Look to the right . . .
In honour of "Walk Safely to School Day" (1 April), we spare a thought this issue for the Australian kids who are trying to navigate the proliferation of complex roadways that traverse our cities and towns. Cross and Hall consider some of the behavioural strategies that have been found to improve children’s safety as pedestrians (→ Child pedestrian safety: the role of behavioural science).
This week (3-9 April) is Motor Neurone Disease Awareness week. To mark the occasion, Kiernan is the bearer of a rare piece of good news for sufferers (→ Riluzole: a glimmer of hope in the treatment of motor neurone disease).
Denied best treatment?
There are now clear and well-publicised indications for certain drugs, investigations and interventions after patients present with acute coronary syndromes, but several Australian studies over the past few years have shown that this advice is not always adhered to. Using data from the Queensland Health Cardiac Collaborative Registry, Scott et al have tried to determine just where and why the gaps in care occur in their state (→ Variations in indicated care of patients with acute coronary syndromes in Queensland hospitals).
According to Talbot et al, many obese patients are also missing out on treatment. While bariatric surgery is covered by Medicare, and is recommended for selected patients with morbid obesity (NHMRC guidelines), it is virtually impossible to access it in a public hospital. This makes little sense economically and raises issues of equity, say the authors (→ Difficulties in provision of bariatric surgical services to the morbidly obese).
On a much larger scale, at last year’s World Congress of Clinical Pharmacology and Therapeutics, which was held in Brisbane, a major theme was global equity of access to medicines. Day and colleagues were there, and report on the highlights in "Access to medicines and high-quality therapeutics: global responsibilities for clinical pharmacology".
OTC but not risk free
Another item to add to your checklist of advice to pregnant patients might be to go easy on the antacids. On the back of a convincing cautionary tale, Gordon et al suggest more advice to and monitoring of women who might be purchasing these medications over the counter, unaware of the possible adverse effects (→ Life-threatening milk-alkali syndrome resulting from antacid ingestion during pregnancy).
Australians after the wave
Four days after a tsunami devastated much of the Indian Ocean region, a team of Australian health professionals travelled to the Maldives to assist with the medical and public health response. As Robertson et al explain, it is unusual for Australia to deploy civilian teams to disaster areas and, while the Australian and Maldivian collaboration was very successful, the experience has provided lessons for future such efforts (→ “Operation South East Asia Tsunami Assist”: an Australian team in the Maldives).
In Banda Aceh the problems were similar, but on a larger scale. Visiting Australian doctors like Allworthhad to treat very sick patients without access to basic diagnostic facilities, nursing assistance or clinical records. A number of patients with recalcitrant respiratory infections a month after immersion in the tsunami waters prompted further investigation and treatment, and this letter to the MJA (→ "Tsunami lung: a necrotising pneumonia in survivors of the Asian tsunami") .
In his 30 years as a general practitioner–surgeon, Wilson has operated on many patients who elected to have more than one minor procedure under a single anaesthetic. His pragmatic report and subsequent discussion pose an important question for an increasingly subspecialised profession (→ Multispecialty surgical conditions in general practice). Is there still a role for this multitasking approach and, if so, who is trained and willing to fill it? In a linked editorial, Bruening and Maddern explore the possible comeback of the general surgeon (→ Who will do general surgery?).
The English novelist Nick Hornby has written and spoken of receiving a diagnosis of autism for your child — no matter how you dress it up, it’s very bad news. And by the time many parents receive this news they have endured years of uncertainty and, sometimes, a delay in effective intervention. How can we ensure that children with language problems are detected and treated early? Wray et al bring their expertise to our MJA Practice Essentials — Paediatrics series (→ 7. Language disorders and autism).
Another time ... another place
Fingers replace brains, and handicraft outruns science.
Archibald EW. Higher degrees in the profession of surgery. Ann Surg 1935; 102: 481-495. 
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