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Ruth Armstrong
Med J Aust 2007; 186 (8): 386.
Published online: 16 April 2007

Undiagnosed IEMs can be fatal

The case of a 44-year-old man who died of hyperammonaemia 8 days after coronary artery bypass surgery illustrates several important points (Chiong et al, “Fatal late-onset ornithine transcarbamylase deficiency after coronary artery bypass surgery”). Unbeknown to his doctors, the man had an inborn error of metabolism, ornithine transcarbamylase deficiency. Surgery and fasting produced the fatal ammonia build-up, which could have been prevented if the patient’s condition had been known before surgery, or suspected when he first developed neurological symptoms after surgery.

Australian hospitals ill-prepared for mass emergencies

Australian hospitals are not prepared for a sudden influx of patients, as would occur with a mass casualty incident or an outbreak of disease, say Traub et al (→ The Surge Capacity for People in Emergencies (SCOPE) study in Australasian hospitals). Using United States benchmarks for surge capacity (the ability to provide acute care to both critical and non-critical mass casualties simultaneously), Traub and colleagues’ national survey of emergency department directors reveals that, if a major incident affected 500 per million population (eg, about 1900 people in Sydney), our capacity to manage the crisis would vary markedly depending on where it occurred. Based on their audit of operating theatres, intensive care beds and x-ray facilities, most critically injured patients would face delays to operation and many would not receive timely access to intensive care. The less critically injured could face delays in access to radiological investigations. But measuring infrastructure, counter Robertson and Cooper on “Disaster surge planning in Australia: measuring the immeasurable”, is just one approach to evaluating our preparedness for unpredictable events.

Cancer screening in Qld men is not evidence-based

Queensland men are much more likely to have had screening via a prostate specific antigen (PSA) test than a faecal occult blood test (FOBT) or a skin check, despite the evidence for PSA testing being the weakest of the three, say Carrière et al (→ Cancer screening in Queensland men). In the Queensland Cancer Risk Study, 2336 men aged 50-75 years were asked if they had ever had a PSA test, FOBT, and/or a whole-body skin examination and, if so, why. Excluding those in whom the test was not considered to be screening, the men were more than twice as likely to have had a PSA test than either of the other two tests. Only 15.5% of men had had an FOBT for any reason.

COPD on the rise in women

Asthma morbidity and mortality have fallen over the past decade, but chronic obstructive pulmonary disease (COPD) has not abated, and is on the increase in women. These were the findings of Wilson et al’s analysis of several South Australian and national datasets (→ Trends in hospital admissions and mortality from asthma and chronic obstructive pulmonary disease in Australia, 1993-2003). Between 1993 and 2003, hospital separations for, and deaths from, asthma steadily declined. Hospitalisation for COPD, on the other hand, appeared to be increasing, especially in women, with some inconsistencies between national and SA data. In both SA and Australia as a whole, death from COPD declined in men but increased in women. The authors call for renewed efforts to reduce smoking rates, and for earlier diagnosis and treatment of COPD.

Letters of condolence

Writing a letter of condolence to the family of a patient who has died is the decent thing to do; it offers closure for the family, the doctor, the practice staff and the medical record; and is good for the soul. So says thoracic and sleep physician, Allen (→ On the merits of writing to the next of kin after the death of your patient: an Australian perspective). In today’s fast-paced and risk-averse environment, such letters are bound to be rare. Would you write one?

Another time . . . another place

In 19th century America, the process of grieving was detailed and elaborate. The doctor’s letter of condolence was an accepted responsibility and an important part of the support offered to the bereaved . . . Today, the pattern of mourning has changed.

  • Ruth Armstrong


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