A recurring theme in the Journal this year has been patient safety. Arguably, the first step towards improving this is to take a close look at adverse events (such as deaths), why they occurred and what might have prevented them. In keeping with these principles, Semmens et al established the Western Australian Audit of Surgical Mortality, in which the circumstances of deaths after surgery are peer reviewed and feedback is provided. In “The Western Australian Audit of Surgical Mortality: advancing surgical accountability” they report on the first 2 years of the project which, according to Thompson et al (→ Surgical accountability: a framework for trust and change), is a prototype for a national system of surgical audit.
Rubin and Leeder are also concerned about patient safety. In the wake of the recent Paterson review and the proposal for a new Australian Commission on Safety and Quality in Health Care, they outline the path ahead, including an essential first step (→ Health care safety: what needs to be done?).
In addition to these important articles our readers have a say about patient safety on “The Bundaberg Hospital scandal: the need for reform in Queensland and beyond”: in Matters Arising we publish the unprecedented volume of correspondence in response to our Editor’s take on the Bundaberg Hospital scandal in the 19 September issue.
The sex factor
For the first time ever, Australia has a National Sexually Transmissible Infections Strategy. According to Mindel and Kippax (→ A national sexually transmissible infections strategy: the need for an all-embracing approach) the strategy is a good start, but stops far short of going all the way. Couldwell (→ Management of unprotected sexual encounters) is like-minded. Her Update on the management of unprotected sexual encounters, while an excellent guide to restraining the bolted horse, begins and ends with education, prevention and the mighty condom.
N-Acetylcysteine can be life-saving stuff after paracetamol overdose, but beware the maths when calculating the dose, say Little et al (→ A potentially fatal prescribing error in the treatment of paracetamol poisoning).
The second birth
As obstetricians are well aware, decisions made in the antenatal clinic or the delivery suite can have far-reaching implications for both mother and baby. Taylor et al point out that additional factors to consider when contemplating caesarean section are the mode of delivery and possible outcome of subsequent pregnancies (→ Risk of complications in a second pregnancy following caesarean section in the first pregnancy: a population-based study).
A telling CAPTION
Most doctors would be confident about managing pneumonia, so the results of the Community-Acquired Pneumonia: Towards Improving Outcomes Nationally (CAPTION) study of Australian hospital emergency departments (→ Empiric management of community-acquired pneumonia in Australian emergency departments) might come as a bit of a surprise. Maxwell et al from the NSW Therapeutic Advisory Group provide suggestions for improvement.
In preparation for a move to a new campus earlier this year, Johnson et al knew they needed to do everything possible to reduce the rates of nosocomial methicillin-resistant Staphylococcus aureus infection in their hospital. Their strategy, Operation Clean Start (→ Efficacy of an alcohol/chlorhexidine hand hygiene program in a hospital with high rates of nosocomial methicillin-resistant Staphylococcus aureus (MRSA) infection), is now being rolled out across Victoria.
Is exercise really good for you?
An overweight, middle-aged ex-footballer comes for your advice on a vigorous exercise program to get back in shape. You’ve wondered about doing the same yourself. But what about reports that exercise can be bad for you? In this instalment of our Practice Essentials - Sports Medicine series, Brukner and Brown explore the most important risks: joint injury and major cardiovascular events (yes, including sudden death). How seriously do we take these risks, can they be predicted, and what are the real benefits of exercise? Turn to “3. Is exercise good for you?” for a review of the evidence and some practical advice.
An end to the CF lottery?
One in 25 Australians carries a genetic mutation that, given the right (or wrong) partner, could produce a child with cystic fibrosis. However, unless there is a family history of the disease, most couples embarking on a pregnancy are unaware of their risk. According to Massie et al (→ Screening couples for cystic fibrosis carrier status: why are we waiting?) it’s time to change the way we screen for this disease.
The change merchants
Australians are great innovators, and Australian General Practice is no exception. How sustainable are the outcomes of the endless round of studies, projects and programs? This issue’s supplement, The sustainability of primary health care innovation, from the Australian Primary Health Care Research Institute, details some of the efforts that are being made to effect positive, ongoing change in this most important of our health sectors.