With the complex politics that surround childbirth, you could be forgiven for wondering whether the "experts" have forgotten the desired outcome that is foremost in the mind of every expectant parent — a healthy baby. Musing on yet another media report on the importance of women’s experience of childbirth and on the theme of National Babies Day (October 15), we asked de Costa and Robson to consider the issue from the baby’s perspective (→ Throwing out the baby with the spa water?).
Back on the subject of mothers, Australia has one of the lowest maternal mortality rates in the world, but we still monitor it carefully. "Why?" ask King et al, as they present the latest triennial results (→ Many maternal deaths in Australia are still preventable). Partly because these deaths represent the "tip of the iceberg" of the larger problem of maternal morbidity.
Go west, young man
Testosterone prescribing rates tell a riveting tale in an analysis across Australian states from 1991 to 2001(Handelsman, Trends and regional differences in testosterone prescribing in Australia, 1991–2001). Why the "striking upsurges" and declines in trends? And why that spectacular peak in Western Australia? Well, it certainly wasn’t due to an outbreak of Klinefelter’s syndrome (one of the few clear indications for prescribing testosterone) . . .
So, can ageing males count on testosterone therapy at all? Stuckey’s editorial distinguishes entrepreneurialism from evidence (→ Testosterone prescribing in Australia).
Tube-fed and dying
Can we lawfully withdraw or withhold artificial nutrition and hydration from a dying patient? Yes, said the Victorian Supreme Court last year for a woman in the final stages of Pick’s disease. Ashby and Mendelson take us through the process of making end-of-life decisions in the light of this ruling (→ Gardner; re BWV: Victorian Supreme Court makes landmark Australian ruling on tube feeding).
An end to INRs?
Over the next decade we are likely to see the emergence of a number of new, more "user friendly" anticoagulants. First off the block (although somewhat impeded by a recent decision by the US FDA to gather more safety data before recommending it) is ximelagatran. In “The direct thrombin inhibitor melagatran/ximelagatran”, Brighton details what we know so far about this promising drug.
RSVP for colonoscopy
An important aspect of successful screening is the ability to recruit a high percentage of the at-risk population. In the ACT, Corbett et al wondered if people would respond more readily to an invitation for screening colonoscopy directly from their GP or via a letter generated from the electoral roll ... As good a reason as any to enrol? (→ Colonoscopy screening for colorectal cancer: the outcomes of two recruitment methods)
Statistical hijinks explained
If your eyes glaze over when confronted by reports of multiple, composite and adjusted analyses in clinical trials, the latest Trials on Trial article will clear your vision (Lord et al, → Multiple analyses in clinical trials: sound science or data dredging?). In a companion article, Strippoli and Jonathan give an example of a good study that nonetheless had some problems with an underpowered subgroup analysis (→ Combined treatment with angiotensin-converting enzyme inhibitors and angiotensin-receptor blockers to prevent end-stage kidney disease in patients who do not have diabetes).
HPV: guilty again
Human papillomavirus has recently emerged as a major player in the aetiology of some types of head and neck cancer. Rose et al have participated in multinational research into this topic. They outline what is currently known in “Human papillomavirus: a cause of some head and neck cancers?”.
Too much of a good thing?
Mention the phrase "research ethics committee" in the right circles and watch the fur fly. Ethics committee demands can waste resources and time, say some correspondents in this issue, while others defend their role in saving resources (→ Letters).
Loff and Black give another view of the ethics review process as a test of how much researchers can get away with. They also warn us not to regard ethics committees as repositories for moral decision-making (→ Perhaps a week of intensive training in critical thinking would be the best preparation for members of research ethics committees).
While we're thrashing these issues around in Australia, in the UK Jamrozik et al say the paperwork associated with research there is proliferating like "maggots in a dunghill". A vivid, if unattractive, image for their latest Postcard (→ Lying awake worrying about asteroids).
The yellow brick road
It’s easier to find your way anywhere in life if you know which pathway to follow. With this in mind, Wolff and colleagues developed evidence-based clinical pathways for a number of common clinical scenarios and integrated them into hospital patients' clinical records. You can read the results of their "action research" in “Using checklists and reminders in clinical pathways to improve hospital inpatient care”.
If any of your patients have returned unwell from visiting Greece for the recent Olympics you'd best read the report from Ju et al (→ Visceral leishmaniasis: a trip to the Greek Islands is not always idyllic). As they found out, Mediterranean sandflies play host to a different set of organisms from those found locally.
Another time ... another place
The stones are called in Latin, Testes, that is Witness because they witness one to be a man . . . I need not tell you where they are placed, for Every Boy that knows his right hand from his left, knows that . . . The use of the same stones is, 1. To convert blood spirit into seed for the procreation of man . . . 2. They add heat, strength, and courage to the Body.
Culpeper, Nicholas. A Directory for Midwives, or a Guide for Women in Their Conception, Bearing, and Suckling Their Children. London: Peter & Edward Cole; 1660, p. 11.
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