Fun in the sun?
Enjoying the Aussie summer? Reading this on the beach? From the pallid halls of the MJA we feel bound to remind you of the perils of your favourite pastime. Northern hemispherians — count your blessings.
Skin screening story
The jury is still out on whether regular total-body skin screening in general practice will prevent deaths from melanoma. In preparation for a randomised trial addressing this issue, Janda et al (→ Prevalence of skin screening by general practitioners in regional Queensland) surveyed regional Queenslanders on their skin screening experiences.
Skin snip versus no snip
Are we more reluctant to excise pigmented lesions in certain patients, and do our own characteristics influence our excision rate? As part of a trial in Perth, English and colleagues (→ Factors influencing the number needed to excise: excision rates of pigmented lesions by general practitioners) identified factors in both doctor and patient that were associated with excision of benign, as opposed to malignant, lesions.
Slop, slop, slop
According to Taylor (→ "SunSmart Plus": the more informed use of sunscreens), people generally apply far less sunscreen than the amount needed to provide the advertised sun protection factor. He makes the case for more informed choice among sunscreen users.
Travel insurance: promises, promises . . .
You're alone, sweating profusely, with severe chest pain radiating down one arm. You manage to find a phone, call for help and are told to fax through your ECG! While phone encounters with call centre staff can be trying at the best of times, they can be downright dangerous at 3 am on a remote Pacific island when you need emergency medical advice and assistance from your travel insurer. Grace and Penny (→ Travel insurance and medical evacuation: view from the far side) furnish us with reports of poor service by travel insurance and medical evacuation companies, and make recommendations for better standards and travel advice.
A venomous world
If you're bitten by a snake in Sri Lanka, you can expect a bumpy road to recovery. The snake antivenom used there carries a 60%-80%
chance of anaphylactic or pyogenic reactions. Various empirical treatments are used to prevent these reactions, but their effectiveness is unproven. The randomised controlled trial reported by Gawarammana et al (→ Parallel infusion of hydrocortisone ± chlorpheniramine bolus injection to prevent acute adverse reactions to antivenom for snakebites) will go some way towards providing Sri Lankan doctors with
the guidance they need. However, according to Cheng and Winkel (→ Antivenom efficacy, safety and availability: measuring smoke), the problem of antivenom quality is overshadowed in a global sense by the fact that no antivenom of any kind is available in many snakebite-prone parts of the world.
The 21st century healthcare worker
Older, more specialised, often (re-)training, and wanting flexible work-life choices — that’s the description of our future workforce, delivered at the conference of the Health Leaders Network, Designing the health workforce for the 21st century. So how do we prepare for such challenges while developing a sustainable workforce? The conference turned to other industries such as banking and the airlines for lessons learnt in recruitment, retention, safety and quality (→ Designing the health workforce for the 21st century).
Camping with the enemy
Although the WHO officially declared Australia malaria-free in 1983, malaria can still be acquired locally, although this is rare. Ten adults who stayed at a camping ground in Far North Queensland developed malaria after a man with imported Plasmodium vivax malaria camped there (Hanna et al, (→ An outbreak of Plasmodium vivax malaria in Far North Queensland, 2002)). The culprits were infected mosquitoes, many of which were trapped near a creek and the toilet block. The moral of the story: mosquito repellent makes for happy campers.
Lessons in pain
Diagnostic challenges arise from two cases in this issue. The young man described by O'Leary et al (→ Fatal leptospirosis presenting as musculoskeletal chest pain) has just returned from Vanuatu with pleuritic chest pain. The cause of his illness proves elusive and things take a turn for the worse when he develops renal and respiratory failure, rhabdomyolysis and cardiac arrhythmia.
Another young man has back pain, fever and a more fortunate outcome. As Van Hal and Post report (→ An unusual cause of an epidural abscess), his treatable condition demonstrates the importance of taking a sexual history.
Another time ... another place...
Slip! Slop! Slap!
Sid Seagull and son Sam Anti-Cancer Council of Victoria, 1980