Kids copping cancer
Not all cancer treatments are equal, even for the same cancer type. The incidence of cancer has risen in all age groups, especially in adolescents and young adults. Yet, improvements in survival for this age group have lagged behind younger children.
Looking for some answers, Mitchell et al (→ Cancer in adolescents and young adults: treatment and outcome in Victoria) reviewed cancer treatments and survival of Victorian adolescents and young adults aged 10-24 years. They found gaps in their recruitment onto clinical trials, which is usually associated with lower mortality. Cole’s editorial (→ Doing better with cancer in adolescents and young adults) outlines the four initiatives that may make a difference to this deficit.
Delivering the rads
Although about half of all people with cancer would benefit from radiotherapy at some time during their illness, many miss out. Now a political hot potato, radiation oncology was the subject of a federal government inquiry, the findings of which were delivered in 2002. In → "Radiotherapy in Australia one year after the Baume report: vision or mirage?", Barton et al discuss where we are up to with implementing the inquiry’s recommendations.
MJA travel section
If you're a careful reader you will have noticed a "postcard from the UK" in our Christmas issue. The trio of expat correspondents (Weller, Jamrozik and Heller) have been in touch again (→ Quality, morale and the new contract with GPs) with some fascinating insights into the planned changes in UK general practice. Move over Alistair Cook, as this series is bound to continue.
. . . by any other name
Unless you're a health bureaucrat, the question you may not have asked yourself about access block is whether we can define it out of existence. In → "Access block in NSW hospitals, 1999-2001: does the definition matter?", Forero et al give the bad news about this strategy.
Ask the experts
Few would disagree that it’s a good idea to involve the community in decisions about healthcare provision, but how do you ensure well informed, unbiased and realistic participation? In → "Whose health service is it anyway? Community values in healthcare", Mooney and Blackwell show that it’s possible.
Back on track
" . . . Unable to work, on escalating doses of analgesics, seems depressed". According to Bogduk (→ Management of chronic low back pain), one thing this patient with chronic low back pain may benefit from is a diagnosis!
Priorities — what priorities?
Despite our diverse cultural backgrounds, most of us here at the MJA share our compatriots' love of sport. In the interest of scientific debate, however, we are presenting the findings and opinions of Mitton et al in → "Olympic medals or long life: what’s the bottom line?". They have compared the relative amounts of money spent on winning medals at the Sydney 2000 Olympics with providing healthcare in the same year, for Australia, Canada and the UK.
The oldest case of . . .
. . . undiagnosed chronic adrenal insufficiency is reported in this issue (→ Allgrove syndrome: when a recognisable paediatric disorder occurs in adulthood). Pedreira and Zacharin describe the chain of difficult events in this man’s life which finally made sense (and could be partially remedied) with the diagnosis of Allgrove syndrome.
A middle-aged man with urine that looks like strawberry milk. Turn to (→ "Milky" urine: a case of chyluria) to make a spot diagnosis.
Downside of diabetes drugs
Metformin has enjoyed a rise in popularity over recent years, as its usefulness in diverse groups of patients has been recognised. A warning from Nisbet and colleagues, however — metformin-induced lactic acidosis is also on the rise. They give good advice for staying out of trouble when you use this drug (→ Metformin and serious adverse effects).
Partly because of their increased risk of lactic acidosis with metformin, older people with diabetes are often prescribed sulfonylureas. But as Veitch and Clifton-Bligh attest (→ Long-acting sulfonylureas — long-acting hypoglycaemia), these drugs can also cause problems. Their description of the demise of two elderly women taking long-acting sulfonylureas should convince you to stick to the shorter acting preparations in this group.
A fair hearing based on an unbiased assessment of the evidence. That’s natural justice in a nutshell. How does it apply to human research ethics committees' deliberations? Van Essen et al (→ Natural justice and human research ethics committees: an Australia-wide survey) surveyed the committees' Chairs to find out.
Another time ... another place...
In the community of living tissues, the uncontrolled mob of misfits that is cancer behaves like a gang of perpetually wilding adolescents. They are the juvenile delinquents of cellular society.
Sherwin B Nuland, 1994
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