Topics

We still await well conducted RCTs of CO₂ laser therapy for vaginal atrophy; in the meantime, topical oestrogen therapy remains the gold standard

Vaginal laser therapy has entered the global marketplace promising women relief from symptoms of genitourinary syndrome of menopause (GSM), formerly known as vulvovaginal atrophy.

1 The Wesley Hospital, Brisbane, QLD
2 University of Queensland, Brisbane, QLD

Correspondence: melissa.buttini0@gmail.com

Competing interests:

No relevant disclosures.

1. American College of Obstetricians and Gynecologists: Fractional laser treatment of vulvovaginal atrophy and US Food and Drug Administration clearance: position statement. Washington, DC: ACOG, approved May 2016, reaffirmed July 2018. https://www.acog.org/Clinical-Guidance-and-Publications/Position-Statements/Fractional-Laser-Treatment-of-Vulvovaginal-Atrophy-and-US-Food-and-Drug-Administration-Clearance (viewed Sept 2018).
2. Therapeutic Goods Administration. Public summary for ARTG entry: 106780 High Tech Laser Australia P/L. https://www.ebs.tga.gov.au/servlet/xmlmillr6?dbid=ebs/PublicHTML/pdfStore.nsf&docid=B5C3E89B35339C9ECA2577DD0001F0EB&agid=(PrintDetailsPublic)&actionid=1 (viewed Feb 2018).
3. US Food and Drug Administration. Guidance for industry: estrogen and estrogen/progestin drug products to treat vasomotor symptoms and vulvar and vaginal atrophy symptoms – recommendations for clinical evaluation. Rockville, MD: FDA, 2003. https://www.fda.gov/downloads/Drugs/DrugSafety/informationbyDrugClass/UCM135338.pdf (viewed Feb 2018).
4. Chollet JA. Efficacy and safety of ultra-low-dose Vagifem (10 mcg). Patient Prefer Adherence 2011; 5: 571-574.
5. Wurz GT, Kao CJ, DeGregorio MW. Safety and efficacy of ospemifene for the treatment of dyspareunia associated with vulvar and vaginal atrophy due to menopause. Clin Interv Aging 2014; 9: 1939-1950.
6. Salvatore S, Nappi RE, Zerbinati N, et al. A 12-week treatment with fractional CO₂ laser for vulvovaginal atrophy: a pilot study. Climacteric 2014; 17: 363-369.
7. Salvatore S, Nappi RE, Parma M, et al. Sexual function after fractional microablative CO₂ laser in women with vulvovaginal atrophy. Climacteric 2015; 18: 219-225.
8. Salvatore S, Leone Roberti Maggiore U, Athanasiou S, et al. Histological study on the effects of microablative fractional CO₂ laser on atrophic vaginal tissue: an ex vivo study. Menopause 2015; 22: 845-849.
9. Athanasiou S, Pitsouni E, Antonopoulou S, et al. The effect of microablative fractional CO₂ laser on vaginal flora of postmenopausal women. Climacteric 2016; 19: 512-518.
10. Pitsouni E, Grigoriadis T, Tsiveleka A, et al. Microablative fractional CO₂ laser therapy and the genitourinary syndrome of menopause: an observational study. Maturitas 2016; 94: 131-136.
11. Salvatore S, Pitsouni E, Del Deo F, et al. Sexual function in women suffering from genitourinary syndrome of menopause treated with fractionated CO₂ laser. Sex Med Rev 2017; 5: 486-494.
12. Athanasiou S, Pitsouni E, Falagas ME, et al. CO₂ laser for the genitourinary syndrome of menopause. How many laser sessions? Maturitas 2017; 104: 24-28.
13. Cruz VL, Steiner ML, Pompei LM, et al. Randomized, double-blind, placebo-controlled clinical trial for evaluating the efficacy of fractional CO₂ laser compared with topical estriol in the treatment of vaginal atrophy in postmenopausal women. Menopause 2018; 25: 21-28.

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Guideline summary

Revised Australian national guidelines for colorectal cancer screening: family history

Mark A Jenkins, Driss Ait Ouakrim, Alex Boussioutas, John L Hopper, Hooi C Ee, Jon D Emery, Finlay A Macrae, Albert Chetcuti, Laura Wuellner and D James B St John

Med J Aust 2018; 209 (10): . || doi: 10.5694/mja18.00142
Published online: 29 October 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

Environment and public health

General medicine

Abstract

Introduction: Screening is an effective means for colorectal cancer prevention and early detection. Family history is strongly associated with colorectal cancer risk. We describe the rationale, evidence and recommendations for colorectal cancer screening by family history for people without a genetic syndrome, as reported in the 2017 revised Australian guidelines.

Main recommendations: Based on 10-year risks of colorectal cancer, people at near average risk due to no or weak family history (category 1) are recommended screening by immunochemical faecal occult blood test (iFOBT) every 2 years from age 50 to 74 years. Individuals with moderate risk due to their family history (category 2) are recommended biennial iFOBT from age 40 to 49 years, then colonoscopy every 5 years from age 50 to 74 years. People with a high risk due to their family history (category 3) are recommended biennial iFOBT from age 35 to 44 years, then colonoscopy every 5 years from age 45 to 74 years.

Changes in management as a result of the guidelines: By 2019, the National Bowel Cancer Screening Program will offer all Australians free biennial iFOBT screening from age 50 to 74 years, consistent with the recommendations in these guidelines for category 1. Compared with the 2005 guidelines, there are some minor changes in the family history inclusion criteria for categories 1 and 2; the genetic syndromes have been removed from category 3 and, as a consequence, colonoscopy screening is now every 5 years; and for categories 2 and 3, screening begins with iFOBT for people aged 40 and 35 years, respectively, before transitioning to colonoscopy after 10 years.

1 University of Melbourne, Melbourne, VIC
2 Royal Melbourne Hospital, Melbourne, VIC
3 Sir Charles Gardiner Hospital, Perth, WA
4 Cancer Council Australia, Sydney, NSW
5 Agency for Clinical Innovation, Sydney, NSW
6 Cancer Council Victoria, Melbourne, VIC

Correspondence: m.jenkins@unimelb.edu.au

Acknowledgements:

Mark Jenkins has a Research Fellowship from the NHMRC.

Competing interests:

Albert Chetcuti and Laura Wuellner are employed by Cancer Council Australia to assist in the preparation of these guidelines — Cancer Council Australia received financial support from both Cancer Council Australia and the Australian Government Department of Health. Mark Jenkins, Jon Emery, Finlay Macrae and James St. John received travel support from Cancer Council Australia to attend meetings for development of the guidelines. Mark Jenkins, Jon Emery, Finlay Macrae and James St. John are members of the Clinical Advisory Group of the National Bowel Cancer Screening Program and received travel support and sitting fees.

1. Australian Institute of Health and Welfare 2017. Cancer in Australia 2017 (AIHW Cat. No. CAN 100; Cancer Series No. 101). Canberra: AIHW; 2017. https://www.aihw.gov.au/getmedia/3da1f3c2-30f0-4475-8aed-1f19f8e16d48/20066-cancer-2017.pdf.aspx?inline=true (viewed Aug 2018).
2. Cancer Council Australia; Colorectal Cancer Guidelines Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia; 2017. https://wiki.cancer.org.au/australiawiki/index.php?oldid=173168 (viewed Jan 2018).
3. Johns LE, Houlston RS. A systematic review and meta-analysis of familial colorectal cancer risk. Am J Gastroenterol 2001; 96: 2992-3003.
4. Lynch HT, Lanspa S, Shaw T, et al. Phenotypic and genotypic heterogeneity of Lynch syndrome: a complex diagnostic challenge. Fam Cancer 2018; 17: 403-414.
5. Leoz ML, Carballal S, Moreira L, et al. The genetic basis of familial adenomatous polyposis and its implications for clinical practice and risk management. Appl Clin Genet 2015; 8: 95-107.
6. Nielsen M, Morreau H, Vasen HF, Hes FJ. MUTYH-associated polyposis (MAP). Crit Rev Oncol Hematol 2011; 79: 1-16.
7. Aaltonen L, Johns L, Järvinen H, et al. Explaining the familial colorectal cancer risk associated with mismatch repair (MMR)-deficient and MMR-stable tumors. Clin Cancer Res 2007; 13: 356-361.
8. Jenkins MA, Makalic E, Dowty JG, et al. Quantifying the utility of single nucleotide polymorphisms to guide colorectal cancer screening. Future Oncol 2016; 12: 503-513.
9. Hsu L, Jeon J, Brenner H, et al. A model to determine colorectal cancer risk using common genetic susceptibility loci. Gastroenterology 2015; 148: 1330-1339.
10. Levin B, Lieberman DA, McFarland B, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008. A joint guideline from the American Cancer Society, the US Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. Gastroenterology 2008; 134: 1570-1595.
11. Medical Advisory Secretariat. Fecal occult blood test for colorectal cancer screening: an evidence-based analysis. Ontario Health Technology Assessment Series 2009; 9(10). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3377532/pdf/ohtas-09–40a.pdf (viewed May 2018).
12. Segnan N, Patnick J, von Karsa L; editors. European guidelines for quality assurance in colorectal cancer screening and diagnosis; 1st ed. Belgium: European Union; 2010. http://www.kolorektum.cz/res/file/guidelines/CRC-screening-guidelines-EC-2011-02-03.pdf (viewed May 2018).
13. Australian Cancer Network Colorectal Cancer Guidelines Revision Committee. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia and Australian Cancer Network; 2005. https://wiki.cancer.org.au/australia/Citation:Australian_Cancer_Network_Colorectal_Cancer_Guidelines_Revision_Committee_2005 (viewed May 2018).
14. Cancer Council Australia. Systematic review report for question FSH2. https://wiki.cancer.org.au/australiawiki/images/d/da/CRC_FHS2_systematic_review_report.pdf (viewed May 2018).
15. Cancer Council Australia. NHMRC evidence statement form. https://wiki.cancer.org.au/australiawiki/images/2/23/CRC_FHS2_evidence_statement_form.pdf (viewed May 2018).
16. Wei EK, Giovannucci E, Wu K, et al. Comparison of risk factors for colon and rectal cancer. Int J Cancer 2004; 108: 433-442.
17. Bass AJ, Meyerhardt JA, Chan JA, et al. Family history and survival after colorectal cancer diagnosis. Cancer 2008; 112: 1222-1229.
18. Murphy G, Shu XO, Gao YT, et al. Family cancer history affecting risk of colorectal cancer in a prospective cohort of Chinese women. Cancer Causes Control 2009; 20: 1517-1521.
19. Schoen RE, Razzak A, Yu KJ, et al. Incidence and mortality of colorectal cancer in individuals with a family history of colorectal cancer. Gastroenterology 2015; 149: 1438-1445.
20. Stefansson T, Moller PH, Sigurdsson F, et al. Familial risk of colon and rectal cancer in Iceland: evidence for different etiologic factors? Int J Cancer 2006; 119: 304-308.
21. Taylor DP, Burt RW, Williams MS, et al. Population-based family-history-specific risks for colorectal cancer: a constellation approach. Gastroenterology 2010; 138: 877-885.
22. Fuchs CS, Giovannucci EL, Colditz GA, et al. A prospective study of family history and the risk of colorectal cancer. N Engl J Med 1994; 331: 1669-1674.
23. Leu M, Reilly M, Czene K. Evaluation of bias in familial risk estimates: a study of common cancers using Swedish population-based registers. J Natl Cancer Inst 2008; 100: 1318-1325.
24. Lynch KL, Ahnen DJ, Byers T, et al. First-degree relatives of patients with advanced colorectal adenomas have an increased prevalence of colorectal cancer. Clin Gastroenterol Hepatol 2003; 1: 96-102.
25. Slattery ML, Kerber RA. Family history of cancer and colon cancer risk: the Utah Population Database. J Natl Cancer Inst 1994; 86: 1618-1626.
26. St John DJ, McDermott FT, Hopper JL, et al. Cancer risk in relatives of patients with common colorectal cancer. Ann Intern Med 1993; 118: 785-790.
27. Hall NR, Bishop DT, Stephenson BM, Finan PJ. Hereditary susceptibility to colorectal cancer. Relatives of early onset cases are particularly at risk. Dis Colon Rectum 1996; 39: 739-743.
28. Benhamiche-Bouvier AM, Lejeune C, Jouve JL, et al. Family history and risk of colorectal cancer: implications for screening programmes. J Med Screen 2000; 7: 136-140.
29. Sandhu MS, Luben R, Khaw KT. Prevalence and family history of colorectal cancer: implications for screening. J Med Screen 2001; 8: 69-72.
30. Aitken JF, Bain CJ, Ward M, et al. Risk of colorectal adenomas in patients with a family history of colorectal cancer: some implications for screening programmes. Gut 1996; 39: 105-108.
31. Legget B, Poplawski N, Pachter N, et al. Introduction: high-risk familial syndromes. In: Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. https://wiki.cancer.org.au/australia/Guidelines:Colorectal_cancer/High-risk_familial_syndromes (viewed May 2018).
32. Australian Institute of Health and Welfare, Australasian Association of Cancer Registries. Cancer in Australia 2000 (AIHW CatNo. CAN 18; Cancer Series No. 23). Canberra: AIHW; 2003. https://www.aihw.gov.au/getmedia/73dc566a-3a0a-489a-a8cb-aac16a4a3811/ca00.pdf.aspx?inline=true (viewed Aug 2018).
33. Anderson JC, Attam R, Alpern Z, et al. Prevalence of colorectal neoplasia in smokers. Am J Gastroenterol 2003; 98: 2777-2783.
34. Wuellner W, von Dincklage J, Cancer Council Australia Colorectal Cancer Guidelines Working Party. Guideline development process. Sydney: Cancer Council Australia; 2017. https://wiki.cancer.org.au/australia/Guidelines:Colorectal_cancer/Guideline_development_process (viewed May 2018).
35. Grossman S, Milos ML. Colonoscopic screening of persons with suspected risk factors for colon cancer — I: family history. Gastroenterology 1988; 94: 395-400.
36. Luchtefeld MA, Syverson D, Solfelt M, et al. Is colonoscopic screening appropriate in asymptomatic patients with family history of colon cancer? Dis Colon Rectum 1991; 34: 763-768.
37. Rex DK, Lehman GA, Ulbright TM, et al. Colonic neoplasia in asymptomatic persons with negative fecal occult blood tests: influence of age, gender, and family history. Am J Gastroenterol 1993; 88: 825-831.
38. Hunt LM, Rooney PS, Hardcastle JD, Armitage N. Endoscopic screening of relatives of patients with colorectal cancer. Gut 1998; 42: 71-75.
39. Mandel JS, Bond JH, Church TR, et al. Reducing mortality from colorectal cancer by screening for fecal occult blood. Minnesota Colon Cancer Control Study. N Engl J Med 1993; 328: 1365-1371.
40. Hardcastle JD, Chamberlain JO, Robinson MH, et al. Randomised controlled trial of faecal-occult-blood screening for colorectal cancer. Lancet 1996; 348: 1472-1477.
41. Kronborg O, Fenger C, Olsen J, et al. Randomised study of screening for colorectal cancer with faecal-occult-blood test. Lancet 1996; 348: 1467-1471.
42. Scholefield JH, Moss SM, Mangham CM, et al. Nottingham trial of faecal occult blood testing for colorectal cancer: a 20-year follow-up. Gut 2012; 61: 1036-1040.
43. Lew JB, St John DJB, Xu XM, et al. Long-term evaluation of benefits, harms, and cost-effectiveness of the National Bowel Cancer Screening Program in Australia: a modelling study. Lancet Public Health 2017; 2: e331-e340.
44. St. John J, Ee HC, Canfell K, et al. Population screening: evidence summary and recommendations. In: Cancer Council Australia Colorectal Cancer Guidelines Working Party. Clinical practice guidelines for the prevention, early detection and management of colorectal cancer. Sydney: Cancer Council Australia. https://wiki.cancer.org.au/australiawiki/index.php?oldid=173044 (viewed Jan 2018).
45. Rabeneck L, Paszat LF, Hilsden RJ, et al. Bleeding and perforation after outpatient colonoscopy and their risk factors in usual clinical practice. Gastroenterology 2008; 135: 1899-1906.
46. Viiala CH, Zimmerman M, Cullen DJ, et al. Complication rates of colonoscopy in an Australian teaching hospital environment. Intern Med J 2003; 33: 355-359.
47. Lynch HT, Riley BD, Weismann S, et al. Hereditary nonpolyposis colorectal carcinoma (HNPCC) and HNPCC-like families: problems in diagnosis, surveillance, and management. Cancer 2004; 100: 53-64.
48. Chen CH, Tsai MK, Wen CP. Extending colorectal cancer screening to persons aged 40 to 49 years with immunochemical fecal occult blood test: a prospective cohort study of 513,283 individuals. J Clin Gastroenterol 2016; 50: 761-768.
49. Chen YY, Chen TH, Su MY, et al. Accuracy of immunochemical fecal occult blood test for detecting colorectal neoplasms in individuals undergoing health check-ups. Adv Dig Med 2014; 1: 74-79.

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Editorials

Redefining the physician’s role in the era of online health information

Susan Ieraci

Med J Aust 2018; 209 (8): . || doi: 10.5694/mja18.00652
Published online: 15 October 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Information science

Emergency medicine

General medicine

Clinicians are no longer gatekeepers to privileged information, but rather interpreters, problem solvers, and advisers

Many readers will be accessing the MJA via the internet: on computers, laptops, phones, or tablets. It is therefore essential that we discuss and understand how the internet and social media are used by patients to find health information, as well as the influence that the medical profession might have on such online information.

Emergency medicine consultant, Sydney

Correspondence: sieraci@ozemail.com.au

Competing interests:

I am an executive member of Friends of Science in Medicine.

1. Cocco AM, Zordan R, Taylor DM, et al. Dr Google in the ED: searching for online health information by adult emergency department patients. Med J Aust 2018; 209: 342-347.
2. Thompson A. Hippocrates and the smart phone: the evolving parent and doctor relationship. J Paediatr Child Health 2016; 52: 366-369.
3. Hartzband P, Groopman J. Untangling the web — patients, doctors, and the Internet. N Engl J Med 2010; 362: 1063-1066.

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Medical education
Lessons from practice

Subclavian vein thrombosis with internal jugular vein extension in an Australian rules football player

John WP Wong, Fiona WY Lai and Ian Wilson

Med J Aust 2018; 209 (8): . || doi: 10.5694/mja18.00335
Published online: 15 October 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Hematologic diseases

Vascular diseases

Diagnostic techniques and procedures

General medicine

Clinical record

1 Royal Melbourne Hospital, Melbourne, VIC
2 Northeast Health Wangaratta, Wangaratta, VIC
3 Rural Health, University of Melbourne, Shepparton, VIC

Correspondence: johnwpwong@gmail.com

Competing interests:

No relevant disclosures.

1. Esmon CT. Basic mechanisms and pathogenesis of venous thrombosis. Blood Rev 2009; 23: 225-229.
2. Bernardi E, Pesavento R, Prandoni P. Upper extremity deep venous thrombosis. Semin Thromb Hemost 2006; 32: 729-736.
3. Lindblad B, Tengborn L, Bergqvist D. Deep vein thrombosis of the axillary-subclavian veins: epidemiologic data, effects of different types of treatment and late sequelae. Eur J Vasc Surg 1998; 2: 161-165.
4. Alla VM, Natarajan N, Kaushik M, et al. Paget–Schroetter syndrome: review of pathogenesis and treatment of effort thrombosis. West J Emerg Med 2010; 11: 358-362.
5. Héron E, Lozinguez O, Alhenc-Gelas M, et al. Hypercoaguable states in primary upper-extremity deep vein thrombosis. Arch Intern Med 2000; 160: 382-386.
6. Elman EE, Kahn SR. The post-thrombotic syndrome after upper extremity deep venous thrombosis in adults: a systematic review. Thromb Res 2006; 117: 609-614.

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Perspectives

Australia is responding to the complex challenge of overdiagnosis

Ray Moynihan, Alexandra L Barratt, Rachelle Buchbinder, Stacy M Carter, Thomas Dakin, Jan Donovan, Adam G Elshaug, Paul P Glasziou, Christopher G Maher, Kirsten J McCaffery and Ian A Scott

Med J Aust 2018; 209 (8): . || doi: 10.5694/mja17.01138
Published online: 15 October 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Health services administration

General medicine

An Australian alliance of clinical, consumer, research and public organisations is emerging to tackle overdiagnosis

Overdiagnosis is now a health challenge recognised across many nations.1 Debates about its definition continue, but in short, overdiagnosis happens when health systems routinely diagnose people in ways that do not benefit them or that even do more harm than good.2 Overdiagnosis is unwarranted diagnosis, leading to harms from unnecessary labels and treatments and to the waste of health care resources that could be better spent dealing with genuine needs. To manage overdiagnosis and the sustainability of the health system more broadly, reversing the harm of too much medicine is becoming a health care priority, demanding effective responses in policy and practice. In Australia, a new alliance is developing a national plan to deal with this problem.

1 Centre for Research in Evidence-Based Practice, Bond University, Gold Coast, QLD
2 University of Sydney, Sydney, NSW
3 Cabrini Institute, Melbourne, VIC
4 Monash University, Melbourne, VIC
5 University of Wollongong, Wollongong, NSW
6 Consumers Health Forum of Australia, Canberra, ACT
7 Menzies Centre for Health Policy, University of Sydney, Sydney, NSW
8 George Institute for Global Health, University of Sydney, Sydney, NSW
9 Princess Alexandra Hospital, Brisbane, QLD
10 University of Queensland, Brisbane, QLD

Correspondence: RayMoynihan@bond.edu.au

Competing interests:

All authors were involved in planning the 2017 National Summit on Overdiagnosis.

1. Welch G, Schwartz L, Woloshin S. Overdiagnosed: making people sick in the pursuit of health. Boston: Beacon; 2012.
2. Carter SM, Degeling C, Doust J, Barratt A. A definition and ethical evaluation of overdiagnosis. J Med Ethics 2016; 42: 705-714
3. Esserman LJ, Thompson IM, Reid B. Overdiagnosis and overtreatment in cancer: an opportunity for improvement. JAMA 2013; 310: 797-798.
4. Hoffman JR, Cooper RJ. Overdiagnosis of disease: a modern epidemic. Arch Intern Med 2012; 172: 1123-1124.
5. Vaccarella S, Franceschi S, Bray F, et al. Worldwide thyroid-cancer epidemic? The increasing impact of overdiagnosis. N Engl J Med 2016; 375: 614-617.
6. Glasziou P, Moynihan R, Richards T, Godlee F. Too much medicine; too little care. BMJ 2013; 346: f4247.
7. Elshaug AG, Watt AM, Mundy L, Willis CD. Over 150 potentially low-value health care practices: an Australian study. Med J Aust 2012; 197: 556-560. <MJA full text>
8. Maxwell S, O’Leary P, Slevin T, Moorin R. The increase in cancer prevalence and hospital burden in Western Australia 1992–2011. Popul Health Metr 2014; 12: 33.
9. Treadwell J, McCartney M. Overdiagnosis and overtreatment. Br J Gen Pract 2016; 66: 116-117.
10. Québec Medical Association. Overdiagnosis: findings and action plan. Québec Medical Association; 2014. www.amq.ca/images/stories/documents/m%C3%A9moires/surdiagnostic-plan-action-en.pdf (viewed Jan 2018).
11. Saini V, Garcia-Armesto S, Klemperer D, et al. Drivers of poor medical care. Lancet 2017; 358: 178-190.
12. Pathirana T, Clark J, Moynihan R. Mapping the drivers of overdiagnosis to potential solutions. BMJ 2017; 358: j3879.
13. Scott IA, Soon J, Elshaug A, Lindner R. Countering cognitive biases in minimising low value care. Med J Aust 2017; 206: 407-411. <MJA full text>
14. MacMahon H, Naidich DP, Goo JM, et al. Guidelines for management of incidental pulmonary nodules detected on CT images: from the Fleischner Society 2017. Radiology 2017; 284: 228-243.
15. Soon J, Buchbinder R, Close J, et al. Identifying low-value care: the Royal Australasian College of Physicians’ EVOLVE initiative. Med J Aust 2016; 204: 180-181. <MJA full text>

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Perspectives

Trials and tribulations: improving outcomes for adolescents and young adults with rare and low survival cancers

Adam Walczak, Pandora Patterson and David Thomas

Med J Aust 2018; 209 (8): . || doi: 10.5694/mja17.00976
Published online: 15 October 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Neoplasms

Statistics, epidemiology and research design

Pediatric medicine

Coordinated national action is needed to develop an evidence base and standards of care for young Australians with rare and low survival cancers

In November 2016, the Australian Senate established a select committee to explore the impact of funding models on rare and low survival cancer research. CanTeen Australia presented a submission to this inquiry which highlighted the impact of these cancers on adolescents and young adults (AYAs) and the systemic barriers to improving outcomes for patients with rare and low survival cancers. Drawing from that submission, we present the argument for a strategic national approach, including a national trial network, to facilitate cross-sectoral coordination and investment to improve outcomes for AYA patients with cancer and the broader Australian population affected by rare and low survival cancers.

1 CanTeen Australia, Sydney, NSW
2 Cancer Nursing Research Unit, University of Sydney, Sydney, NSW
3 Kinghorn Cancer Centre, Garvan Institute of Medical Research, Sydney, NSW
4 University of New South Wales, Sydney, NSW

Correspondence: adam.walczak@canteen.org.au

Acknowledgements:

We thank Peter Orchard and Kimberley Allison for their contributions to the development of this manuscript.

Competing interests:

CanTeen Australia received Commonwealth Government funding to support the Australian Young Cancer Patient Clinical Trials Initiative.

1. Australian Institute of Health and Welfare. Cancer in adolescents and young adults in Australia (AIHW Cat. No. CAN 59; Cancer Series No. 62). Canberra: AIHW; 2011. https://www.aihw.gov.au/reports/cancer/cancer-in-adolescents-and-young-adults-in-australi/contents/table-of-contents (viewed Sept 2017).
2. Bleyer A, Budd T, Montello M. Adolescents and young adults with cancer: the scope of the problem and criticality of clinical trials. Cancer 2006; 107: 1645-1655.
3. Thomas DM, Seymour JF, O’Brien T, et al. Adolescent and young adult cancer: a revolution in evolution? Intern Med J 2006; 36: 302-307.
4. Rare Cancers Australia. Just a little more time: rare cancers update report. Bowral, Australia: Rare Cancers Australia; 2016. https://www.rarecancers.org.au/page/1081/reports-submissions (viewed Oct 2017).
5. Bleyer A. Adolescent and young adult (AYA) cancers: distinct biology, different therapy? Cancer Forum 2009; 33: 4-10.
6. Tricoli JV, Blair DG, Anders CK, et al. Biologic and clinical characteristics of adolescent and young adult cancers: Acute lymphoblastic leukemia, colorectal cancer, breast cancer, melanom, and sarcoma. Cancer 2016; 122: 1017-1028.
7. Bond MC, Pritchard S. Understanding clinical trials in childhood cancer. Paediatr Child Health 2006; 11: 148-150.
8. Mitchell AE, Scarcella DL, Rigutto GL, et al. Cancer in adolescents and young adults: treatment and outcome in Victoria. Med J Aust 2004; 180: 59-62. <MJA full text>
9. Teenage Cancer Trust. Giving more young people with cancer the opportunity to take part in clinical trials. London: Teenage Cancer Trust; 2014. https://teenagecancertrust.org/sites/default/files/Clinical%20Trials%20Paper_JR_FINAL_April15.pdf (viewed Oct 2017).
10. Abrahamyan L, Feldman BM, Tomlinson G, et al. Alternative designs for clinical trials in rare diseases. Am J Med Genet C Semin Med Genet 2016; 172: 313-331.
11. Tuffaha HW, Andronis L, Scuffham PA. Setting Medical Research Future Fund priorities: assessing the value of research. Med J Aust 2017; 206: 63-65. <MJA full text>
12. Casali PG, Bruzzi P, Bogaerts J, Blay JY. Rare Cancers Europe (RCE) methodological recommendations for clinical studies in rare cancers: a European consensus position paper. Ann Oncol 2015; 26: 300-306.
13. Augustine EF, Adams HR, Mink JW. Clinical trials in rare disease: challenges and opportunities. J Child Neurol 2013; 28: 1142-1150.
14. Pfister DG. Off-label use of oncology drugs: the need for more data and then some. J Clin Oncol 2012; 30: 584-586.
15. Australian Clinical Trials Alliance. Report on the activities and achievements of clinical trials networks in Australia: 2004–2014. Melbourne: National Health and Medical Research Council; 2015. https://www.australianclinicaltrials.gov.au/report-activities-achievements-clinical-trials-networks (viewed Oct 2017).
16. Panageas KS. Clinical trial design for rare cancers — why a less conventional route may be required. Expert Rev Clin Pharamcol 2015; 8: 661-663.
17. United States Congress. H.R.733 — Recalcitrant Cancer Research Act of 2012. 112th Congress (2011–2012). United States Congress; 2012. https://www.congress.gov/bill/112th-congress/house-bill/733 (viewed Oct 2017).

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Supplement

Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

Helena J Teede, Marie L Misso, Jacqueline A Boyle, Rhonda M Garad, Veryan McAllister, Linda Downes, Melanie Gibson-Helm, Roger J Hart, Luk Rombauts, Lisa Moran, Anuja Dokras, Joop Laven, Terhi Piltonen, Raymond J Rodgers, Mala Thondan, Michael F Costello and Robert J Norman, on behalf of the International PCOS Network

Med J Aust 2018; 209 (7): . || doi: 10.5694/mja18.00656
Published online: 1 October 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Women's health

Endocrine system diseases

General medicine

Abstract

Introduction: We have developed the first international evidence-based guideline for the diagnosis and management of polycystic ovary syndrome (PCOS), with an integrated translation program incorporating resources for health professionals and consumers. The development process involved an extensive Australian-led international and multidisciplinary collaboration of health professionals and consumers over 2 years. The guideline is approved by the National Health and Medical Research Council and aims to support both health professionals and women with PCOS in improving care, health outcomes and quality of life. A robust evaluation process will enable practice benchmarking and feedback to further inform evidence-based practice. We propose that this methodology could be used in developing and implementing guidelines for other women’s health conditions and beyond.

Main recommendations: The recommendations cover the following broad areas: diagnosis, screening and risk assessment depending on life stage; emotional wellbeing; healthy lifestyle; pharmacological treatment for non-fertility indications; and assessment and treatment of infertility.

Changes in management as a result of this guideline: •Diagnosis:▪when the combination of hyperandrogenism and ovulatory dysfunction is present, ultrasound examination of the ovaries is not necessary for diagnosis of PCOS in adult women;▪requires the combination of hyperandrogenism and ovulatory dysfunction in young women within 8 years of menarche, with ultrasound examination of the ovaries not recommended, owing to the overlap with normal ovarian physiology; and▪adolescents with some clinical features of PCOS, but without a clear diagnosis, should be regarded as “at risk” and receive follow-up assessment.•Screening for metabolic complications has been refined and incorporates both PCOS status and additional metabolic risk factors.•Treatment of infertility: letrozole is now first line treatment for infertility as it improves live birth rates while reducing multiple pregnancies compared with clomiphene citrate.

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1 National Health and Medical Research Council Centre for Research Excellence in PCOS, Monash and Adelaide Universities, Melbourne, VIC
2 Monash Centre for Health Research and Implementation, Monash Public Health and Preventive Medicine, Monash University and Monash Health, Melbourne, VIC
3 Polycystic Ovary Syndrome Association of Australia, Sydney, NSW
4 University of Western Australia, Perth, WA
5 Department of Obstetrics and Gynaecology, Monash University, Melbourne, VIC
6 Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA, USA
7 Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynaecology, Erasmus Medical Centre, Rotterdam, Netherlands
8 Obstetrics and Gynecology, PEDEGO Research Unit, Medical Research Centre, Oulu University Hospital, Oulu, Finland
9 Robinson Research Institute, University of Adelaide and Fertility SA, Adelaide, SA
10 Harp Family Medical Centre, Melbourne, VIC
11 UNSW Sydney, Sydney, NSW

Correspondence: helena.teedee@monash.edu

Collaborating authors: Estifanos Baye, Monash Centre for Health Research and Implementation, Melbourne; Leah Brennan, Australian Catholic University, Melbourne; Cheryce Harrison, Monash Centre for Health Research and Implementation, Melbourne; Samantha Hutchison, Monash Health Centre for Research Implementation, Melbourne; Anju Joham, Monash Centre for Health Research and Implementation, Melbourne; Louise Johnson, Victorian Assisted Reproductive Treatment Authority, Melbourne; Cailin Jordan, Genea Hollywood Fertility, Perth; Jayashri Kulkarni, Monash Alfred Psychiatry Research Centre, Melbourne; Darren Mansfield, Monash Health, Melbourne; Kate Marsh, Northside Nutrition and Dietetics, Sydney; Ben W Mol, Monash University, Melbourne; Alexia Peña, Robinson Research Institute, University of Adelaide, Adelaide; Raymond Rodgers, Robinson Research Institute, University of Adelaide, Adelaide; Jane Speight, Deakin University, Geelong; Nigel Stepto, Victoria University, Melbourne; Eliza C Tassone, Monash Centre for Health Research and Implementation, Melbourne; Angela Wan, Monash University, Melbourne; Jane Woolcock, Women’s and Children’s Hospital, Adelaide.

Acknowledgements:

We gratefully acknowledge the contribution of the many women with PCOS and health professionals who guided and contributed to this work. We thank our funding, partner, engaged and collaborating organisations for their roles in prioritising topics and identifying gaps, and contributing members for guideline development, providing peer review and assisting with dissemination. We acknowledge those who independently assessed the guideline against AGREEII criteria and completed methodological review, and those within the NHMRC who managed the approval process. This guideline was approved by all members of the guideline development groups and has been approved by the NHMRC.

Specifically, our funding, partner, collaborator and engaged organisations include:

• The NHMRC through the funded Centre for Research Excellence in Polycystic Ovary Syndrome and the members of this Centre who coordinated this international guideline effort.

• Our partner organisations which co-funded the guideline: the American Society for Reproductive Medicine and the European Society of Human Reproduction and Embryology.

• Our collaborating and engaged societies and consumer groups: Androgen Excess and Polycystic Ovary Syndrome Society; American Pediatric Endocrine Society; Asia Pacific Paediatric Endocrine Society; Asia Pacific Initiative on Reproduction; Australasian Paediatric Endocrine Group; Australian Diabetes Society; British Fertility Society; Canadian Society of Endocrinology and Metabolism; Dietitians Association Australia; Endocrine Society (US);Endocrine Society Australia; European Society of Endocrinology; European Society for Paediatric Endocrinology; Exercise and Sports Science Australia; Fertility Society Australia; International Society of Endocrinology; International Federation of Fertility Societies; International Federation of Gynaecology and Obstetrics; Italian Society of Gynaecology and Obstetrics; Japanese Society for Paediatric Endocrinology; Latin American Society for Paediatric Endocrinology; Nordic Federation of Societies of Obstetrics and Gynaecology; PCOS Challenge; PCOS Society of India; Paediatric Endocrine Society; Polycystic Ovary Association Australia; Royal Australasian College of Physicians; Royal Australian College of General Practitioners; Royal Australian and New Zealand College of Obstetricians and Gynaecologists; Royal College of Obstetricians and Gynaecologists (UK); South African Society of Gynaecology and Obstetrics; Verity UK; Victorian Assisted Reproductive Technology Association (VARTA).

• Our Australian translation partners: Jean Hailes for Women’s Health and VARTA.

Funding: The guideline and translation program was primarily funded by the NHMRC Centre for Research Excellence in PCOS grant (APP1078444) and partnership grant (APP1133084). This funding was supported by a partnership with the European Society of Human Reproduction and Embryology and the American Society for Reproductive Medicine. Translation costs were supported by the NHMRC Centre for Research Excellence and partnership grant. Jean Hailes for Women’s Health funded the cost of this MJA supplement.

Competing interests:

Disclosures of conflicts of interest were declared at the outset and updated throughout the guideline process, aligned with NHMRC guideline processes. Full details of conflicts declared across the guideline development groups are available at guideline in the register of disclosures of interest.

1. Bozdag G, Mumusoglu S, Zengin D, et al. The prevalence and phenotypic features of polycystic ovary syndrome: A systematic review and meta-analysis. Hum Reprod 2016; 31: 2841-2855.
2. Boyle JA, Cunningham J, O’Dea K, et al. Prevalence of polycystic ovary syndrome in a sample of Indigenous women in Darwin, Australia. Med J Aust 2012; 196: 62-66. <MJA full text>
3. Rotterdam ESHRE/ASRM-Sponsored PCOS Consensus Workshop Group. Revised 2003 consensus on diagnostic criteria and long-term health risks related to polycystic ovary syndrome. Hum Reprod 2004; 19: 41-47.
4. Tata B, Mimouni NEH, Barbotin A-L, et al. Elevated prenatal anti-Müllerian hormone reprograms the fetus and induces polycystic ovary syndrome in adulthood. Nat Med 2018; 24: 834-846.
5. Diamanti-Kandarakis E, Dunaif A. Insulin resistance and the polycystic ovary syndrome revisited: an update on mechanisms and implications. Endocr Rev 2012; 33: 981-1030.
6. Stepto NK, Cassar S, Joham AE, et al. Women with polycystic ovary syndrome have intrinsic insulin resistance on euglycaemic-hyperinsulaemic clamp. Hum Reprod 2013; 28: 777-784.
7. Moran LJ, Norman RJ, Teede HJ. Metabolic risk in PCOS: phenotype and adiposity impact. Trends Endocrinol Metab 2015; 26: 136-143.
8. Dokras A, Stener-Victorin E, Yildiz BO, et al. Androgen excess- Polycystic Ovary Syndrome Society: position statement on depression, anxiety, quality of life, and eating disorders in polycystic ovary syndrome. Fertil Steril 2018; 109: 888-899.
9. Teede HJ, Misso ML, Deeks AA, et al. Assessment and management of polycystic ovary syndrome: summary of an evidence-based guideline. Med J Aust 2011; 195 (6 Suppl): S65-S110. <MJA full text>
10. Teede HJ, Joham AE, Paul E, et al. Longitudinal weight gain in women identified with polycystic ovary syndrome: results of an observational study in young women. Obesity 2013; 21: 1526-1532.
11. Gibson-Helm M, Teede H, Dunaif A, Dokras A. Delayed diagnosis and a lack of information associated with dissatisfaction in women with polycystic ovary syndrome. J Clin Endocrinol Metab 2017; 102: 604-612.
12. Teede H, Gibson-Helm M, Norman RJ, et al. Polycystic ovary syndrome: perceptions and attitudes of women and primary health care physicians on features of PCOS and renaming the syndrome. J Clin Endocrinol Metab 2014; 99: E107-E111.
13. Gibson-Helm ME, Lucas IM, Boyle JA, Teede HJ. Women’s experiences of polycystic ovary syndrome diagnosis. Fam Pract 2014; 31: 545-549.
14. Dokras A, Saini S, Gibson-Helm M, et al. Gaps in knowledge among physicians regarding diagnostic criteria and management of polycystic ovary syndrome. Fertil Steril 2017; 107: 1380-1386.e1.
15. Brakta S, Lizneva D, Mykhalchenko K, et al. Perspectives on Polycystic Ovary Syndrome: Is Polycystic Ovary Syndrome Research Underfunded? J Clin Endocrinol Metab 2017; 102: 4421-4427.
16. Teede H, Legro R, Norman R. A vision for change in PCOS through international collaboration. Semin Reprod Med 2018; in press.
17. Teede H, Deeks A, Moran L. Polycystic ovary syndrome: a complex condition with psychological, reproductive and metabolic manifestations that impacts on health across the lifespan. BMC Med 2010; 8: 41.
18. National Health and Medical Research Council. 2016 NHMRC Standards for Guidelines. https://www.nhmrc.gov.au/guidelines-publications/information-guideline-developers/2016-nhmrc-standards-guidelines (viewed Aug 2018).
19. Misso M, Teede H. Evidence based guideline (EBG) development: a practical guide. In: Ilic D, editor. Knowledge transfer: practices, types and challenges. New York: Nova Publishers, 2012.
20. Teede HJ, Misso ML, Costello MF, at al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Fertil Steril 2018; 110: 364-379.
21. Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Clin Endocrinol (Oxf) 2018; doi:10.1111/cen.13795[Epub ahead of print].
22. Teede HJ, Misso ML, Costello MF, et al. Recommendations from the international evidence-based guideline for the assessment and management of polycystic ovary syndrome. Hum Reprod 2018; doi:10.1093/humrep/dey256 [Epub ahead of print].
23. Norman R, Teede H. A new evidence-based guideline for assessment and management of polycystic ovary syndrome. Med J Aust 2018; 209: 299-300.
24. National Institutes of Health. NIH evidence-based methodology workshop on Polycystic Ovary Syndrome: executive summary. 3-5 Dec 2012. https://prevention-archive.od.nih.gov/docs/programs/pcos/FinalReport.pdf (viewed Aug 2018).
25. Davis SR, Knight S, White V, et al. Preliminary indication of a high prevalence of polycystic ovary syndrome in indigenous Australian women. Gynecol Endocrinol 2002; 16: 443-446.
26. Boyle J, Hollands G, Beck S, et al. Process evaluation of a pilot evidence-based Polycystic Ovary Syndrome clinic in the Torres Strait. Aust J Rural Health 2017; 25: 175-181.
27. Australian Bureau of Statistics. 4715.0 National Aboriginal and Torres Strait Islander Health Survey, 2004-05. Canberra: ABS, 2006. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4715.0/ (viewed Jan 2018).
28. Vos T, Barker B, Begg S, et al. Burden of disease and injury in Aboriginal and Torres Strait Islander Peoples: the Indigenous health gap. Int J Epidemiol 2009; 38: 470-477.
29. Hunt J, Marshall AL, Jenkins D. Exploring the meaning of, the barriers to and potential strategies for promoting physical activity among urban Indigenous Australians. Health Promot J Aust 2008; 19: 102-108.
30. Thompson SJ, Gifford SM, Thorpe L. The social and cultural context of risk and prevention: food and physical activity in an urban Aboriginal community. Health Educ Behav 2000; 27: 725-743.
31. Hancock H. Aboriginal women’s perinatal needs, experiences and maternity services: a literature review to enable considerations to be made about quality indicators. Ngaanyatjarra Health Service, Dec 2006. https://www.lowitja.org.au/sites/default/files/docs/Ngaanyatjarra-Health-Service-Lit-Review.pdf (viewed Aug 2018).
32. Kildea S, Bowden FJ. Reproductive health, infertility and sexually transmitted infections in Indigenous women in a remote community in the Northern Territory. Aust N Z J Public Health 2000; 24: 382-386.

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Narrative review

Management of inflammatory bowel disease

Emily K Wright, Nik S Ding and Ola Niewiadomski

Med J Aust 2018; 209 (7): . || doi: 10.5694/mja17.01001
Published online: 1 October 2018

ARTICLE
AUTHORS
REFERENCES

Topics

Digestive system diseases

Immune system diseases

Summary

Australia has one of the highest incidence rates of inflammatory bowel disease (IBD) in the world.
Early diagnosis and treatment for IBD is critical. For Crohn disease, in particular, this may change the natural history of disease and reduce disability.
Faecal calprotectin is a sensitive test that can be used by primary care physicians to assist in determining which patients with gastrointestinal symptoms may have IBD. This allows for prompt identification of patients who may benefit from endoscopy.
Regular re-evaluation of disease status with strategies that can safely, readily and reliably detect the presence of inflammation with faecal biomarkers and imaging is important. To avoid the risks of cumulative radiation exposure, magnetic resonance imaging and/or intestinal ultrasound, rather than computed tomography scanning, should be performed when possible.
Drug treatments for IBD now include five biological drugs listed by the Pharmaceutical Benefits Scheme: adalimumab, infliximab, golimumab, vedolizumab and ustekinumab. Such developments offer the possibility for improved disease control in selected patients.

1 St Vincent's Hospital Melbourne, Melbourne, VIC
2 Box Hill Hospital, Melbourne, VIC

Correspondence: Emily.Wright@svha.org.au

Competing interests:

No relevant disclosures.

1. Molodecky NA, Soon IS, Rabi DM, et al. Increasing incidence and prevalence of the inflammatory bowel diseases with time, based on systematic review. Gastroenterology 2012; 142: 46-54.e42; quiz e30.
2. Wilson J, Hair C, Knight R, et al. High incidence of inflammatory bowel disease in Australia: a prospective population-based Australian incidence study. Inflamm Bowel Dis 2010; 16: 1550-1556.
3. Niewiadomski O, Studd C, Hair C, et al. Prospective population-based cohort of inflammatory bowel disease in the biologics era: disease course and predictors of severity. J Gastroenterol Hepatol 2015; 30: 1346-1353.
4. Ng SC, Tang W, Ching JY, et al. Incidence and phenotype of inflammatory bowel disease based on results from the Asia–Pacific Crohn’s and colitis epidemiology study. Gastroenterology 2013; 145: 158-165.e2.
5. Jones J, Loftus EV Jr, Panaccione R, et al. Relationships between disease activity and serum and fecal biomarkers in patients with Crohn’s disease. Clin Gastroenterol Hepatol 2008; 6: 1218-1224.
6. Pariente B, Cosnes J, Danese S, et al. Development of the Crohn’s disease digestive damage score, the Lemann score. Inflamm Bowel Dis 2011; 17: 1415-1422.
7. Burisch J, Jess T, Martinato M, et al. The burden of inflammatory bowel disease in Europe. J Crohns Colitis 2013; 7: 322-337.
8. Frolkis AD, Dykeman J, Negrón ME, et al. Risk of surgery for inflammatory bowel diseases has decreased over time: a systematic review and meta-analysis of population-based studies. Gastroenterology 2013; 145: 996-1006.
9. Jostins L, Ripke S, Weersma RK, et al. Host-microbe interactions have shaped the genetic architecture of inflammatory bowel disease. Nature 2012; 491: 119-124.
10. Gevers D, Kugathasan S, Denson LA, et al. The treatment-naive microbiome in new-onset Crohn’s disease. Cell Host Microbe 2014; 15: 382-392.
11. Morgan XC, Tickle TL, Sokol H, et al. Dysfunction of the intestinal microbiome in inflammatory bowel disease and treatment. Genome Biol 2012; 13: R79.
12. Hou JK, Abraham B, El-Serag H. Dietary intake and risk of developing inflammatory bowel disease: a systematic review of the literature. Am J Gastroenterol 2011; 106: 563-573.
13. Schoepfer AM, Beglinger C, Straumann A, et al. Fecal calprotectin correlates more closely with the Simple Endoscopic Score for Crohn’s disease (SES-CD) than CRP, blood leukocytes, and the CDAI. Am J Gastroenterol 2010; 105: 162-169.
14. van Rheenen PF, Van de Vijver E, Fidler V. Faecal calprotectin for screening of patients with suspected inflammatory bowel disease: diagnostic meta-analysis. BMJ 2010; 341: c3369.
15. Bryant RV, Friedman AB, Wright EK, et al. Gastrointestinal ultrasound in inflammatory bowel disease: an underused resource with potential paradigm-changing application. Gut 2018; 67: 973-985.
16. Soetikno RM, Lin OS, Heidenreich PA, et al. Increased risk of colorectal neoplasia in patients with primary sclerosing cholangitis and ulcerative colitis: a meta-analysis. Gastrointest Endosc 2002; 56: 48-54.
17. Askling J, Dickman PW, Karlen P, et al. Family history as a risk factor for colorectal cancer in inflammatory bowel disease. Gastroenterology 2001; 120: 1356-1362.
18. Rutter MD, Saunders BP, Wilkinson KH, et al. Cancer surveillance in longstanding ulcerative colitis: endoscopic appearances help predict cancer risk. Gut 2004; 53: 1813-1816.
19. Sutherland L, Macdonald JK. Oral 5-aminosalicylic acid for induction of remission in ulcerative colitis. Cochrane Database Syst Rev 2006; (2): CD000543.
20. Sutherland L, Macdonald JK. Oral 5-aminosalicylic acid for maintenance of remission in ulcerative colitis. Cochrane Database Syst Rev 2006; (2): CD000544.
21. James SL, Irving PM, Gearry RB, Gibson PR. Management of distal ulcerative colitis: frequently asked questions analysis. Intern Med J 2008; 38: 114-119.
22. Ford AC, Kane SV, Khan KJ, et al. Efficacy of 5-aminosalicylates in Crohn’s disease: systematic review and meta-analysis. Am J Gastroenterol 2011; 106: 617-629.
23. Ford AC, Khan KJ, Talley NJ, Moayyedi P. 5-Aminosalicylates prevent relapse of Crohn’s disease after surgically induced remission: systematic review and meta-analysis. Am J Gastroenterol 2011; 106: 413-420.
24. Lichtenstein GR, Abreu MT, Cohen R, Tremaine W; American Gastroenterological Association. American Gastroenterological Association Institute technical review on corticosteroids, immunomodulators, and infliximab in inflammatory bowel disease. Gastroenterology 2006; 130: 940-987.
25. Lakatos PL, Golovics PA, David G, et al. Has there been a change in the natural history of Crohn’s disease? Surgical rates and medical management in a population-based inception cohort from Western Hungary between 1977–2009. Am J Gastroenterol 2012; 107: 579-588.
26. Feagan BG, Rochon J, Fedorak RN, et al. Methotrexate for the treatment of Crohn’s disease. The North American Crohn’s Study Group Investigators. N Engl J Med 1995; 332: 292-297.
27. Herfarth HH, Osterman MT, Isaacs KL, et al. Efficacy of methotrexate in ulcerative colitis: failure or promise. Inflamm Bowel Dis 2010; 16: 1421-1430.
28. Stein RB, Hanauer SB. Comparative tolerability of treatments for inflammatory bowel disease. Drug Saf 2000; 23: 429-448.
29. Ariyaratnam J, Subramanian V. Association between thiopurine use and nonmelanoma skin cancers in patients with inflammatory bowel disease: a meta-analysis. Am J Gastroenterol 2014; 109: 163-169.
30. Siegel CA. Review article: explaining risks of inflammatory bowel disease therapy to patients. Aliment Pharmacol Ther 2011; 33: 23-32.
31. D’Haens G, Baert F, van Assche G, et al. Early combined immunosuppression or conventional management in patients with newly diagnosed Crohn’s disease: an open randomised trial. Lancet 2008; 371: 660-667.
32. Colombel JF, Sandborn WJ, Reinisch W, et al. Infliximab, azathioprine, or combination therapy for Crohn’s disease. N Engl J Med 2010; 362: 1383-1395.
33. Panaccione R, Ghosh S, Middleton S, et al. Combination therapy with infliximab and azathioprine is superior to monotherapy with either agent in ulcerative colitis. Gastroenterology 2014; 146: 392-400.e3.
34. Croft A, Walsh A, Doecke J, et al. Outcomes of salvage therapy for steroid-refractory acute severe ulcerative colitis: ciclosporin vs. infliximab. Aliment Pharmacol Ther 2013; 38: 294-302.
35. Ben-Horin S, Chowers Y. Review article: loss of response to anti-TNF treatments in Crohn’s disease. Aliment Pharmacol Ther 2011; 33: 987-995.
36. Dave M, Purohit T, Razonable R, Loftus EV. Opportunistic infections due to inflammatory bowel disease therapy. Inflamm Bowel Dis 2014; 20: 196-212.
37. Kotlyar DS, Osterman MT, Diamond RH, et al. A systematic review of factors that contribute to hepatosplenic T-cell lymphoma in patients with inflammatory bowel disease. Clin Gastroenterol Hepatol 2011; 9: 36-41.e1.
38. Raaschou P, Simard JF, Holmqvist M, Askling J; ARTIS Study Group. Rheumatoid arthritis, anti-tumour necrosis factor therapy, and risk of malignant melanoma: nationwide population based prospective cohort study from Sweden. BMJ 2013; 346: f1939.
39. Fidder H, Schnitzler F, Ferrante M, et al. Long-term safety of infliximab for the treatment of inflammatory bowel disease: a single-centre cohort study. Gut 2009; 58: 501-508.
40. Sandborn WJ, Feagan BG, Rutgeerts P, et al. Vedolizumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med 2013; 369: 711-721.
41. Feagan BG, Rutgeerts P, Sands BE, et al. Vedolizumab as induction and maintenance therapy for ulcerative colitis. N Engl J Med 2013; 369: 699-710.
42. Feagan BG, Sandborn WJ, Gasink C, et al. Ustekinumab as induction and maintenance therapy for Crohn’s disease. N Engl J Med 2016; 375: 1946-1960.
43. Ma C, Fedorak RN, Kaplan GG, et al. Long-term maintenance of clinical, endoscopic, and radiographic response to ustekinumab in moderate-to-severe Crohn’s disease: real-world experience from a multicenter cohort study. Inflamm Bowel Dis 2017; 23: 833-839.
44. van Nood E, Vrieze A, Nieuwdorp M, et al. Duodenal infusion of donor feces for recurrent Clostridium difficile. N Engl J Med 2013; 368: 407-415.
45. Paramsothy S, Kamm MA, Kaakoush NO, et al. Multidonor intensive faecal microbiota transplantation for active ulcerative colitis: a randomised placebo-controlled trial. Lancet 2017; 389: 1218-1228.
46. Costello SP, Soo W, Bryant RV, et al. Systematic review with meta-analysis: faecal microbiota transplantation for the induction of remission for active ulcerative colitis. Aliment Pharmacol Ther 2017; 46: 213-224.
47. Graff LA, Walker JR, Bernstein CN. Depression and anxiety in inflammatory bowel disease: a review of comorbidity and management. Inflamm Bowel Dis 2009; 15: 1105-1118.
48. Rahier JF, Magro F, Abreu C, et al. Second European evidence-based consensus on the prevention, diagnosis and management of opportunistic infections in inflammatory bowel disease. J Crohns Colitis 2014; 8: 443-468.
49. Sigall-Boneh R, Pfeffer-Gik T, Segal I, et al. Partial enteral nutrition with a Crohn’s disease exclusion diet is effective for induction of remission in children and young adults with Crohn’s disease. Inflamm Bowel Dis 2014; 20: 1353-1360.
50. Lindberg E, Järnerot G, Huitfeldt B. Smoking in Crohn’s disease: effect on localisation and clinical course. Gut 1992; 33: 779-782.

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The first published randomised controlled trial of laser treatment for vaginal atrophy raises serious questions

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Revised Australian national guidelines for colorectal cancer screening: family history

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Redefining the physician’s role in the era of online health information

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Subclavian vein thrombosis with internal jugular vein extension in an Australian rules football player

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Trials and tribulations: improving outcomes for adolescents and young adults with rare and low survival cancers

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Translation and implementation of the Australian-led PCOS guideline: clinical summary and translation resources from the International Evidence-based Guideline for the Assessment and Management of Polycystic Ovary Syndrome

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Management of inflammatory bowel disease

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A new evidence-based guideline for assessment and management of polycystic ovary syndrome

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Pathway to ending avoidable diabetes-related amputations in Australia

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Pagination