In hot water
It wouldn’t be an Australian summer without a walk on the beach, crunching stranded bluebottles underfoot, but encounters with these jellyfish in the water cause thousands of painful stings each year. Recently, the standard first aid measure of applying ice packs has been questioned amid a series of small studies suggesting that hot water might actually be better. In response, Loten et al conducted a randomised controlled trial on the beaches of Newcastle, NSW. We published the results, which indeed favour the warmer solution, as a rapid online publication to catch the end of the peak swimming season. The print version follows in “A randomised controlled trial of hot water (45°C) immersion versus ice packs for pain relief in bluebottle stings”.
Breathe easy
The Australian Lung Foundation recently updated its guidelines for the treatment of chronic obstructive pulmonary disease (COPDX) in line with the most recent Cochrane reviews. For a summary of the new guidelines, complete with a helpful aide memoire, see Abramson et al (→ COPDX: an update of guidelines for the management of chronic obstructive pulmonary disease with a review of recent evidence).
Consume with care
The first step towards preventing adverse events is understanding when and how they happen. This is why studies like that of Miller et al, which examines adverse drug events in Australian general practice, are very important (→ Adverse drug events in general practice patients in Australia). Having assessed the damage, say Roughead and Lexchin (“Adverse drug events: counting is not enough, action is needed”), we now need watertight systems for safer prescribing.
More than two years after its debut on the Pharmaceutical Benefits Scheme, the antipsychotic drug amisulpride seems to be well tolerated at therapeutic doses. The effects of overdose, however, take a while to emerge. In “Amisulpride deliberate self-poisoning causing severe cardiac toxicity including QT prolongation and torsades de pointes”, Isbister et al describe four patients who suffered severe cardiac toxicity in this situation.
Real world diabetes
Few doctors would doubt the importance of optimising blood glucose levels to prevent the complications of type 2 diabetes, so it might be assumed that decisions to progress from diet to drugs, or drugs to insulin in the pursuit of euglycaemia would be simple and swift. But patients and their medical carers often have competing priorities and concerns. The Fremantle Diabetes Study reveals that there are often long periods of hyperglycaemia before therapy is escalated (Davis et al, “Glycaemic levels triggering intensification of therapy in type 2 diabetes in the community: the Fremantle Diabetes Study”).
Physicians who treat type 1 diabetes are beginning to realise that rigid regimens based on clinical ideals are rarely compatible with real life. Some European centres have been training patients with diabetes to vary their own insulin doses according to fluctuations in their diet (McIntyre, “DAFNE (Dose Adjustment for Normal Eating): structured education in insulin replacement therapy for type 1 diabetes”). Several Australian centres are now following suit, with promising early results.
You are my sunshine
Summer is also a time when many of us are ambivalent about our relationship with the sun. In “Estimates of beneficial and harmful sun exposure times during the year for major Australian population centres”, Samanek et al give an estimate of how much time in the sun will keep you vitamin D replete but out of the dermatologist’s waiting room.
Debating medical education
In the next few years, Australia’s medical workforce will undergo a marked transformation as a growing number of international graduates and graduates from both the established and the new medical schools join the current pool of doctors. How will we ensure that they are ready to practise, that their training needs are met, and that Australia has an adequate medical workforce? Luckily, some of our best minds are engaged in thinking these issues through, as evidenced in this issue by contributions from McGrath et al (→ Lack of integration of medical education in Australia: the need for change), Paltridge (→ Prevocational medical training in Australia: where does it need to go?), and Dahlenburg et al (→ Medical education in Australia: changes are needed). The recommendations are clear, placing the onus on governments to respond.
Timely advice
Most of us probably believe that the message that women’s fertility decreases as they age has been very well propagated by the media and our politicians, but Bachrach — who has experienced secondary infertility on the basis of menopause — believes doctors have a responsibility to reinforce the message and actively assist women to plan for the number of children they want (→ Missed conceptions: a call for “positive” family planning). Fertility experts Chapman et al agree that doctors have a role to play in helping women get what they want out of their reproductive lives (→ Missed conceptions: the need for education).
Tweaking the look
Like all great fashion icons, the MJA changes its style in barely perceptible increments. In this issue, you will notice that we’ve substituted the rather flashy boxes of author details (previously found on the first page of most articles) for an understated but clearly visible section at the end of each article. We hope you’ll agree that the result is both tailored and functional.
Another time . . . another place
The country needs fewer and better doctors; and . . . the way to get them better is to produce fewer.
Abraham Flexner, 1910