Aspects of diabetes
If Australia follows in the footsteps of other developed countries, we can expect that our children will fall victim to obesity and some of its complications. McMahon et al have looked back over the past 12 years at children presenting with type 2 diabetes in Western Australia. (→ Increase in type 2 diabetes in children and adolescents in Western Australia) National statistics are yet to be released, but the news is not good.
As the use of metformin to treat type 2 diabetes has grown, the question of its use in pregnancy has also arisen. In “Metformin therapy and diabetes in pregnancy”, Simmons et al present an update from an Ad Hoc Working Party of the Australasian Diabetes in Pregnancy Society, which might help you decide when the benefits of this drug outweigh the risks.
This chapter of MJA Practice Essentials: Endocrinology by Proietto and Baur gives timely advice on the different management strategies for obesity (→ 10. Management of obesity). These involve the tried and true, as well as newer treatments on the horizon.
Previous MJA articles (on travel insurance and overseas evacuation, and prehospital treatment of Irukandji syndrome) drew a flurry of responses (→ Sublingual glyceryl trinitrate as prehospital treatment for hypertension in Irukandji syndrome). We also have original reports of the relationship between the El Niño Southern Oscillation Index and hepatitis A transmission (→ El Niño Southern Oscillation and the transmission of hepatitis A virus in Australia), and of murine typhus infection in Victoria (→ Murine typhus: the first reported case from Victoria).
Exercise your fatigue
A randomised controlled trial of graded exercise (aerobic activity of the larger muscles) with “pacing” (varying duration of exercise with symptoms) shows the value of this treatment for people with chronic fatigue syndrome (CFS). Wallman and colleagues found that such activity improved physical work capacity, mood and cognition (→ Randomised controlled trial of graded exercise in chronic fatigue syndrome).
This study adds to the evidence that such exercise should be the cornerstone for CFS treatment, says Lloyd in his editorial (→ To exercise or not to exercise in chronic fatigue syndrome? No longer a question). It’s not a cure, but it will at least improve quality of life while awaiting recovery.
Out with guesstimates
How well did Australian and English doctors do when asked to estimate the patient’s risk of disease in three clinical scenarios? Turn to the report of this survey by Attia et al to find out (→ Generating pre-test probabilities: a neglected area in clinical decision making).
A fair bit does ride on our ability to estimate disease likelihood, says Scott (→ Estimating disease likelihood: a case of rubbery figures), as this determines our management approach. So, roll out the validated decision aids, avoid those vague rules of thumb, and let’s get closer to the mark!
A grand IDEA
When staff at a Melbourne hospital decided that spending the equivalent of 3 weeks a year on the phone for antibiotic approvals was way too much, they came up with IDEA3S (infectious diseases electronic antibiotic advice and approval system). Grayson and colleagues evaluate their computer-based system on (→ Impact of an electronic antibiotic advice and approval system on antibiotic prescribing in an Australian teaching hospital).
Aching for a diagnosis
The patient described by Rando et al has myalgia, hypercholesterolaemia (on atorvastatin), BMI of 32 kg/m2 (and rising), and CK level of nearly 5000 IU/L (→ Successful reintroduction of statin therapy after myositis: was there another cause?). What’s his diagnosis? You do the maths . . .
From the Indian subcontinent comes a case of a man with a cough, fever, respiratory signs and a striking x-ray. Bhalotra et al share the details of this patient’s rare condition (→ A pulmonary snowstorm).
Change isn't progress
This issue’s Postcard from the UK charts the most recent attempts to modernise Britain’s NHS. Believe it or not, say our UK correspondents, Australians may actually be better off than the Brits (→ Modernisation or reform? The NHS approach).
Upping the anti
How much anticoagulation should we aim for when treating recurrent thrombosis due to antiphospholipid antibody syndrome? Baker’s editorial applies the results of recent randomised trials to real life (→ Prevention of recurrent thrombosis in the antiphospholipid antibody syndrome: how long and how high with oral anticoagulant therapy?).
Decision by subanalysis
In this instalment of EBM: Trials on Trial, Simes and colleagues give a practical approach to interpreting and using subgroup analyses (→ Subgroup analysis: application to individual patient decisions). Peat and Naughton dissect a trial assessing how high-impact exercise affects the bone mineral content of prepubertal girls (→ Does high-impact exercise in the prepubertal period have an osteogenic effect in females?).
Another time ... another place...
Mind you, that you have a sound scientific theory to correlate your observations at the bedside. Mere experience by itself is nothing. If I take my dog to the bedside with me, he sees what I see. But he learns nothing from it. Why? Because he’s not a scientific dog.
The Doctor’s Dilemma, act 1, 1913 George Bernard Shaw