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In this section you can talk about events which have made an impact on you, or which you feel it is important to share. These may concern scientific articles, congresses, thoughts on training for young people, the handling of tumours in children by health authorities.
It is also an opportunity to compare different practices throughout the world. Please send all ideas, suggestions and comments to Edward Halperin.
De B., et al. Late effects of craniospinal irradiation using electron spinal fields for pediatric patients with cancer. Int J Rad Oncol Biol Phys 115:164-173, 2023.
Remember electron fields for the spinal component of craniospinal irradiation? We did calculations of the intervetebral distances and created compensators to account for the effect of bone on the penetration of the electrons. We hoped to reduce the risk of radiation-induced ill effects on the thyroid, heart, oesophagus, and intestines. Some people used the expression “poor man’s protons”. Remember?
In this paper, investigators from MD Anderson Hospital in Houston, Texas; University of Southern California in Los Angeles, California; and the Mayo Clinic in Rochester, Minnesota combine forces to review the long-term results of 84 patients irradiated between 1983 and 2014. The median follow-up is 19 years, and 47 patients were alive at last follow-up.
It’s a tiny bit of good news and a lot of bad news for those 47 patients. The good news is that there were not long-term ill-effects of the radiation on the heart. The bad news was that 40% of the patients had hypothryoidism, 10% had second malignant neoplasms, one patient had an oesophageal stricture and periaortic hemorrhage, one had restrictive pulmonary disease, 34% had scoliosis, and there was a significant decrease in crown-rump height. =
It’s hard to get too excited about our memories of spinal electron beams in craniospinal irradiation.
Kimberly R. Myers, Molly L. Osborne, Charlotte A. Wu, and Illustrations by Zoe Schein. Clinical Ethics: A Graphic Medicine Casebook. University Park PA: The Pennsylvania State University Press, 2022
Let’s start with a definition. What is “graphic medicine”? Graphic medicine is defined as the use of comics to provide information about illness, health, and the practice of medicine. By combining words and drawings, graphic medicine seeks to give the transmission of information emotional impact and render it approachable. In essence, a graphic medicine book is a comic book for adults about serious medical subjects.
Some of the readers of our PROS newsletter will be familiar with graphic novels such as “MAUS”. Others may have employed graphic medicine books in patient or medical student education such as “Mom’s Cancer” by Brian Fries, about adult lung cancer, or “Cancer Vixen” by Marissa Marchetto, about adult breast cancer.
“Clinical Ethics: A Graphic Medicine Casebook” is, one one level, a quick read at 112 pages of interspersed comics and text. The eight cases tackle the nuts-and-bolts topics of clinical medical ethics: Patient Autonomy, Informed Consent, Unconscious Bias, Mandated Reporting of Suspected Child Abuse, Confidentiality, Medical Mistakes and Truth-Telling, Surrogate Decision-Making and Advanced Care Planning, and Futility. On a deeper level, the drawings and stories are so well done, and the succinct discussions which follow each comic raise multiple ethical questions worthy of contemplation and discussion.
This book would serve as an excellent teaching tool for medical students.
And a tip: If you’re tempted to buy this book, get the paperback edition. the hardcover edition, depending on where you shop, is about four to five times the price of the paperback.
Edward C. Halperin MD MA