (→ Preventing pressure ulcers). Instead, let’s avoid any dyed-in-the-wool habits that don't include active institution-wide prevention, adequate staffing and pressure-relieving devices.
Anything but osteoporosis
From the barrage of information on osteoporosis that’s bombarded us in recent years, anyone might be forgiven for forgetting that other bone disorders do exist. We asked Prince and Glendenning to redress the balance in their instalment of MJA Practice Essentials: Endocrinology (→ 8: Disorders of bone and mineral other than osteoporosis).
Another time ... another place...
What of the allegedly indisputable nature of the evidence on which so much of the so-called scientific medicine is based? On close inspection, much of that turns out to be disputable and even undependable. In a word, uncertain.
Sherwin B Nuland The American Scholar. Spring 1998
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.