- Written by David Guest
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
The Pap smear is gone. Welcome the CST (Cervical Screening Test). December 1 marks the change over to the new system. General practitioners have been inundated with information about the new test but on page 23 Dr Ruth Tinker gives the one page guide for the busy GP.
Change in medical practice happens slowly but the understanding of the biology of human papilloma virus and the advent of early virus detection together with a nationwide vaccination program will further reduce the mortality from this deadly disease. The management of positive results will be addressed in a subsequent article.
- Written by Dr Ruth Tinker
A new cervical screening began nationally on 1 December 2017. It will use an HPV DNA test rather than examining cervical cells on a microscope slide (Papanicolaou test). The sample is still collected from the cervix using a vaginal speculum to ensure accurate collection.
So from the point of view of the woman being screened, the process is the same. However because of greater accuracy, if negative, the screening interval will extend to five years. Practices will need to review their recall protocols to conform to the new program.
The program is based on an understanding that more than 99 per cent of cervical cancer is caused by HPV. This includes squamous cell and adenocarcinoma. A third type of cervical cancer, neuroendocrine or small cell cervical cancer, is often more aggressive, but accounts for less than 1 per cent of cervical cancers. Neither the Pap test nor the new Cervical Screening Test effectively detects neuroendocrine cancers.
All women who have symptoms still need investigation, regardless of when they were screened last.
- Written by Robin Osborne
Your Brain Knows More Than You Think - the new frontiers of neuroplasticity
Niels Birbaumer (Scribe 262 pp)
Lamenting how society ascribes ‘immutability’ to our brains, psychologist and neurobiologist Niels Birbaumer sets out to explain how the latest brain-machine interface (BMI) technology can help address a range of severe conditions, and in so doing mounts a strong case against euthanasia.
While he may be just the latest author to explore neuroplasticity, “the virtually limitless capacity of the brain to remould itself,” he takes a different, i.e. more technological, tack to the likes of the great Norman Doige (The Brain that Changes Itself, and The Brain’s Way of Healing).
The main difference is the use of BMI, which in various forms creates a ‘neurofeedback’ loop in a series of steps, from the brain to MRI signal reception, thence brain-image transfer and signal analysis by computer program, transfer of processed brain activity to the BMI software and finally, feedback of blood flow in the brain.
- Written by Dr Ruth Tinker
Antarctica has been on my bucket list for many years. Earlier this year I ticked that box.
After meeting the group in Buenos Aires we flew to Ushuaia, the main departure point for the Antarctic Peninsula. Our ship Ocean Endeavour took 199 passengers but was dwarfed by the Princess cruise liner moored across the dock, and another expedition ship still bigger than our own.
We set sail through the Beagle Passage, and rumours soon circulated that we had “Shackletons aboard”. Indeed, we did have some distant cousins of the famed Sir Ernest Shackleton, who were soon sharing stories of the great man’s exploits. The journey became infused with the Shackleton influence with several of our landings linked to the story of the miraculous rescue of his crew from the Endurance.
One of our landing groups was named ‘Shackleton’, the others ‘Crean’, ‘Worsley’ and ‘Wild’ in recognition of some of his team.
- Written by Dr Ian McPhee
Life takes many turns, for us, just as for our patients. Wellness for most is a fleeting state, punctuated by crises of varying impact on ourselves and those we love.
When a busy life had been slowly curtailed by years of ongoing fatigue I was more puzzled than distressed. I was frustrated by not being able to ‘keep up’, but accepting that, for whatever reason, this was how it had to be. Little doubt you can imagine that I struggled through with ‘eczema’ being pitched as a primary cause. Four years on from an initial eczema diagnosis, and after more than one ‘opinion’, a skin biopsy revealed that there was a little more to this malady that had largely taken over my life. Suddenly I was confronted with the potential reality of a rare, rapidly progressive lymphoma.
‘Rare’ however comes with myriad implications. The first was the question: where might a pathologist be found who would make a call on the histology? And to think we all regard the radiologist’s emblem as a fence depicted suitably encircled by the obligatory ‘Latin’? Indeed, it was exactly so for a pathological opinion. But it didn’t end there. Where next to find expert haematological assessment and ongoing care?
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