We d n e s d a y 2 0 M a y 2 0 0 9
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Cervical two-year risk period
Doctors’ cars cause burns
■ Michael Woodhead
■ Louise Durack
W
omen treated for cervical intraepithelial neoplasia (CIN) have a high risk of recurrent lesions and cancer in the next two years, a study (link) suggests. Published in the Journal of the National Cancer Institute, the follow up of more than 37,000 women who had treatment for CIN 1, 2 or 3, found that they had a six-fold higher risk for subsequent invasive carcinoma of the cervix compared to a control group. The risk of a subsequent CIN was age-related, and highest in women over 40. Likewise, risk
of recurrent CIN or an invasive carcinoma was related to the grade of the initial lesion, with a higher risk in women with higher grade lesions. The overall risks of a CIN 2/3 lesion in the first six years after treatment were 14.0% for women originally treated for CIN 3, 9.3% for CIN 2, and 5.6% for CIN 1. Most of the recurrent lesions and cancers occurred within two years of the initial lesion, suggesting that they were persistent lesions, rather than a true recurrence of a new lesion, the study authors say. Recurrence also depended on the mode of treatment, with
highest recurrence rates seen in women treated with laser ablation or cryotherapy and the lowest recurrence rates in those who had loop electrosurgical excision or cone biopsy. “Findings of this study support the shift in recommendations for screening of women with CIN from indefinite annual screening to an initial period of 6–18 months of more intensive annual examination, followed by a return to routine screening,” they suggest. The Australian treatment guidelines are here: (link) What do you think? comment@6minutes.com.au
Children and adults shouldn't mix ■ Louise Durack The growing trend for children to be co-located with adults in hospitals should be reversed, says the Royal Australasian College of Physicians (RACP), which is today calling (link) for separate facilities and staff be retained for the two groups. Dr Jenny Proimos, president of the RACP’s Paediatrics & Child Health Division says children and adolescents differ in many ways to adults, including their, physiology, the type of conditions and diseases they suffer from, and the
treatments, medical equipment and pain management strategies required to deal with them. “To ensure the best outcomes for younger patients, the physical and medical differences between children and/or adolescents and adults need to be recognised, and appropriate, specialist training and facilities provided.” “Placing children and adolescents alongside adults in general wards exposes them to risk from a number of directions, potentially increasing the chance of medical misadventure, unintentional
neglect or even abuse from other patients,” she says. About a third of Australian hospitals do not have separate wards for children, and most of these are in rural and regional areas of the country, says Dr Proimos. “It’s not just a matter of medical needs and safety, but also the psychosocial support needs of children and adolescents - especially disabled young adults - which differ from those of adults, and are highly dependent on age and stage”. What do you think? comment@6minutes.com.au
Protruding exhausts are a risk. Senior doctors have been blasted for buying flashy cars with exhaust pipes that have the potential to cause serious contact burns, especially in children. In the journal Burns (link) this month, doctors at the burns unit of the Royal Children’s Hospital in Brisbane report the case of a 10-year-old boy with an ‘end on’ leg burn from the protruding exhaust of a sports car. They say the burn was worse than the typical ‘side on’ exhaust burn. A survey of cars parked in the hospital's senior doctors' car park found that eight out of 40 cars had protruding exhaust pipes. All eight were sports cars. “Is there a value in having a car with a protruding exhaust pipe?” ask the authors. "Children may needlessly suffer burns by such exhaust pipes. Adults must make sure that young children are not allowed near the back of the vehicle and car manufacturers too, should consider how to avoid this danger,” they say. comment@6minutes.com.au
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