The Medical journal of Australia
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Patients with adrenal insufficiency (AI) require additional glucocorticoid doses during surgery or medical illness, but there is no universally accepted regimen for glucocorticoid supplementation therapy. The high doses and long duration of glucocorticoid coverage that have traditionally been used do not reflect the hypothalamic-pituitary-adrenal response to surgical stress and medical illness in normal people. ⋯ The recommended use of lower doses of glucocorticoids during surgical and medical stress should not de-emphasise the importance of additional supplementation during such events. Our recommendations do not replace clinical judgement, but their use will ensure that patients with AI are safely managed during illness or surgery without the risk of an adrenal crisis or excessive steroid dosing.
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Multicenter Study
When continuity of care breaks down: a systems failure in identification of osteoporosis risk in older patients treated for minimal trauma fractures.
Minimal trauma fractures may be the first indication of osteoporosis. Our aim was to determine the proportion of patients who underwent bone density testing for osteoporosis of those with a minimal trauma wrist fracture treated in the emergency department (ED). ⋯ Follow-up of patients suffering minimal trauma wrist fractures treated in the ED is poor. Systems to improve the identification and treatment of osteoporosis in this group are needed if future osteoporotic fractures and their consequences are to be avoided.
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To determine the association between smoking in pregnant teenagers and baby birthweight. ⋯ Babies whose mothers smoked during pregnancy were more likely to have LBW than babies whose mothers did not smoke. Mothers who continue to smoke in the second half of pregnancy increase their baby's risk of LBW. There is significant scope to improve the quitting rate, and health professionals need to target smoking cessation at all contacts with pregnant women who continue to smoke.
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There has been a call to include empathy as a selection criterion in medical training. Empathy is a complex construct currently assessed by self-rating and observational scales, which may be complicated by the subjectivity of such measurements. Neuroscientific research into disorders of empathy such as autism should be encouraged to help further refine the evolving construct of empathy. ⋯ Competence and empathy may be independent qualities developed by different aspects of medical training. Provision of better work conditions and environments for physicians may forestall erosion of empathy, reducing the need to predict and enhance its development. Empathy should be valued in medical students and doctors, but more research is needed into the nature, assessment, and correlates of empathy before its adoption as a selection criterion for medical students.