Non-compliance with randomised allocation and missing outcome data in randomised controlled trials evaluating surgical interventions : a systematic review

Acknowledgements JAC held MRC training (reference number: G0601938) and methodology (reference number: G1002292) fellowships while this research was undertaken. The Health Services Research Unit is core funded by the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The authors accept full responsibility for this manuscript.Peer reviewedPublisher PD

Long-term hormone replacement therapy

Reproduced with permission from Australian Prescriber The document attached has been archived with permission from the publisher/copyright holderAlastair H. MacLenna

Hormone replacement therapy: where to now?

Copyright © 2003 Australian Prescriber Reproduced with permission from Australian Prescriber The document attached has been archived with permission from the publisher/copyright holder.The Women's Health Initiative Study was stopped because of safety concerns about hormone replacement therapy with oestrogen and progestogen. There was an increase in breast cancer, however this was not greater than the increase reported in observational studies. Although there was an increase in vascular events, many of the women in the study had pre-existing risk factors for cardiovascular disease. No long-term trials of combined hormone replacement therapy are continuing, so the balance between benefit and harm will remain uncertain. Hormone replacement therapy can still be prescribed for menopausal symptoms and for osteoporosis prevention, but the need for continued use should be reviewed annually.Alastair H. MacLenna

Are the Earth and the Moon compositionally alike? Inferences on lunar composition and implications for lunar origin and evolution from geophysical modeling

The main objective of the present study is to discuss in detail the results obtained from an inversion of the Apollo lunar seismic data set, lunar mass, and moment of inertia. We inverted directly for lunar chemical composition and temperature using the model system CaO-FeO-MgO-Al2O3-SiO2. Using Gibbs free energy minimization, stable mineral phases at the temperatures and pressures of interest, their modes and physical properties are calculated. We determine the compositional range of the oxide elements, thermal state, Mg#, mineralogy and physical structure of the lunar interior, as well as constraining core size and density. The results indicate a lunar mantle mineralogy that is dominated by olivine and orthopyroxene ( 80 vol%), with the remainder being composed of clinopyroxene and an aluminous phase (plagioclase, spinel, and garnet present in the depth ranges 0–150 km, 150–200 km, and >200 km, respectively). This model is broadly consistent with constraints on mantle mineralogy derived from the experimental and observational study of the phase lationships and trace element compositions of lunar mare basalts and picritic glasses. In particular, by melting a typical model mantle composition using the pMELTS algorithm, we found that a range of batch melts generated from these models have features in common with low Ti mare basalts and picritic glasses. Our results also indicate a bulk lunar composition and Mg# different to that of the Earth’s upper mantle, represented by the pyrolite composition. This difference is reflected in a lower bulk lunar Mg# ( 0.83). Results also indicate a small iron-like core with a radius around 340 km.The Carlsberg Foundation, NER

Reporting and dealing with missing quality of life data in RCTs : has the picture changed in the last decade?

Peer reviewedPublisher PD

The poetry of Guy Butler

[From the introduction]: Guy Butler, born in Cradock on 21 January 1918, was a serious poet. Nearly a third of his poems are about death or loss, and many of the rest about parting failure, or difficult self-denial. His poetry is generally thoughtful and responsible to a deep religious vision. Of the ninety poems published between 1939 and 1979 the finest are those written between 1943 and 1963, from “Syrian Spring” to “Sweetwater.” The best poems cluster like moons round “On First Seeing Florence,” which is a major poem seldom given its rightful attention

Projections of Australian obstetricians ceasing practice and the reasons

The document attached has been archived with permission from the editor of the Medical Journal of Australia (10 January 2008). An external link to the publisher’s copy is included.Objectives: To assess the intentions of Australia's specialist obstetricians to cease practice and their reasons for abandoning this specialty. Design: A structured questionnaire posted to Fellows of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists (RANZCOG), issued 11 July 2001 with a return date of 31 July 2001 (in practice, responses were accepted up to 31 August 2001). Participants: Australian specialists holding a Fellowship of the RANZCOG. Main outcome measures: Demographic data (eg, age, sex); type and location of practice; past, current and intended future obstetric practice; reasons for stopping practice; cost of indemnity premiums; experience of litigation and its influence on practice; and experience in giving medicolegal opinion. Results: The response rate was 74% (829/1116), with 826 responses fulfilling our selection criteria. The median number of years since admission as a Fellow was 17 (range, 1–47 years), and 19% (158/817) of respondents were women (9 people did not specify their sex). Of the 826 respondents, 596 (72%) were currently practising obstetrics, 548 (66%) intended to still be practising after one year, 365 (44%) intended to be practising after five years, and 196 (24%) intended to be practising after 10 years. The median indemnity premium in 2001–02 was $35 515 (range, nil to$156 000) for practising obstetricians. The main reasons given for ceasing obstetrics were intention to specialise in gynaecology, fear of litigation, high indemnity costs, family disruption, and long working hours. About two-thirds of respondents (557/818) had experienced the threat of litigation, and almost all (768/803) desired some type of "no-fault" indemnity scheme. Thirty-three of the 314 respondents who had given medicolegal opinions accounted for 71% of the total number of opinions. Many of these were non-practising obstetricians who were not accredited RANZCOG expert witnesses. Conclusion: There will soon be a shortage of experienced practising obstetricians in Australia.Alastair H MacLennan and Michael K Spence