A time for everything
Ziegler and Graves tell us why we should be screening all pregnant women in Australia for HIV infection, given that we can now prevent virus transmission to the baby (→ The time to recommend antenatal HIV screening for all pregnant women has arrived).
Williamson and colleagues observe the UK controversy over identified data appearing in cancer registries without patients' knowledge. They believe the time has come for registry guidelines that safeguard patient privacy and consent, while still allowing for data to be used in research and quality improvement (→ Medical registry governance and patient privacy).
And the time for birth may be very early indeed for extremely low birth weight infants. Doyle gauged how frequently such babies were born in high-risk perinatal centres in Victoria between 1979 and 1997, and how well they fared (→ Changing availability of neonatal intensive care for extremely low birthweight infants in Victoria over two decades).
Blame the Romans
The Romans are said to have introduced rigid class distinctions to British society centuries ago. According to our latest Postcard from the UK, little has changed, and healthcare in the UK is still a class act, and one that’s perpetuating health inequities (→ UK health inequalities: the class system is alive and well).
CAM and the art of ethicolegal maintenance
What are the ethics of referring patients to a complementary medicine practitioner? Would such a referral be considered negligent in the eyes of the law? Sometimes, say Kerridge and McPhee, as demonstrated by a case in the latest of our Complementary and Alternative Medicine series (→ Ethical and legal issues at the interface of complementary and conventional medicine). Even more contentiously, they ask, can it ever be unethical or negligent not to refer or inform patients about alternative therapies?
In the US, merely referring patients to complementary practitioners doesn’t leave you open to a malpractice suit, says Cohen, but there are exceptions to this rule (→ Legal and ethical issues in complementary medicine: a United States perspective). His commentary also gives an ethical framework to work with when conventional care seems to conflict with a patient’s interest in CAM.
Dark side of adolescence
Deliberate self-harm may be related to suicidality but doesn’t necessarily arise from it. We know very little about this behaviour, but it does appear more common in young people. As part of an international collaboration, De Leo and Heller surveyed 4000 high school students on Queensland’s Gold Coast to find out how many had deliberately harmed themselves and what factors were associated with this behaviour (→ Who are the kids who self-harm? An Australian self-report school survey).
Dropping out of a conversation while on a mobile phone can be annoying, but that’s nothing to the possibility of medical equipment dropping out due to mobile phone use in hospitals. That’s why most hospitals have signs asking visitors to turn off their mobiles. But what’s the evidence that their use affects the clinical function of medical devices? Lawrentschuk and Bolton conducted a systematic review to find out (→ Mobile phone interference with medical equipment and its clinical relevance: a systematic review).
Heading off the rural divide
In the past few years we've published several articles on the tyranny of distance when it comes to the health of Australians in rural and remote areas. In this regard, a study by Harradine et al, on the outcomes of rehabilitation after traumatic brain injury (→ Severe traumatic brain injury in New South Wales: comparable outcomes for rural and urban residents), should be of interest to anyone trying to provide equitable services for people living in the country, as well as anybody who wants to hear about an Australian program that is working!
A SNAPP-y approach
Tip number 4 for teaching on the run, by Lake and Ryan, discusses the pros and cons of bedside teaching, and shares their “one-minute teacher” approach (→ Teaching on the run tips 4: teaching with patients).
Australians all do rejoice in our sunny climes but not in our high rates of skin cancer (or drought). However, there are other risk factors for skin cancer apart from sun exposure, ultraviolet radiation from arc welding being one possibility. Dixon and Dixon review the evidence for this claim and its significance for professional welders (→ Ultraviolet radiation from welding and possible risk of skin and ocular malignancy).
For anyone who thought that chickenpox was a trivial childhood ailment, this issue’s Lessons from Practice will make you think again. A 33-year-old woman presents to the emergency department with a 10-day history of chickenpox and 12 hours of dyspnoea and facial swelling. She dies within 44 hours, despite intensive treatment. This sobering report from Stride et al is a case in point for vaccination (→ Adult chickenpox complicated by fatal necrotising pneumonia).
It’s all in the legs
Did you know that having peripheral arterial disease puts someone at much higher risk of cardiovascular death? Norman and colleagues (→ Peripheral arterial disease: prognostic significance and prevention of atherothrombotic complications) not only enlighten us on the prognostic significance of this condition, but also how best to prevent serious vascular events in these patients and the role of the ankle–brachial pressure index as a screening tool.
Another time ... another place
Pressing home a seeming advantage, the sceptical youth asks pointed questions about the values his mentors hold so dearly. His parents react, perhaps, by tightening the rules and by demanding behaviour more circumspect than they ask of themselves.
Nurcombe B. Adolescence in a changing society. Med J Aust 1970; 2: 1225-1229
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.