Drugs, droughts and snouts
In the late 1990s, amid a glut of cheap, relatively pure heroin, drug overdose deaths in Australia rose alarmingly. However, for various reasons, the supply later dried up and, by 2001, drug users were reporting a veritable drought. Degenhardt et al watched it all unfold. Did the reduced supply lead to fewer overdoses and deaths, or did users simply overdose on other drugs? Turn to “The effect of a reduction in heroin supply on fatal and non-fatal drug overdoses in New South Wales, Australia” for the answers.
Of course, heroin overdose is still a common reason for ambulance callouts. Giving intramuscular naloxone, the usual first-line treatment for suspected drug overdose, exposes ambulance officers to the risk of contracting blood-borne viruses from needlestick injuries. In a randomised controlled trial, Kelly et al tested the theory that intranasal naloxone administration would be just as effective (→ Randomised trial of intranasal versus intramuscular naloxone in prehospital treatment for suspected opioid overdose).
We didn’t need films like Black Hawk Down to associate helicopters with danger — watching the news can also do the trick. However, helicopters clearly have a crucial role to play in aeromedical transport, as well as military endeavours. How safe are they? Holland and Cooksley evaluate the accident record over 11 years for Australia’s helicopter emergency services (→ Safety of helicopter aeromedical transport in Australia: a retrospective study). Editorialists Garner and colleagues believe we can further improve helicopter safety — find out how in “Safety of emergency medical service helicopters”.
Not to be sneezed at
Allergic rhinitis is not a trivial condition when you consider its prevalence and its impact on quality of life, other medical conditions and productivity. Walls and colleagues present a Clinical Update on optimal management of this perennial problem (→ Optimising the management of allergic rhinitis: an Australian perspective).
What’s the point?
This question — with regard to the medical humanities — is often raised with Gordon, author of one of several articles on this topic. She defines the term "medical humanities" and points out the value of including this subject in the basic medical curriculum, citing "case histories" of doctors and students who've become converts to the cause (→ Medical humanities: to cure sometimes, to relieve often, to comfort always). In fact, Evans, a UK Professor of Humanities in Medicine and a keynote speaker at a conference on the subject in Sydney last year, argues that the reductionism of modern medicine makes engaging with the humanities even more vital (→ Is medicine a “cultural good”?).
GP Hellman weighs in for the defence with her compelling tale of the death of a friend. The moral: that story-telling can help doctors cope with tragedy (→ Narrative and illness: the death of a doctor’s friend).
Domestic and international relations
If you find the latest Australian immunisation schedule (which includes some unfunded vaccines) confusing, you're not alone. The conference report from the 9th National Immunisation/1st Asia-Pacific Vaccine Preventable Diseases Conference held last year politely states that this issue "generated vigorous discussion". You'll be interested to hear, though, that rotavirus and HPV vaccines will not be long in the offing. To put things into global perspective, problems associated with providing vaccines in the Pacific were also highlighted (→ Immunisation at the crossroads: 9th National Immunisation/ 1st Asia-Pacific Vaccine Preventable Diseases Conference).
Imagine there’s no barriers, says Sydney GP Mann, at least not between hospital and community. In this Utopia, the currency is in "bunyas", patient care is seamless, the healthcare world lives as one, and, wait for it, waiting lists fall. You may say she’s a dreamer, but Mann cites evidence that suggests some of this dream is well within reach (→ From "silos" to seamless healthcare: bringing hospitals and GPs back together again).
Dip into our Letters to the Editor for our usual varied fare. Did you know about the analgesic tramadol being associated with seizures? How often do hospital doctors prescribe nicotine replacement therapy and how well immunised are our preschoolers against varicella? There were also vigorous responses to previous articles on elective surgery and smokers; using tissue plasminogen activator in stroke; web and telecounselling; playground safety standards; and subsidised access to TNF-α inhibitors (→ Letters).
Two years apart, two elderly women presented in extremis to a Taiwanese hospital. Their marked hypertension and pulmonary oedema landed them both in intensive care, where all the usual measures proved ineffective. These women shared a rare complication of a common illness. Lee et al tell the story (→ Hepatitis C-associated cryoglobulinaemia presenting with refractory hypertensive crisis and acute pulmonary oedema)).
Another time ... another place
If we wish to know about a man, we ask "what is his story — his real, inmost story?" — for each of us is a biography, a story. Each of us is a singular narrative, which is constructed continually, unconsciously, by, through, and in us — through our perceptions, our feelings and thoughts and our actions, not least, our discourse, our spoken narrations. Biologically, physiologically, we are not so different from each other; historically, as narratives, we are each of us unique.
Oliver W Sacks, 1985
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