Our cover image is part of a photographic exhibition entitled Face of Donation, by Marco Sacchi, which is aimed at increasing community awareness of organ donation. At the beginning of this year, there were 1716 people around Australia awaiting organ transplantation. Many will still be waiting at year’s end as the demand is not matched by donor rates. In “Potential for organ donation in Victoria: an audit of hospital deaths”, Opdam and Silvester examine this shortfall in Victoria, using an audit of hospital deaths to estimate the current and the maximum practically achievable organ donation rates in 12 major hospitals. In the United States, donor rates have long been higher than those in Australia, and have improved markedly with the introduction of a national program involving collaboration between hospitals to share strategies. A similar program has now been funded in Australia, for which Mathew and Chapman hold high hopes (→ Organ donation: a chance for Australia to do better).
In North Queensland, where the sun is fierce and dermatologists are shy, most general practitioners find themselves excising a lot of minor skin lesions. In a randomised trial published elsewhere, Heal et al, from Mackay, found that the wound infection rate after minor excisions by GPs in the town was 8%–9%, whether or not the wound was kept dry and covered. In a second article (→ Risk factors for wound infection after minor surgery in general practice), they report the risk factors for infection — such as age, comorbidities and the site of the excision — among the whole study sample.
Experts have predicted that the surge in type 2 diabetes in Australia will be followed by an epidemic of renal impairment. To help GPs keep an eye out for this important complication, it has been suggested that laboratories routinely calculate and report an estimated glomerular filtration rate (eGFR) whenever a serum creatinine level is requested. Do GPs need this to identify patients with renal impairment? According to Thomas et al’s study, yes ... and no (→ The assessment of kidney function by general practitioners in Australian patients with type 2 diabetes (NEFRON-2)).
Watching the feast
Australian experts continue to debate the relative roles of diet and exercise in the obesity epidemic, but they are doing so in somewhat of an information vaccum. There are very few available data on what Australians are eating and whether this is changing over time. According to Webb et al, this is just not good enough. In “Nutrition surveys or surveillance: one-night stands or a long-term commitment?”, they issue a call for ongoing funding for longitudinal nutrition research.
This issue offers not one but two Lessons from Practice. Patradoon-Ho et al report on a young patient who suffered an uncommon adverse event from excessive doses of a common medication (→ Inhaled corticosteroids, adrenal suppression and benign intracranial hypertension), while Kolbe et al describe a patient with a rash due to an uncommon but important infection (→ A case of human cutaneous anthrax).
Recent reports have shown that vitamin D deficiency and nutritional rickets are now occurring in children in Australia. Who is at risk, and how should you advise and treat your patients? A consensus statement by Australasian experts (Munns et al, “Prevention and treatment of infant and childhood vitamin D deficiency in Australia and New Zealand: a consensus statement”) gives specific and relevant advice.
It’s all in the CONSORT
Many medical journals, including the MJA, ask authors of randomised controlled trials to adhere to a set of principles and follow a checklist known as the CONSORT (CONsolidated Standards of Reporting Trials) statement, when submitting their research. Research reporting is renowned for being sloppy, despite repeated pleas for improvement, and a number of studies have now assessed the impact of CONSORT on the quality of the research articles in journals that have adopted it. Plint et al report a systematic review of studies to date addressing this issue (→ Does the CONSORT checklist improve the quality of reports of randomised controlled trials? A systematic review).
Finding a wavelength
Do you ever come away from a consultation wondering what on earth went on and suspecting that the patient might be having a similar experience? Communication can be one of the most difficult elements of clinical practice. In recognition of this, the NHMRC has designed a communications “toolkit” for use in practice. Greenberg et al outline its uses in “Optimising communication between consumers and clinicians”.
The deadliest allergy
Although anaphylaxis is relatively uncommon (8.4–21 new cases/100 000 patient-years), it is one of the medical emergencies that all doctors need to know how to treat. With anaphylactic food allergies apparently on the increase, you will find the second article in our MJA Practice Essentials — Allergy series (Brown et al, “2. Anaphylaxis: diagnosis and management”) an invaluable resource. The related Focus article by Heddle explains that anaphylaxis to stings and bites responds well to insect venom immunotherapy (→ Anaphylaxis to stings and bites).
Another time . . . another place
The NHMRC “guidelines for guidelines” emphasises approaches to implementation and the need for review of the “outcome” of having developed a given guideline. What is the point of a guideline if it is not adopted, or, if it is adopted, it cannot be shown to have any benefit?
Publication of your online response is subject to the Medical Journal of Australia's editorial discretion. You will be notified by email within five working days should your response be accepted.