of interesting stuff for doctors today.

CLICK HERE to subscribe for

FREE!FREE!

Wednesday 20 May 2009

Women 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

■ Michael Woodhead

Children and adults shouldn't mix

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

■ Louise Durack

Cervical two-year risk period

Before prescribing, please review Product Information and PBS Information in the primary advertisement in this publication.

Further information is available on request from AstraZeneca Pty Ltd. ABN 54 009 682 311. Alma Road, North Ryde NSW 2113. CRESTOR is a trademark of the AstraZeneca Group. Licensed from Shionogi & Co. Ltd, Osaka, Japan. 02/09 AST1895/CJB rosuvastat in

Doctors’ cars cause burns

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

■ Louise Durack

Protruding exhausts are a risk.

2

In other news ...A ‘well-known doctor’ on Sydney’s north shore is leasing premises to an illegal brothel, prompting complaints from legal brothel operators in the area to Willoughby Council, reports The Daily Telegraph. (read more)

An emergency specialist in Tweed Heads, NSW, had an “unrepentant, belligerent and overbearing” attitude when he ignored a court order not to drive, and believed he should be immune to punishment because he was an emergency room doctor, the Tweed News reports. (read more)

Health bureaucrats in Victoria were paid bonuses of $15,000 last year despite the dysfunctional state health system, the Herald Sun reports. (read more)

A record 13,000 people a day have been having flu vaccination, probably because of fears of a swine flu pandemic, say health officials in The Daily Telegraph. (read more)

A 40-year-old man was sacked when he told his employers he had motor neurone disease, says the Herald Sun. (read more)

GP practices in WA will be offered up to $100,000 per year for providing weekday after-

hours services from 8pm to midnight and up to $200,000 to provide services from midnight until dawn, says Perth Now. (read more)

Drug reps mocked safety concerns about Vioxx in an in-house skit that likened the drug’s cardiovascular adverse reactions problems to having a bad hair day, The Australian reports. (read more)

HIV patients are calling for nurse practitioners to be given the right to prescribe anti-HIV drugs because patients often use the same drug for years and yet find it hard to access a GP, says the Star Observer. (read more)

A rural GP in Victoria used a household drill to bore into the head of a 12-year-old boy and saved his life after he developed

internal bleeding form a fall, says the Herald Sun. (read more)

Researchers at Melbourne's Florey Neuroscience Institute have developed a wrist watch that can fine tune medication doses for people with Parkinson's disease by monitoring bradykinesia and dyskinesia, The Age reports. (read more)

Rural maternity services will get a boost with Nicola Roxon to announce an $11 million specialist outreach assistance program for teams that include obstetricians, midwives, registered maternal and child health nurses, says the Courier Mail. (read more)

Flu fears mean vaccine use is up

Before prescribing, please review Product Information and PBS Information in the primary advertisement in this publication.Further information is available on request from AstraZeneca Pty Ltd. ABN 54 009 682 311. Alma Road, North Ryde NSW 2113.

CRESTOR is a trademark of the AstraZeneca Group. Licensed from Shionogi & Co. Ltd, Osaka, Japan. 01/09 AST1895SM/CJB

Have anything to say? Click hereClick here

3

Crackdown on dodgy

allergy clinics (link)

It is about time that gullible individuals are protected from these operators who promise unrealistic cures where there is no scientific justification for their methodologies. There must be more scrutiny of this lot, as well as a host of others in the "allergy market" purporting to have simple answers and ready cures!CH KatelarisProfessor, Immunology and Allergy, UWS & Campbelltown Hospital

Easyclaim promo (link)

Re Easyclaim: Initially thought it was fantastic until a mistake was made. You can't correct a mistake except between 8.30 am and 5pm!

The wrong patient was bulk billed (at 6.15pm) and immediately we tried to correct it. No can do. We had to write a letter to Medicare, enclosing a cheque for the wrongly bulk billed amount and asking for the patient's record to be altered so that she could claim her rebate for her item 23 ... What a lot of nonsense.Clair Marsh,Practice Manager

I think its idiocy to do this now and make any impost on GPs when we are about to face a flu pandemic of 1957 proportions.It is also only a half solution as it isn’t as user friendly like the HICAPS dental/AHP systems, as government, doesn’t want real efficiency as it might make billing for gaps too easy.Phil Lowen,CEO, ACT Division of General Practice

Medicare rejects

‘scaremongering’ (link)

I think Medicare has a double standard when it comes to audits. Doctors are being entrapped into co-operating with Medicare: officers are stating over the

phone to doctors it is an “educational exercise”, only to find out the information volunteered leads to a bigger audit with penalties that are not being explained at the initial phone call. The Tax Office is not allowed to operate like this.

Intimidation auditing is the easiest way to raise revenue. These cases are not being reported in the PSR reports as they are being settled in confidence, under questionable grounds. This is a breach of High Court principles that state that every citizen is allowed procedural fairness.

Medicare Australia was found guilty in the Federal Court for breaching this responsibility. This means people should have the full nature, extent and consequences of an audit including a right to seek a lawyer (which they have been discouraged on the grounds that it is not necessary because 'its just a chat' ...) explained to them. People have a natural right to defend themselves.

Medicare needs to explain on what basis they been selected (eg. overservicing by seeing more than six patients an hour).

Medicare needs a valid high risk reason for conducting an audit. Press reports that doctors are being prosecuted successfully for a $78.05 error hardly constitute a high risk, yet a full blown audit was ordered.

Get everything in writing and don’t answer phone call questions. In writing, ask for the name and qualifications of the person you are speaking to and the questions they wish to ask, and then contact a lawyer. After all, who is making the auditors accountable?David Dahm, Health & Life Pty Ltd,Adelaide

You said it... To have your say CLICK HERE

BRISBANE AGED CARE SERVICES

Brisbane’s largest provider of medical sessions

to Aged Care Facilities. Dedicated doctor’s rooms,nursing

and admin support, repeat prescription management, remote

access laptop computers, admin assistance with EPC items,

full or part time work available.Interested?

Email admin@toowongdoctors.com.au

for more information

Time to upgrade your 3M™ Littmann

®

Stethoscope?visit www.littmann.com.au

for two great end of financial year offers.

4

Please review full Product Information before prescribing. Product Information available on request from AstraZeneca. CRESTOR® (rosuvastatin calcium). Indications: As an adjunct to diet when the response to diet and exercise is inadequate for the treatment of hypercholesterolaemia (including familial hypercholesterolaemia). Contraindications: Known hypersensitivity to any of the ingredients; patients with active liver disease, or unexplained persistent elevations in serum transaminases; pregnancy and lactation; in women of childbearing potential, unless they are taking adequate contraceptive precautions; CRESTOR 40 mg is contraindicated in patients with pre-disposing factors for myopathy/rhabdomyolysis, including hypothyroidism, personal or family history of hereditary muscular disorders, previous history of muscular toxicity with another HMG-CoA reductase inhibitor or fibrate, alcohol abuse, situations where an increase in rosuvastatin plasma levels may occur, severe renal impairment (CrCl <30 mL/min), Asian patients, concomitant use of fibrates. Precautions: Liver effects; myopathy/rhabdomyolysis; renal insufficiency; hepatic dysfunction; Asian patients; pregnancy (Category D); lactation. Interactions: Warfarin and other coumarin anticoagulants; cyclosporin; gemfibrozil; antacids; lopinavir/ritonavir. Adverse reactions (common): Dizziness, constipation, nausea, abdominal pain, myalgia, asthenia, headache. For less common adverse reactions, see full PI. Dosage: The recommended starting dose is 5 mg or 10 mg once per day both in statin naïve patients and in those switched from another HMG-CoA reductase inhibitor. The choice of starting dose should take into account the individual patient’s cholesterol level, special patient populations and future cardiovascular risk as well as the potential risk for adverse reactions. A dose adjustment can be made after 4 weeks of therapy where necessary. The usual maximum dose of rosuvastatin is 20 mg once per day. A dose of 40 mg once per day should only be considered in patients who are still at high cardiovascular risk after their response to a dose of 20 mg once per day is assessed. This may particularly apply to patients with familial hypercholesterolaemia. It is recommended that the 40 mg dose is used only in patients in whom regular follow-up is planned. A dose of 40 mg must not be exceeded in any patient taking rosuvastatin. Specialist supervision should be considered when the dose is titrated to 40 mg. Date of TGA approval: 2 September 2008. PBS Dispensed Price: 5 mg $50.75, 10 mg $69.48, 20 mg $96.00 & 40 mg $134.01. AstraZeneca Pty Ltd. ABN 54 009 682 311.Alma Road, North Ryde NSW 2113. CRESTOR is a trademark of the AstraZeneca Group. Licensed from Shionogi & Co. Ltd, Osaka, Japan. 01/09 AST1894SM/CJB

PBS Information: Restricted Benefit. For use in patients that meet the criteria set out in the General Statement for Lipid-lowering Drugs.

rosuvastat in

BPH drug causes eye

surgery problems

The -adrenergic receptor blocker tamsulosin (Flomaxtra), used to treat BPH in older men, may increase the intraoperative difficulty of cataract surgery and its use is associated with serious postoperative ophthalmic adverse events, a study (link) in JAMA this week suggests.

ARBs do not prevent

renal disease

Angiotensin-receptor blockers (ARBs) do not prevent clinically important renal disease in the absence of proteinuria, according to a study (link) in Annals of Internal Medicine (Online 19 May) of telmisartan in patients with cardiovascular disease or diabetes.

Don't delay angioplasty

Any delay in ‘door-to-balloon time’ for heart attack patients undergoing balloon angioplasty is associated with higher mortality, even among patients treated within 90 minutes of admission, a new US study (link) in the BMJ of patients undergoing primary PCI has found.

H1N1 flu vaccine fears

Uncertainties about the production of a possible pandemic influenza flu vaccine remain, according to a WHO report (link) which cites doubts about the optimal antigen content, number of doses required and dose intervals as well as risks of Guillan Barré Syndrome.

Keep it brief ...Overpaid artist Damien Hirst has moved on from dead sharks to ripping off anatomy models.

The controversial British artist created a six metre high work “Hymn” that may look familiar to would-be medical students.

That’s because the $2 million dollar bronze sculpture is based on the popular anatomy model manufactured by Humbrol. The manufacturer has had the last laugh, with Hirst reported to have agreed to pay compensation that will go to two children’s charities.

But the designer of the anatomical model, Norman Emms, said the amount was less than he had hoped for, adding that he was paid less than $4000 for creating the original.

What do you think? comment@6minutes.com.au

Artist fined for gross anatomy ■ Michael Woodhead

This Damien Hirst artwork, based

on a school anatomy model, is six

metres high and sold for more

than $2 million in the UK.