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The concept of "loss of chance" as an alternative cause of action in cases of medical negligence has succeeded in recent cases where actions based on causation have failed. The plaintiff must prove negligence and loss of a chance of a better outcome. The quantity of loss of chance must be more than "speculative" (1%). Damages are awarded as a proportion of the total injury commensurate with the loss of chance. More claims may be expected, although damages will generally be less than those awarded under causation. Doctors' insurance premiums may rise.

A High Court of Australia ruling has reinstated the need for patients to prove causation of injury. Language: en

OBJECTIVE To increase the frequency of handwashing by medical staff. DESIGN a prospective study of handwashing before and after patient contact. SETTING A paediatric intensive care unit in a tertiary hospital. PARTICIPANTS 61 intensive care unit medical staff and visiting medical staff. INTERVENTIONS A five-phase behaviour modification program:(i) unobtrusive observation for four weeks to obtain a baseline handwashing rate (ii) overt observation for five weeks (preceded by written advice); (iii) overt observation continued for four weeks with performance feedback; (iv) all observation and feedback discontinued for seven weeks; and (v) unobtrusive observation for five weeks to obtain a residual rate. RESULTS 939 patient contacts were observed. The baseline handwashing rates before and after patient contact were 12.4% and 10.6%, respectively. During overt observation, the respective rates increased and plateaued at 32.7% and 33.3%, but increased further (to 68.3% and 64.8%) during the period of performance feedback. The residual handwashing rates, observed unobtrusively seven weeks after the cessation of performance feedback, were 54.6% before and 54.9% after patient contact.

The effects of the venom of the male Sydney funnel-web spider were studied in closely monitored monkeys, and a number of new features were observed. Excessive catecholamine release was demonstrated and linked to the development of hypertension, arrhythmias, pulmonary oedema, hyperthermia, and metabolic acidosis. Acute intracranial hypertension was found, and may partly explain the central neurological manifestations. It is believed that a neurogenic basis for pulmonary oedema may sometimes exist. Survival after massive envenomation was achieved with the use of aggressive pharmacological denervation of the motor and autonomic nervous systems.

An antivenom to the Sydney Funnel-web Spider, Atrax robustus, developed in rabbits, passed exhaustive quality control studies and was subsequently tested in monkeys. It was shown to reverse the syndrome that follows envenomation in both a conscious unmonitored monkey and in two anaesthetised, monitored monkeys. This paper reports the results of these experiments. An autonomic crisis appears to be the major cause of mortality and morbidity in human victims and monkeys; this aspect of the syndrome is rapidly attenuated by the antivenom. We observed no ill-effects of antivenom. Language: en

Venom of the male Sydney funnel-web spider was injected subcutaneously into the limbs of monkeys (Macaca fascicularis), and the central movement of venom was delayed by first-aid treatment. This treatment consisted of the application of firm pressure over the site of injection and immobilization of the limb. It was found that quantities of venom as high as 2 mg were inactivated when the first-aid procedures were maintained for 24 hours. Over a six-hour period, 0.5 mg of venom could be inactivated. Since the amount of venom injected by the spider into a human victim is unlikely to exceed 0.2 mg, these findings have immediate application both to the first aid and to actual medical management of human victims.

A young pregnant woman, near term, died shortly after being bitten by an immature brown snake (genus Pseudonaja). Analysis of the bitten area suggested that the degree of envenomation was mild, and could not satisfactorily explain her rapid demise. It was concluded that the supine hypotensive syndrome of pregnancy was a contributing factor in her death.