Preserving the future
Thanks to advances in oncology, three out of every four children and adolescents diagnosed with cancer are now expected to survive well into adulthood. The need to plan for these children’s futures prompted Heath and Stern to survey paediatric oncology units in Australia and New Zealand, asking about their protocols for fertility preservation (→ Fertility preservation in children newly diagnosed with cancer: existing standards of practice in Australia and New Zealand). What options are there for young people who are about to embark on treatments that may impair future fertility? In “Preserving the fertility of children with cancer”, Canadian paediatric oncologists Greenberg and Urbach review the current procedures, and the possible reasons for Australian oncologists’ lack of adherence to a uniform protocol. On a similar theme, if a bill currently before the New South Wales Parliament becomes law, cancer patients in prison for serious crimes in NSW will not be permitted to store reproductive material. In a letter on a “Bill to ban reproduction of inmates with cancer proposed in New South Wales”, Rasko voices his concern that such a move would be a vote of no confidence for rehabilitation, and “cruel and unusual punishment”.
In any given year, about 3% of Australian women will experience violence inflicted by an intimate partner. Although the percentage is thought to be even higher among women seen in general practice, there has been a lack of practical advice for general practitioners on how to detect domestic violence and manage its effects on the woman and her family. However, thanks to an international collaboration of experts (Taft et al, “Tackling partner violence in families”), a new set of guidelines has just been released.
Up close and digital
There is good evidence that using a dermoscope will improve your ability to recognise a melanoma but, with a burgeoning market in these devices, should you invest in a model with digital monitoring? See Menzies (→ Technologies for the diagnosis of primary melanoma of the skin) for an evidence-based answer.
Hendra in horse handlers
In 1994 in Brisbane, 14 horses and their trainer died from a newly recognised infectious disease caused by Hendra virus, and, since then, five further outbreaks have occurred in Queensland. In “Hendra virus infection in a veterinarian” Hanna et al describe the most recent human case, in which a veterinarian became infected after performing an autopsy on a horse.
An end to allergy
Our popular MJA Practice Essentials — Allergy series winds up this issue with two important contributions. Rimmer and Ruhno present an integrated approach to rhinitis and asthma, with the underlying observation that both conditions are manifestations of a single inflammatory process (which has been referred to as “united airway disease”), while Smith and Wormald focus in on chronic rhinosinusitis (→ Allergy and sinus disease).
It is thought that about 300 000 Australians have chronic heart failure, and several recent studies indicate that detection and management of this condition are not always optimal. An abbreviated version of the new Guidelines for the prevention, detection and management of people with chronic heart failure in Australia, published in this issue, emphasises early detection and management to improve survival (→ Guidelines for the prevention, detection and management of people with chronic heart failure in Australia 2006).
Existentialism and the law
Recently in Australia, the High Court has had to rule on some difficult issues. In 2003, a “wrongful birth” action, brought by a couple whose failed sterilisation resulted in a healthy but initially unwanted child, was successful. Earlier this year, however, two unsuccessful actions for “wrongful life” were brought on behalf of children born with severe disabilities not predicted antenatally. In “Wrongful life claims: dignity, disability and “a line in the sand””, Neville and Lokuge explain some of the Court’s thinking in judging these two cases, which posed the terrible question of whether non-existence is preferable to life with disability.
Imagine that the Chief Medical Officer of Australia has announced a pandemic influenza alert. As a doctor — in hospital or private practice — how will this affect you and what do you need to know? The supplement included with this issue gives a practical overview of the Australian Government’s plan for just such an eventuality — a plan whose success will depend in no small part on the preparedness of individual health professionals.
Another time . . . another place
The influenza epidemic of 1919 . . . was, in fact, the worst epidemic since the Middle Ages, is seldom mentioned, and most [people] have apparently forgotten it. This is not surprising. The human mind always tries to expunge the intolerable from memory, just as it tries to conceal it while current.