A mystery to the medical world : Florence Nightingale, Rosendo Salvado and the risk of civilisation

In 1860 Florence Nightingale conducted a study on the mortality rates of indigenous children attending native colonial schools across the British Empire. Her study was driven by the question: ‘Can we civilise the natives without killing them?’ One colonial school that participated in the survey was New Norcia Benedictine mission in Western Australia. When Rosendo Salvado, the mission’s superintendent, responded, he drew on his daily encounters with the Yuat people, his statistics on the mission residents and his Benedictine philosophy of civilisation and conversion of colonised peoples. The correspondence between Salvado and Nightingale took place in the climate of intense debates about Aboriginal health, colonisation and extinction in Britain and the colonies. While many settlers and colonial observers understood Aboriginal depopulation to be the result of either the vices and diseases of unprincipled Europeans or an unstoppable destiny, whether Divine Providence or natural selection, Nightingale and Salvado shared a belief in practical solutions to what they understood to be a practical problem. Their collaboration is an example of the humanitarian opposition to the racial pessimism of Social Darwinism. They both sought to use the recently influential intellectual discipline of social statistics to support their conviction that Aborigines, if patiently and carefully handled, would survive the admittedly risky process of civilisation.

Medical evidence in child sexual assault cases

Purpose – Previous studies suggest that the presence of medical evidence is rare in child sexual assault (CSA) cases, and if present at all, such evidence is unlikely to identify a specific assailant. This study aims to examine the role medical evidence plays in criminal cases of CSA. Specifically, the prevalence of medical evidence in CSA cases, its impact on decisions to prosecute CSA cases, as well as its effect on conviction rates are examined.

Design/methodology/approach – A systematic literature review was conducted on the impact of medical evidence in criminal child sexual abuse (CSA) cases.

Findings – The results of the review suggest medical evidence increases the likelihood of prosecution; however the impact of medical evidence on conviction rate is equivocal.

Research limitations/implications – The implications of these findings for legal and psychological practice, government policy and future areas for academic research are discussed.

Originality/value – To the authors' knowledge, no other review has systematically examined the role of medical evidence on the prosecution and conviction of CSA cases.

Implementing scanned medical record systems in Australia : a structured case study on envisioned changes to elective admissions process in a Victorian hospital

In recent years, influenced by the pervasive power of technology, standards and mandates, Australian hospitals have begun exploring digital forms of keeping this record. The main rationale is the ease of accessing different data sources at the same time by varied staff members. The initial step in this transition was implementation of scanned medical record systems, which converts the paper based records to digitised form, which required process flow redesign and changes to existing modes of work. For maximising the benefits of scanning implementation and to better prepare for the changes, Austin Hospital in the State of Victoria commissioned this research focused on elective admissions area. This structured case study redesigned existing processes that constituted the flow of external patient forms and recommended a set of best practices at the same time highlighting the significance of user participation in maximising the potential benefits anticipated. In the absence of published academic studies focused on Victorian hospitals, this study has become a conduit for other departments in the hospital as well as other hospitals in the incursion.

Work differences by sector for medical specialists : evidence of a public sector ethos

Work-related characteristics representative of the ethos for medical specialists have been relatively unexplored, particularly compared to the array of research on primary care physicians. Analyses of 4,166 specialists, from the first wave of the Medicine in Australia: Balancing Employment and Life (MABEL) study, revealed that specialists have a choice between either challenging work in the public sector or straightforward yet well-paid work in the private sector. Despite more challenging conditions, health and intent to leave were not key issues for specialists in the public sector, with specialists in private rooms more likely to leave the profession despite more positive work conditions. This result may be due to the public sector ethos suggested in other studies. Ultimately this study provides evidence that suggests differences in the ethos between medical specialists in the public and private sectors.

Managing panic disorder in general medical practice

Panic disorder (PD) is common in the community and contributes to significant distress and decreased quality of life for people who suffer from it. Most people with PD will present in the first instance to their general practitioner or hospital emergency department for assistance, often with a focus on somatic symptoms and concerns. This article aims to assist the GP to manage this group of patients by providing an outline of aetiology, approaches to assessment, and common management strategies. Although GPs have an important role to play in ruling out any causal organic basis for panic symptoms, the diagnosis of PD can usually be made as a positive diagnosis on the basis of careful history taking. Thorough and empathic education is a vital step in management. The prognosis for PD can be improved by lifestyle changes, specific psychological techniques, and the judicious use of pharmacotherapy.

Impact of medical Qigong on quality of life, fatigue, mood and inflammation in cancer patients : a randomized controlled trial

Background: Substantial numbers of cancer patients use complementary medicine therapies, even without a supportive evidence base. This study aimed to evaluate in a randomized controlled trial, the use of Medical Qigong (MQ) compared with usual care to improve the quality of life (QOL) of cancer patients. Patients and methods: One hundred and sixty-two patients with a range of cancers were recruited. QOL and fatigue were measured by Functional Assessment of Cancer Therapy—General and Functional Assessment of Cancer Therapy—Fatigue, respectively, and mood status by Profile of Mood State. The inflammatory marker serum C-reactive protein (CRP) was monitored serially. Results: Regression analysis indicated that the MQ group significantly improved overall QOL (t144 = −5.761, P < 0.001), fatigue (t153 = −5.621, P < 0.001), mood disturbance (t122 =2.346, P = 0.021) and inflammation (CRP) (t99 = 2.042, P < 0.044) compared with usual care after controlling for baseline variables. Conclusions: This study indicates that MQ can improve cancer patients’ overall QOL and mood status and reduce specific side-effects of treatment. It may also produce physical benefits in the long term through reduced inflammation.

Risk factors for incident delirium in acute medical in-patients. A systematic review

Review question/objective
What risk factors are associated with incident delirium in adult patients during an acute medical hospitalisation?
More specifically, the objectives are to:
Identify and synthesise the best available evidence on the factors which are associated with delirium in adult patients admitted to acute medical facilities.

Types of participants
This review will consider studies that include adults (defined as 18 years and above) who were admitted to an acute medical setting (e.g. general medical units, stroke units, short stay units and neuromedical units) who were not delirious on admission (in order to differentiate incident delirium) but who developed incident delirium during hospitalisation

The review will exclude patients who were:
- critically ill and admitted to specialist unit e.g. ICU or CCU
- admitted for any type of surgery
- admitted for alcohol related reasons
- admitted to psychiatric facility
These patients will be excluded in order to determine factors that may be exclusive to the medical in patient setting.

Types of intervention(s)/phenomena of interest
This review will consider studies that evaluate any risk factors that may contribute to the development of delirium during in-patient hospitalisation. The review will look at factors present on admission (predisposing) and also factors that may occur during hospitalisation (precipitating) that contribute to incident delirium.

Types of outcomes
This review will consider studies that include the following outcome measures: the incidence of delirium as related to individual risk factors.