Home sweet hospital
Getting pneumonia or a pulmonary embolus in the right part of the world no longer means you’re condemned to a long(ish) stretch in hospital. A randomised controlled trial from New Zealand showed that people with mild to moderate community-acquired pneumonia were no worse off when cared for at home by primary care teams (Richards et al, “Home management of mild to moderately severe community-acquired pneumonia: a randomised controlled trial”). Selected patients with pulmonary embolism were treated at home and as outpatients in one area of Sydney, with similar outcomes to hospital cohorts (Ong et al, “Management of pulmonary embolism in the home”).
While the United Kingdom appears to be veering away from these schemes, Australia and New Zealand seem to be leading the charge. UK editorialists Wilson and Parker note that the future of hospital in the home resides in how we choose the best models (→ Hospital in the home: what next?).
Big picture health
Three articles in this issue deal with where we’re headed with public health in wealthier countries. Leeder’s editorial rightly acknowledges that the world’s poorest countries needed to be put on the global radar with the Millennium Development Goals, but also notes that we ignore the needs of less impoverished nations (such as those in Latin South America) to their peril (and ours) (→ Setting goals for health in a time of prosperity).
Closer to home, Corbett argues that Australia should have a new “Ministry for the Public’s Health”, to respond effectively to major public health challenges such as the obesity epidemic. Does the proposal have legs? See for yourself in “A Ministry for the Public’s Health: an imperative for disease prevention in the 21st century?”.
Finally, another finalist in the Dr Ross Ingram Memorial Essay Competition gives us an insider’s view of the benefits and pitfalls of affirmative action in Indigenous health (Paradies, “Affirmative action and equity in Aboriginal and Torres Strait Islander health”).
Dying well
Much publicity surrounded decisions to withdraw artificial feeding this year from two women with severe brain damage — Terri Schiavo in the US and Maria Korp in Australia. Faunce and Stewart discuss a lesser known Australian case, and the role of a third party (such as the courts) in settling such disputes (→ The Messiha and Schiavo cases: third-party ethical interventions in futile care disputes).
How can we prevent things getting this far? Ashby and colleagues discuss the key practical questions for clinicians to address when considering treatment abatement. However, they observe that it’s time we, as a society, reorient our views on death and dying (→ Resolving conflict in end-of-life care).
Palliative care can make a big difference to the manner of our dying, but performing research in this area is fraught with dificulties. Aoun and Kristjanson discuss alternative study designs and ways to rate the evidence (→ Evidence in palliative care research: how should it be gathered?).
Caveat educator
Problem-based learning (PBL) has been embraced by many medical schools in Australia and overseas. Does the evidence justify its popularity? Sanson-Fisher and Lynagh wonder, as they put the evidence for its efficacy and reasons for its “success” under the microscope (→ Problem-based learning: a dissemination success story?).
And for teachers on the run, Vickery and Lake offer their tips for giving feedback in “Teaching on the run tips 10: giving feedback”.
Can’t Get You Out Of My Head
When a celebrity falls ill, health issues become big news. Singer Kylie Minogue’s diagnosis of breast cancer in May this year generated a media frenzy, and news coverage of the condition rose 20-fold. As a result, women flocked to book themselves in for screening mammography. For full details of the “Kylie effect”, turn to the analysis by Chapman and colleagues in “Impact of news of celebrity illness on breast cancer screening: Kylie Minogue’s breast cancer diagnosis”.
Not so sweet
We’ve peppered this issue with an array of child and adolescent health topics. Taplin and colleagues mine the data on childhood diabetes in NSW to determine if the condition is still on the rise (→ The rising incidence of childhood type 1 diabetes in New South Wales, 1990–2002).
A recent editorial on the use of antidepressants in young people with depression (Med J Aust 2005; 182: 378-379) unleashed vigorous correspondence, including a comment from the Chairman of the Adverse Drug Reactions Advisory Committee (Letters, “Depressed youth, suicidality and antidepressants”).
Our Letters section also touches on the real risk of severe peanut allergy in Australian children, and whether the new funding for universal varicella vaccination is a good thing (→ Severe peanut allergy in Australian children).
Accolades and alcohol
You still have time to win both of these if you enter this year’s Christmas Competition. See the ad for details.
Another time ... another place
The trained nurse has given nursing the human, or shall we say, the divine touch, and made the hospital desirable for patients with serious ailments regardless of their home advantages.
Charles H Mayo [1865-1939]