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    A guide to the management of atrial fibrillation in Santa Claus

    Mark T Mills and David R Warriner
    Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51341
    Published online: 13 December 2021

    Summary

    1. • In view of his advanced age and risk factors, Santa Claus is at high risk of developing atrial fibrillation. Despite this, no guidelines exist on the subject.
    2. • Following a review of the literature, we present our position on the management of atrial fibrillation in Santa Claus, and propose the use of the SANTA CLAUS mnemonic to aid clinicians: Screen for atrial fibrillation; Anticoagulate; Normalise heart rate; Treat comorbidities; Anti‐arrhythmic drugs; Cardioversion; Lifestyle measures; Ablation treatment; Understand emotional and psychological impact; Save Santa Claus.

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    • 1 University of Sheffield, Sheffield, United Kingdom
    • 2 Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
    • 3 Doncaster and Bassetlaw, Teaching Hospitals NHS Foundation Trust, Doncaster, United Kingdom
    • 4 Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom


    Correspondence: marktmills1@gmail.com

    Disclaimer

    The guidance provided in this article is inspired by the National Institute for Health and Care Excellence (NICE),2 the European Society of Cardiology (ESC),3 and the National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand (NHFA)4 guidelines. Our advice applies only to the management of atrial fibrillation (AF) in Santa Claus, and should not be used in other individuals with AF. Important areas of AF management not covered in our guidance include the prevention of AF, left atrial appendage occlusion for stroke prevention, and the surgical treatment of AF in Santa Claus.

    Patient and public involvement

    No patients or public were asked for input in the creation of this article, but we did send a copy to Santa Claus along with our Christmas list for 2021.

    Competing interests:

    No relevant disclosures.

     

    • 1. Weng L, Preis SR, Hulme OL, et al. Genetic predisposition, clinical risk factor burden, and lifetime risk of atrial fibrillation. Circulation 2018; 137: 1027–1038.
    • 2. National Institute for Health and Care Excellence. Atrial fibrillation: diagnosis and management. NICE guideline [NG196]. Published: 27 April 2021; last updated: 30 June 2021. https://www.nice.org.uk/guidance/ng196 (viewed Oct 2021).
    • 3. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio‐Thoracic Surgery (EACTS). Eur Heart J 2020 Aug 29; ehaa612.
    • 4. Brieger D, Amerena J, Attia JR, et al. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018. Med J Aust 2018; 209: 356–362. https://www.mja.com.au/journal/2018/209/8/national‐heart‐foundation‐australia‐and‐cardiac‐society‐australia‐and‐new
    • 5. Engdahl J, Andersson L, Mirskaya M, et al. Stepwise screening of atrial fibrillation in a 75‐year‐old population: implications for stroke prevention. Circulation 2013; 127: 930–937.
    • 6. Yes Santa is Real. How old is Santa Claus? https://yessantaisreal.com/how‐old‐is‐santa‐claus/ (viewed Oct 2021).
    • 7. Friberg L, Rosenqvist M, Lip GYH. Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study. Eur Heart J 2012; 33: 1500–1510.
    • 8. Ovesen L, Lyduch S, Idorn ML. The effect of a diet rich in Brussels sprouts on warfarin pharmacokinetics. Eur J Clin Pharmacol 1988; 34: 521–523.
    • 9. Paeng CH, Sprague M, Jackevicius CA. Interaction between warfarin and cranberry juice. Clin Ther 2007; 29: 6.
    • 10. Grafton J. When Santa Got Stuck Up The Chimney [song]. 1953. https://www.discogs.com/artist/2059148‐Jimmy‐Grafton (viewed Oct 2021).
    • 11. Connor T. I Saw Mommy Kissing Santa Claus [song]. 1952. https://en.wikipedia.org/wiki/I_Saw_Mommy_Kissing_Santa_Claus (viewed Oct 2021).
    • 12. Straube S, Fan X. The occupational health of Santa Claus. J Occup Med Toxicol 2015; 10: 44.
    • 13. Van Gelder IC, Groenveld HF, Crijns HJGM, et al. Lenient versus strict rate control in patients with atrial fibrillation. N Engl J Med 2010; 362: 1363–1373.
    • 14. Gumprecht J, Domek M, Lip GYH, et al. Invited review: hypertension and atrial fibrillation: epidemiology, pathophysiology, and implications for management. J Hum Hypertens 2019; 33: 824–836.
    • 15. Huxley RR, Filion KB, Konety S, et al. Meta‐analysis of cohort and case–control studies of type 2 diabetes mellitus and risk of atrial fibrillation. Am J Cardiol 2011; 108: 56–62.
    • 16. Sandle T. If Santa was human he’d have died aged 54. Digital Journal 2019; 20 Dec. http://www.digitaljournal.com/life/health/if‐santa‐was‐human‐he‐d‐have‐died‐aged‐54/article/563947 (viewed Jan 2021).
    • 17. Shapira‐Daniels A, Mohanty S, Contreras‐Valdes FM, et al. Prevalence of undiagnosed sleep apnea in patients with atrial fibrillation and its impact on therapy. JACC Clin Electrophysiol 2020; 6: 1499–1506.
    • 18. Pathak RK, Middeldorp ME, Meredith M, et al. Long‐term effect of goal‐directed weight management in an atrial fibrillation cohort. J Am Coll Cardiol 2015; 65: 2159–2169.
    • 19. Smart NA, King N, Lambert JD, et al. Exercise‐based cardiac rehabilitation improves exercise capacity and health‐related quality of life in people with atrial fibrillation: a systematic review and meta‐analysis of randomised and non‐randomised trials. Open Heart 2018; 5: e000880.
    • 20. University of Leicester. Calculations reveal Santa travels at 0.5% the speed of light. https://le.ac.uk/news/2018/december/21‐calculations‐reveal‐how‐quickly‐santa‐travels (viewed Oct 2021).

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      Living through a pandemic as an MJA editor and a general practitioner

      Aajuli Shukla
      Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51338
      Published online: 13 December 2021

      The end of 2021 offers many opportunities to look back on the year that was and make predictions about what is to come. At the time of writing, modelling based on vaccination rates and plans for reopening the country are the trends du jour. Yet, in approaching the end of another year in which coronavirus disease 2019 (COVID‐19) has dominated medical, public health and media agendas, it is vital we take an opportunity to reflect on the impacts that the pandemic has had on Australia’s health system, including the way in which the crisis has spurred valuable innovation and reform. For me personally, experiencing this year as an MJA editor and a general practitioner working in Western Sydney, alongside being an expectant mother from a migrant background, has given me intersecting lenses through which to view the impact of the pandemic on medical publishing, clinical practice, and learning to “live with COVID”.


      • The Medical Journal of Australia , Sydney, NSW


      Correspondence: ashukla@mja.com.au
      Competing interests:

      No relevant disclosures.

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        Goodbye, 2021: a year of triumphs and failures

        Nicholas J Talley
        Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51345
        Published online: 13 December 2021

        Australians have been challenged in many ways over the past two years: some more than others

        Welcome to the December issue of the MJA. It has not been a very jolly year, but I hope that reflecting on what has been and where we are (or should be) going is therapeutic. And I remain optimistic that, despite the challenges, the future is brighter.

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        • Editor‐in‐Chief


        Correspondence: ntalley@mja.com.au
        Acknowledgements: 

        I thank the tireless efforts of the editorial team throughout 2021, without which the quality and timely publication of our Journal would not be possible: deputy medical editors Alisha Dorrigan, Francis Geronimo, Robyn Godding, Tania Janusic, Wendy Morgan, Aajuli Shukla, and Elizabeth Zuccala; our scientific and structural editors, Paul Foley, Graeme Prince, and Laura Teruel; our consultant biostatistician, Elmer Villanueva; our news and online editor, Cate Swannell; our graphic designer, Leilani Widya; our head of publishing content, Ben Dawe; and our senior publishing coordinator, Kerrie Harding.

        Competing interests:

        A complete list of disclosures is available at https://www.mja.com.au/journal/staff/editor‐chief‐professor‐nick‐talley

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          Care of older people and people requiring palliative care with COVID‐19: guidance from the Australian National COVID‐19 Clinical Evidence Taskforce

          Saskia Cheyne, Richard I Lindley, Natasha Smallwood, Britta Tendal, Michael Chapman, David Fraile Navarro, Phillip D Good, Peter Jenkin, Steve McDonald, Deidre Morgan, Melissa Murano, Tanya Millard, Vasi Naganathan, Velandai Srikanth, Penelope Tuffin, Joshua Vogel, Heath White, Samantha P Chakraborty, Elizabeth Whiting, Leeroy William, Patsy M Yates, Mandy Callary, Julian Elliott and Meera R Agar, for the National COVID‐19 Clinical Evidence Taskforce
          Med J Aust 2022; 216 (4): . || doi: 10.5694/mja2.51353
          Published online: 6 December 2021

          Abstract

          Introduction: Older people living with frailty and/or cognitive impairment who have coronavirus disease 2019 (COVID‐19) experience higher rates of critical illness. There are also people who become critically ill with COVID‐19 for whom a decision is made to take a palliative approach to their care. The need for clinical guidance in these two populations resulted in the formation of the Care of Older People and Palliative Care Panel of the National COVID‐19 Clinical Evidence Taskforce in June 2020. This specialist panel consists of nursing, medical, pharmacy and allied health experts in geriatrics and palliative care from across Australia.

          Main recommendations: The panel was tasked with developing two clinical flow charts for the management of people with COVID‐19 who are i) older and living with frailty and/or cognitive impairment, and ii) receiving palliative care for COVID‐19 or other underlying illnesses. The flow charts focus on goals of care, communication, medication management, escalation of care, active disease‐directed care, and managing symptoms such as delirium, anxiety, agitation, breathlessness or cough. The Taskforce also developed living guideline recommendations for the care of adults with COVID‐19, including a commentary to discuss special considerations when caring for older people and those requiring palliative care.

          Changes in management as result of the guideline: The practice points in the flow charts emphasise quality clinical care, with a focus on addressing the most important challenges when caring for older individuals and people with COVID‐19 requiring palliative care. The adult recommendations contain additional considerations for the care of older people and those requiring palliative care.

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          • 1 NHMRC Clinical Trials Centre, University of Sydney, Sydney, NSW
          • 2 Cochrane Australia, Monash University, Melbourne, VIC
          • 3 Westmead Applied Research Centre, University of Sydney, Sydney, NSW
          • 4 George Institute for Global Health, Sydney, NSW
          • 5 Alfred Hospital, Melbourne, VIC
          • 6 Monash University, Melbourne, VIC
          • 7 Canberra Hospital, Canberra, ACT
          • 8 Australian Institute of Health Innovation, Macquarie University, Sydney, NSW
          • 9 St Vincent’s Private Hospital, Brisbane, Brisbane, QLD
          • 10 Resthaven, Adelaide, SA
          • 11 Research Centre for Palliative Care, Death and Dying, Flinders University, Adelaide, SA
          • 12 Flinders University, Adelaide, SA
          • 13 Centre for Education and Research on Ageing (CRGH), University of Sydney, Sydney, NSW
          • 14 Royal Perth Hospital, Perth, WA
          • 15 Fiona Stanley Hospital, Perth, WA
          • 16 Maternal, Child and Adolescent Health Program, Burnet Institute, Melbourne, VIC
          • 17 Prince Charles Hospital, Brisbane, QLD
          • 18 Eastern Health, Melbourne, VIC
          • 19 Centre for Cancer and Palliative Care Outcomes, Queensland University of Technology, Brisbane, QLD
          • 20 Royal Adelaide Hospital, Adelaide, SA
          • 21 IMPACCT Centre, University of Technology Sydney, Sydney, NSW


          Correspondence: saskia.cheyne@monash.edu
          Acknowledgements: 

          We acknowledge all members of the National COVID‐19 Clinical Evidence Taskforce, the member organisations, partners, governments and funders that support the initiative (online Supporting Information). These guidelines have received funding from the Australian Government Department of Health; the Victorian Government Department of Health and Human Services; the Ian Potter Foundation; the Walter Cottman Endowment Fund, managed by Equity Trustees; and the Lord Mayor’s Charitable Foundation.

          Competing interests:

          No relevant disclosures.

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            Increasing ICU capacity to accommodate higher demand during the COVID‐19 pandemic

            Edward Litton, Sue Huckson, Shaila Chavan, Tamara Bucci, Anthony Holley, Evan Everest, Sean Kelly, Steven McGloughlin, Johnny Millar, Nhi Nguyen, Mark Nicholls, Paule Secombe and David Pilcher
            Med J Aust 2021; 215 (11): . || doi: 10.5694/mja2.51318
            Published online: 15 November 2021

            Abstract

            Objectives: To describe the short term ability of Australian intensive care units (ICUs) to increase capacity in response to heightened demand caused by the COVID‐19 pandemic.

            Design: Survey of ICU directors or delegated senior clinicians (disseminated 30 August 2021), supplemented by Australian and New Zealand Intensive Care Society (ANZICS) registry data.

            Setting: All 194 public and private Australian ICUs.

            Main outcome measures: Numbers of currently available and potentially available ICU beds in case of a surge; available levels of ICU‐relevant equipment and staff.

            Results: All 194 ICUs responded to the survey. The total number of currently open staffed ICU beds was 2183. This was 195 fewer (8.2%) than in 2020; the decline was greater for rural/regional (18%) and private ICUs (18%). The reported maximal ICU bed capacity (5623) included 813 additional physical ICU bed spaces and 2627 in surge areas outside ICUs. The number of available ventilators (7196) exceeded the maximum number of ICU beds. The reported number of available additional nursing staff would facilitate the immediate opening of 383 additional physical ICU beds (47%), but not the additional bed spaces outside ICUs.

            Conclusions: The number of currently available staffed ICU beds is lower than in 2020. Equipment shortfalls have been remediated, with sufficient ventilators to equip every ICU bed. ICU capacity can be increased in response to demand, but is constrained by the availability of appropriately trained staff. Fewer than half the potentially additional physical ICU beds could be opened with currently available staff numbers while maintaining pre‐pandemic models of care.

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            • 1 Fiona Stanley Hospital, Perth, WA
            • 2 The University of Western Australia, Perth, WA
            • 3 Centre for Outcome and Resource Evaluation (CORE), Australian and New Zealand Intensive Care Society (ANZICS), Melbourne, VIC
            • 4 Royal Brisbane and Women's Hospital, Brisbane, QLD
            • 5 Flinders Medical Centre, Adelaide, SA
            • 6 Central Coast Local Health District, Charmhaven, NSW
            • 7 The Alfred Hospital, Melbourne, VIC
            • 8 Royal Children’s Hospital, Melbourne, VIC
            • 9 NSW Agency for Clinical Innovation, Sydney, NSW
            • 10 Nepean Hospital, Penrith, NSW
            • 11 St Vincent's Hospital Sydney, Sydney, NSW
            • 12 Alice Springs Hospital, Alice Springs, NT


            Correspondence: ed.litton@health.wa.gov.au
            Acknowledgements: 

            We thank all data collectors and clinicians, particularly the directors and nurse unit managers of all 194 Australian ICUs who contributed to this study.

            Competing interests:

            No relevant disclosures.

            • 1. Litton E, Bucci T, Chavan S, et al. Surge capacity of intensive care units in case of acute increase in demand caused by COVID‐19 in Australia. Med J Aust 2020; 212: 463–467. https://www.mja.com.au/journal/2020/212/10/surge‐capacity‐intensive‐care‐units‐case‐acute‐increase‐demand‐caused‐covid‐19
            • 2. Kadri SS, Sun J, Lawandi A, et al. Association between caseload surge and COVID‐19 survival in 558 US hospitals, March to August 2020. Ann Intern Med 2021; 174: 1240–1251.
            • 3. Toth AT, Tatem KS, Hosseinipour N, et al. Surge and mortality in ICUs in New York City’s public healthcare system. Crit Care Med 2021; 49: 1439–1450.
            • 4. Bravata DM, Perkins AJ, Myers LJ, et al. Association of intensive care unit patient load and demand with mortality rates in US Department of Veterans Affairs hospitals during the COVID‐19 pandemic. JAMA Netw Open 2021; 4: e2034266.
            • 5. Gupta S, Hayek SS, Wang W, et al; STOP‐COVID Investigators. Factors associated with death in critically ill patients with coronavirus disease 2019 in the US. JAMA Intern Med 2020; 180: 1436–1447.
            • 6. Taccone FS, Van Goethem N, De Pauw R, et al. The role of organizational characteristics on the outcome of COVID‐19 patients admitted to the ICU in Belgium [letter]. Lancet Reg Health Eur 2021; 2: 100019.
            • 7. Australian Government. National plan to transition Australia’s national COVID‐19 response. 30 July 2021. https://www.pm.gov.au/sites/default/files/media/national‐plan‐to‐transition‐australias‐national‐covid‐19‐response‐30‐july‐2021.pdf (viewed Sept 2021).
            • 8. ANZICS Centre for Outcome and Resource Evaluation. 2020 report. https://www.anzics.com.au/annual‐reports (viewed Oct 2021).
            • 9. Australian Bureau of Statistic. National, state and territory population. Reference period: December 2020. 17 June 2021. https://www.abs.gov.au/statistics/people/population/national‐state‐and‐territory‐population/dec‐2020 (viewed Sept 2021).
            • 10. Dobson H, Malpas CB, Burrell AJ, et al. Burnout and psychological distress amongst Australian healthcare workers during the COVID‐19 pandemic. Australas Psychiatry 2021; 29: 26–30.
            • 11. Painvin B, Messet H, Rodriguez M, et al. Inter‐hospital transport of critically ill patients to manage the intensive care unit surge during the COVID‐19 pandemic in France. Ann Intensive Care 2021; 11: 54.
            • 12. Pilcher D, Coatsworth NR, Rosenow M, McClure J. A national system for monitoring intensive care unit demand and capacity: the Critical Health Resources Information System (CHRIS). Med J Aust 2021; 214: 297–298.e1. https://www.mja.com.au/journal/2021/214/7/national‐system‐monitoring‐intensive‐care‐unit‐demand‐and‐capacity‐critical
            • 13. Pilcher D, Duke G, Rosenow M, et al. Assessment of a novel marker of ICU strain, the ICU Activity Index, during the COVID‐19 pandemic in Victoria, Australia. Crit Care Resusc 2021; 23: 300–307.
            • 14. Secombe P, Brown A, Bailey M, et al. Characteristics and outcomes of patients admitted to regional and rural intensive care units in Australia. Crit Care Resusc 2020; 22: 335–343.

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              Is it time to abandon clinical breast examination?

              Belinda E Kiely and Annabel Goodwin
              Med J Aust 2021; 215 (10): . || doi: 10.5694/mja2.51285
              Published online: 15 November 2021

              Despite limits to its clinical value, the potential benefits for women should not be overlooked

              Women with mutations in breast cancer predisposition genes have a very high risk of developing breast cancer and are offered risk‐reducing strategies and intensified surveillance; many are referred to specialist risk management clinics. Because magnetic resonance imaging (MRI) is more sensitive for detecting breast cancer at an early stage than mammography,1 it is part of most high risk breast cancer screening programs, and in Australia is covered by Medicare for women at high risk under 50 years of age.2


              • 1 NHMRC Clinical Trials Centre, the University of Sydney, Sydney, NSW
              • 2 Concord Repatriation General Hospital, Sydney, NSW


              Correspondence: belinda.kiely@sydney.edu.au
              Competing interests:

              Belinda Kiely has received honoraria from Roche for sitting on an advisory board (2018, 2019), and Annabel Goodwin has received honoraria from AstraZeneca and Pfizer for sitting on advisory boards (2018, 2019).

              • 1. Warner E, Messersmith H, Causer P, et al. Systematic review: using magnetic resonance imaging to screen women at high risk for breast cancer. Ann Intern Med 2008; 148: 671–679.
              • 2. Australian Department of Health. Medicare Benefits Schedule: item 63464. MBS Online. http://www9.health.gov.au/mbs/fullDisplay.cfm?type=item&q=63464&qt=item&criteria=breast%20MRI (viewed Sept 2021).
              • 3. Hettipathirana T, Macdonald C, Xie J, et al. The value of clinical breast examination in a breast cancer surveillance program for women with germline BRCA1 or BRCA2 mutations. Med J Aust 2021; 215: 460–464.
              • 4. Runowicz CD, Leach CR, Henry NL, et al. American Cancer Society/American Society of Clinical Oncology Breast Cancer Survivorship Care Guideline. J Clin Oncol 2016; 34: 611–635.
              • 5. Ngan TT, Nguyen NTQ, Van Minh H, et al. Effectiveness of clinical breast examination as a ‘‘stand‐alone’’ screening modality: an overview of systematic reviews. BMC Cancer 2020; 20: 1070.
              • 6. Mittra I, Mishra GA, Dikshit RP, et al. Effect of screening by clinical breast examination on breast cancer incidence and mortality after 20 years: prospective, cluster randomised controlled trial in Mumbai. BMJ 2021; 372: n256.
              • 7. Nelson HD, Tyne K, Naik A, et al. Screening for breast cancer: an update for the US Preventive Services Task Force. Ann Intern Med 2009; 151: 727–737.
              • 8. Rijnsburger AJ, Obdeijn IM, Kaas R, et al. BRCA1‐associated breast cancers present differently from BRCA2‐associated and familial cases: long‐term follow‐up of the Dutch MRISC Screening Study. J Clin Oncol 2010; 28: 5265–5273.
              • 9. MARIBS Study Group. Screening with magnetic resonance imaging and mammography of a UK population at high familial risk of breast cancer: a prospective multicentre cohort study (MARIBS). Lancet 2005; 365: 1769–1778.
              • 10. Guindalini RSC, Zheng Y, Abe H, et al. Intensive surveillance with biannual dynamic contrast‐enhanced magnetic resonance imaging downstages breast cancer in BRCA1 mutation carriers. Clin Cancer Res 2019; 25: 1786–1794.
              • 11. Spiegel TN, Hill KA, Warner E. The attitudes of women with BRCA1 and BRCA2 mutations toward clinical breast examinations and breast self‐examinations. J Womens Health (Larchmt) 2009; 18: 1019–1024.

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                Universal genetic testing of patients with newly diagnosed breast cancer — ready for prime time?

                Dilanka L De Silva, Paul A James, G Bruce Mann and Geoffrey J Lindeman
                Med J Aust 2021; 215 (10): . || doi: 10.5694/mja2.51317
                Published online: 15 November 2021

                Current genetic testing guidelines may overlook patients with actionable mutations in high risk breast and ovarian cancer predisposition genes

                The discovery of the BRCA1 and BRCA2 genes just over 25 years ago1 ushered in a new era of genetic testing for patients diagnosed with breast and/or ovarian cancer. A new field of practice in familial cancer emerged that has continued to evolve at an accelerating pace over the intervening years. With improvements in technology, changing patient attitudes and striking new clinical data, genetic testing may have now arrived at another defining moment — as a routine investigation for virtually all patients with newly diagnosed breast cancer (universal testing), a notion that was unimaginable a quarter of a century ago.


                • 1 Familial Cancer Centre, Peter MacCallum Cancer Centre and Royal Melbourne Hospital, Melbourne, VIC
                • 2 Memorial Sloan Kettering Cancer Center, New York, USA
                • 3 University of Melbourne, Melbourne, VIC
                • 4 Royal Melbourne and Royal Women's Hospitals, Melbourne, VIC
                • 5 Peter MacCallum Cancer Centre, Melbourne, VIC
                • 6 Walter and Eliza Hall Institute of Medical Research, Melbourne, VIC


                Correspondence: lindeman@wehi.edu.au
                Acknowledgements: 

                Geoffrey Lindeman is supported by a National Health and Medical Research Council (NHMRC) Leadership Fellowship (1175960). The NHMRC played no role in the planning, writing or publication of this work.

                Competing interests:

                No relevant disclosures.

                • 1. Narod SA, Foulkes WD. BRCA1 and BRCA2: 1994 and beyond. Nat Rev Cancer 2004; 4: 665–676.
                • 2. Cancer Australia. Advice about familial aspects of breast cancer and epithelial ovarian cancer. Sydney: Cancer Australia, 2015. https://www.canceraustralia.gov.au/publications‐and‐resources/cancer‐australia‐publications/advice‐about‐familial‐aspects‐breast‐cancer‐and‐epithelial‐ovarian‐cancer (viewed Oct 2021).
                • 3. Tung NM, Garber JE. BRCA1/2 testing: therapeutic implications for breast cancer management. Br J Cancer 2018; 119: 141–152.
                • 4. Robson M, Im SA, Senkus E, et al. Olaparib for metastatic breast cancer in patients with a germline BRCA mutation. N Engl J Med 2017; 377: 523–533.
                • 5. EviQ. BRCA1 and BRCA2 genetic testing: Cancer Institute NSW. https://www.eviq.org.au/cancer‐genetics/adult/genetic‐testing‐for‐heritable‐pathogenic‐variants/620‐brca1‐and‐brca2‐genetic‐testing (viewed Oct 2021).
                • 6. Antoniou AC, Hardy R, Walker L, et al. Predicting the likelihood of carrying a BRCA1 or BRCA2 mutation: validation of BOADICEA, BRCAPRO, IBIS, Myriad and the Manchester scoring system using data from UK genetics clinics. J Med Genet 2008; 45: 425–431.
                • 7. Kirk J, Barlow‐Stewart KK, Poplawski NK, et al. Medicare‐funded cancer genetic tests: a note of caution. Med J Aust 2018; 209: 193–196. https://www.mja.com.au/journal/2018/209/5/medicare‐funded‐cancer‐genetic‐tests‐note‐caution
                • 8. Hu C, Hart SN, Gnanaolivu R, et al. A population‐based study of genes previously implicated in breast cancer. N Engl J Med 2021; 384: 440–451.
                • 9. Audeh MW, Carmichael J, Penson RT, et al. Oral poly(ADP‐ribose) polymerase inhibitor olaparib in patients with BRCA1 or BRCA2 mutations and recurrent ovarian cancer: a proof‐of‐concept trial. Lancet 2010; 376: 245–251.
                • 10. Moore K, Colombo N, Scambia G, et al. Maintenance olaparib in patients with newly diagnosed advanced ovarian cancer. N Engl J Med 2018; 379: 2495–505.
                • 11. Tutt ANJ, Garber JE, Kaufman B, et al. Adjuvant olaparib for patients with BRCA1‐ or BRCA2‐mutated breast cancer. N Engl J Med 2021; 384: 2394–2405.
                • 12. Tung NM, Zakalik D, Somerfield MR, for the Hereditary Breast Cancer Guideline Expert Panel. Adjuvant PARP inhibitors in patients with high‐risk early‐stage HER2‐negative breast cancer and germline BRCA mutations: ASCO hereditary breast cancer guideline rapid recommendation update. J Clin Oncol 2021; 39: 2959–2961.
                • 13. Kuchenbaecker KB, Hopper JL, Barnes DR, et al. Risks of breast, ovarian, and contralateral breast cancer for BRCA1 and BRCA2 mutation carriers. JAMA 2017; 317: 2402–2416.
                • 14. Fasching PA, Yadav S, Hu C, et al. Mutations in BRCA1/2 and other panel genes in patients with metastatic breast cancer ‐association with patient and disease characteristics and effect on prognosis. J Clin Oncol 2021; 39: 1619–1630.
                • 15. Plon SE, Eccles DM, Easton D, et al. Sequence variant classification and reporting: recommendations for improving the interpretation of cancer susceptibility genetic test results. Hum Mutat 2008; 29: 1282–1291.
                • 16. Robson M, Domchek S. Broad application of multigene panel testing for breast cancer susceptibility ‐ Pandora’s Box Is opening wider. JAMA Oncol 2019; 5: 1687–1688.
                • 17. Kemp Z, Turnbull A, Yost S, et al. Evaluation of cancer‐based criteria for use in mainstream BRCA1 and BRCA2 genetic testing in patients with breast cancer. JAMA Netw Open 2019; 2: e194428.
                • 18. Beard C, Monohan K, Cicciarelli L, et al. Mainstream genetic testing for breast cancer patients: early experiences from the Parkville Familial Cancer Centre. Eur J Hum Genet 2021; 29: 872–880.

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                  It is time for governments to support retailers in the transition to a smoke‐free society

                  Coral E Gartner, April Wright, Marita Hefler, Andrew Perusco and Janet Hoek
                  Med J Aust 2021; 215 (10): . || doi: 10.5694/mja2.51312
                  Published online: 15 November 2021

                  Phasing out tobacco retailing is gaining traction as the natural next step in controlling the tobacco pandemic

                  The commercial tobacco trade is a complex system involving multiple actors, from tobacco growers and manufacturers to the importers and wholesalers that distribute products to retailers, who onsell to consumers. Consumers who purchase and use products form the demand side. Governments can influence each actor through policy, but have historically focused on the demand‐side measures in the World Health Organization Framework Convention on Tobacco Control (WHO FCTC; Articles 6–14). These outnumber the supply‐side measures (Articles 15–17), which have primarily focused on constraining tobacco product manufacturers. Calls are growing for governments to increase attention on retail supply — the critical link in the supply chain between manufacturers and consumers.1


                  • 1 University of Queensland, Brisbane, QLD
                  • 2 Charles Darwin University, Darwin, NT
                  • 3 Australian National University, Canberra, ACT
                  • 4 University of Otago, Dunedin, New Zealand


                  Correspondence: c.gartner@uq.edu.au
                  Acknowledgements: 

                  Coral Gartner is the chief investigator in a National Health and Medical Research Council (NHMRC) grant (GNT1198301). Andrew Perusco holds an Australian Government Research Training Scholarship administered by Australian National University. The manuscript was written as part of the activities of the NHMRC‐funded Centre of Research Excellence on Achieving the Tobacco Endgame. The funder played no role in the study design, manuscript preparation, or the decision to submit it for publication.

                  Competing interests:

                  No relevant disclosures.

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                    Who cares about climate?

                    Hugh Montgomery and Fintan Hughes
                    Med J Aust 2021; 215 (9): . || doi: 10.5694/mja2.51300
                    Published online: 1 November 2021

                    The threat of climate change is immediate and grave, and now is the time to act


                    • 1 University College London, London, UK
                    • 2 Duke University, Durham, NC, USA


                    Correspondence: h.montgomery@ucl.ac.uk
                    Competing interests:

                    Hugh Montgomery chairs the Lancet Countdown on health and climate change, which is funded by the Wellcome Trust.

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                      Mucormycosis: early treatment is the key to survival

                      Timothy R Holmes, Jenny L Hepschke, Ian Jacobson and Anthony Maloof
                      Med J Aust 2021; 215 (9): . || doi: 10.5694/mja2.51290
                      Published online: 1 November 2021

                       


                      • Prince of Wales Hospital and Community Health Services, Sydney, NSW


                      Acknowledgements: 

                      We thank the patient and his wife for their insights and help in preparing this article. Their fortitude and commitment throughout his illness were remarkable. We also acknowledge the many other clinicians involved in the patient's care, without whose contributions the outcome might have been quite different.

                      Competing interests:

                      No relevant disclosures.

                      • 1. Cornely OA, Alastruey‐Izquierdo A, Arenz D, et al. Global guideline for the diagnosis and management of mucormycosis: an initiative of the European Confederation of Medical Mycology in cooperation with the Mycoses Study Group Education and Research Consortium. Lancet Infect Dis 2019; 19: e405–e421.
                      • 2. Vaughan C, Bartolo A, Vallabh N, Leong SC. A meta‐analysis of survival factors in rhino‐orbital‐cerebral mucormycosis‐has anything changed in the past 20 years? Clin Otolaryngol 2018; 43: 1454–1464.
                      • 3. Prakash H, Ghosh AK, Rudramurthy SM, et al. A prospective multicenter study on mucormycosis in India: epidemiology, diagnosis, and treatment. Med Mycol 2019; 57: 395–402.
                      • 4. Chamilos G, Lewis RE, Kontoyiannis DP. Delaying amphotericin B‐based frontline therapy significantly increases mortality among patients with hematologic malignancy who have zygomycosis. Clin Infect Dis 2008; 47: 503–509.
                      • 5. Gamba JL, Woodruff WW, Djang WT, Yeates AE. Craniofacial mucormycosis: assessment with CT. Radiology 1986; 160: 207–212.
                      • 6. Fanos V, Cataldi L. Amphotericin B‐induced nephrotoxicity: a review. J Chemother 2000; 12: 463–470.
                      • 7. Saedi B, Sadeghi M, Seilani P. Endoscopic management of rhinocerebral mucormycosis with topical and intravenous amphotericin. Br J Laryngol Otol 2011; 125: 807–810.

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