Connect
MJA
MJA

    Untapped potential in Australian hospitals for organ donation after circulatory death

    Sandeep S Rakhra, Helen I Opdam, Laura Gladkis, Byron Arcia, Michael A Fink, John Kanellis, Peter S Macdonald, Gregory I Snell and David V Pilcher
    Med J Aust 2017; 207 (7): . || doi: 10.5694/mja16.01405
    Published online: 25 September 2017

    Abstract

    Objective: To determine the potential for organ donation after circulatory death (DCD) in Australia by applying ideal and expanded organ suitability criteria, and to compare this potential with actual DCD rates.

    Design: Retrospective cohort study.

    Setting, methods: We analysed DonateLife audit data for patients aged 28 days to 80 years who died between July 2012 and December 2014 in an intensive care unit or emergency department, or who died within 24 hours of discharge from either, in the 75 Australian hospitals contributing data to DonateLife. Ideal and expanded organ donation criteria were derived from international and national guidelines, and from expert opinion. Potential DCD organ donors were identified by applying these criteria to patients who had been intubated and were neither confirmed as being brain-dead nor likely to have met brain death criteria at the official time of death.

    Results: 8780 eligible patients were identified, of whom 202 were actual DCD donors. For 193 potential ideal (61%) and 313 potential expanded criteria DCD donors (72%), organ donation had not been discussed with their families; most were potential donors of kidneys (416 potential donors) or lungs (117 potential donors). Potential donors were typically older, dying of non-neurological causes, and more frequently had chronic organ disease than actual donors. Identifying all these potential donors, assuming a consent rate of 60%, would have increased Australia’s donation rate from 16.1 to 21.3 per million population in 2014.

    Conclusions: The untapped potential for DCD in Australia, particularly of kidneys and lungs, is significant. Systematic review of all patients undergoing end-of-life care in critical care environments for donor suitability could result in significant increases in organ donation rates.

    Please login with your free MJA account to view this article in full

    LOGIN
    CREATE AN ACCOUNT

    Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

    View on Wiley Online Library

    • 1 Alfred Health, Melbourne, VIC
    • 2 Austin Health, Melbourne, VIC
    • 3 Australian Organ and Tissue Authority, Canberra, ACT
    • 4 University of Melbourne, Melbourne, VIC
    • 5 Monash Health, Melbourne, VIC
    • 6 Centre for Inflammatory Diseases, Monash University, Melbourne, VIC
    • 7 St Vincent's Hospital, Sydney, NSW
    • 8 Monash University, Melbourne, VIC


    Correspondence: sandeeprakhra@gmail.com
    Acknowledgements: 

    We acknowledge and thank all data collectors and audit officers who contribute to the DonateLife Audit. The DonateLife organisation is funded by the Australian Government. This particular research project was not funded.

    Competing interests:

    No relevant disclosures.

    • 1. Australia and New Zealand Organ Donation Registry. ANZOD Registry annual report 2015. Adelaide: ANZOD Registry, 2015. http://www.anzdata.org.au/anzod/ANZODReport/2015/2015ANZOD_annrpt.pdf (accessed Nov 2015).
    • 2. Australian Organ and Tissue Donation and Transplantation Authority. Annual report 2014–15. Canberra: AOTDTA, 2015. http://www.donatelife.gov.au/sites/default/files/OTA_AR2015.pdf (accessed Dec 2015).
    • 3. International Registry in Organ Donation and Transplantation. Final numbers 2014. IRODT, 2015. http://www.irodat.org/img/database/pdf/NEWSLETTER2015_December2.pdf (accessed Feb 2017).
    • 4. Manara AR, Murphy PG, O’Callaghan G. Donation after circulatory death. Br J Anaesth 2012; 108 (Suppl 1): i108-i121.
    • 5. Kootstra G, Daemen JH, Oomen AP. Categories of non-heart-beating donors. Transplant Proc 1995; 27: 2893-2894.
    • 6. Snell GI, Esmore DS, Westall GP, et al. The Alfred Hospital lung transplant experience. Clin Transpl 2007: 131-144.
    • 7. Doyle MBM, Collins K, Vachharajani N, et al. Outcomes using grafts from donors after cardiac death. J Am Coll Surg 2015; 221: 142-152.
    • 8. Suárez F, Otero A, Solla M, et al. Biliary complications after liver transplantation from Maastricht category-2 non-heart-beating donors. Transplantation 2008; 85: 9-14.
    • 9. Callaghan CJ, Charman SC, Muiesan P, et al. Outcomes of transplantation of livers from donation after circulatory death donors in the UK: a cohort study. BMJ Open 2013; 3: e003287.
    • 10. Agopian VG, Petrowsky H, Kaldas FM, et al. The evolution of liver transplantation during 3 decades: analysis of 5347 consecutive liver transplants at a single center. Ann Surg 2013; 258: 409-421.
    • 11. Macdonald P, Verran D, O’Leary M, et al. Heart transplantation from donation after circulatory death donors. Transplantation 2015; 99: 1101-1102.
    • 12. Dhital KK, Iyer A, Connellan M, et al. Adult heart transplantation with distant procurement and ex-vivo preservation of donor hearts after circulatory death: a case series. Lancet 2015; 385: 2585-2591.
    • 13. Pilcher D, Gladkis L, Arcia B, et al. Estimating the number of organ donors in Australian hospitals — implications for monitoring organ donation practices. Transplantation 2015; 99: 2203-2209.
    • 14. Opdam HI, Silvester W. Potential for organ donation in Victoria: an audit of hospital deaths. Med J Aust 2006; 185: 250-254. <MJA full text>
    • 15. Opdam HS, Silvester W. Identifying the potential organ donor: an audit of hospital deaths. Intensive Care Med 2004; 30: 1390-1397.
    • 16. Kirchner C, Raduenz S, Fruehauf NR, et al. Estimated organ donor potential in German maximum care hospitals. Transplant Proc 2013; 45: 1310-1312.
    • 17. Sheehy E, Conrad SL, Brigham LE, et al. Estimating the number of potential organ donors in the United States. N Engl J Med 2003; 349: 667-674.
    • 18. Coulson TG, Pilcher DV, Graham SM, et al. Single-centre experience of donation after cardiac death. Med J Aust 2012; 197: 166-169. <MJA full text>
    • 19. Transplantation Society of Australia and New Zealand. Clinical guidelines for organ transplantation from deceased donors; version 1.0. Apr 2015. http://www.donatelife.gov.au/sites/default/files/TSANZ%20Clinical%20Guidelines%20for%20Organ%20Transplantation%20from%20Deceased%20Donors_Version%201.0_April%202016.pdf (accessed Dec 2015).
    • 20. British Transplantation Society. Transplantation from deceased donors circulatory death. 2013. https://bts.org.uk/wp-content/uploads/2016/09/15_BTS_Donors_DCD-1.pdf (accessed Oct 2015).
    • 21. Scalea JR, Redfield RR, Rizzari MD, et al. When do DCD donors die? Outcomes and implications of DCD at a high-volume, single-center OPO in the United States. Ann Surg 2016; 263: 211-216.
    • 22. Canadian Institute for Health Information. Deceased organ donor potential in Canada: report. Dec 2014. https://www.cihi.ca/sites/default/files/organdonorpotential_2014_en_0.pdf (accessed Feb 2016).
    • 23. NHS Blood and Transplant. Organ donation and transplantation activity report 2014/15. http://nhsbtmediaservices.blob.core.windows.net/organ-donation-assets/pdfs/activity_report_2014_15.pdf (accessed Feb 2016).
    • 24. Australia and New Zealand Intensive Care Society. 2015 Annual report. Melbourne: ANZICS, 2015. http://www.anzics.com.au/Downloads/ANZICS Annual Report 2015.pdf (accessed Mar 2017).

    Author
    remove_circle_outline Delete Author
    add_circle_outline Add Author
    Comment
    Do you have any competing interests to declare? *
    I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
    I/we agree to the Terms of use of the Medical Journal of Australia *
    Email me when people comment on this article
    Online responses are no longer available. Please refer to our instructions for authors page for more information.

      REM sleep behaviour disorder: not just a bad dream

      Elie Matar and Simon JG Lewis
      Med J Aust 2017; 207 (6): . || doi: 10.5694/mja17.00321
      Published online: 18 September 2017

      Summary

       

      • Rapid eye movement (REM) sleep behaviour disorder (RBD) is a parasomnia characterised by the loss of the normal atonia during the REM stage of sleep, resulting in overt motor behaviours that usually represent the enactment of dreams. Patients will seek medical attention due to sleep-related injuries or unpleasant dream content.
      • Idiopathic RBD which occurs independently of any other disease occurs in up to 2% of the older population. Meanwhile, secondary RBD is very common in association with certain neurodegenerative conditions. RBD can also occur in the context of antidepressant use, obstructive sleep apnoea and narcolepsy.
      • RBD can be diagnosed with a simple screening question followed by confirmation with polysomnography to exclude potential mimics.
      • Treatment for RBD is effective and involves treatment of underlying causes, modification of the sleep environment, and pharmacotherapy with either clonazepam or melatonin.
      • An important finding in the past decade is the recognition that almost all patients with idiopathic RBD will ultimately go on to develop Parkinson disease or dementia with Lewy bodies. This suggests that idiopathic RBD represents a prodromal phase of these conditions.
      • Physicians should be aware of the risk of phenoconversion. They should educate idiopathic RBD patients to recognise the symptoms of these conditions and refer as appropriate for further testing and enrolment into research trials focused on neuroprotective measures.

       


      • 1 Brain and Mind Centre, University of Sydney, Sydney, NSW
      • 2 Royal Prince Alfred Hospital, Sydney, NSW


      Correspondence: simon.lewis@sydney.edu.au
      Acknowledgements: 

      This work was conducted by the ForeFront project team and SJGL is supported by an NHMRC–ARC Dementia Research Development Fellowship (1110414). ForeFront is a large collaborative research group dedicated to the study of neurodegenerative diseases and is funded by grants from the National Health and Medical Research Council of Australia (1037746), Dementia Research Team (1095127), NeuroSleep Centre of Research Excellence (1060992), Australian Research Council Centre of Excellence in Cognition and its Disorders Memory Program (CE110001021) and the Sydney Research Excellence Initiative 2020. We thank Dr Negar Memarian for providing the polysomnography recording data shown in Box 2.

      Competing interests:

      No relevant disclosures.

      • 1. Aserinsky E, Kleitman N. Regularly occurring periods of eye motility, and concomitant phenomena, during sleep. Science 1953; 118: 273-274.
      • 2. Iranzo A, Santamaria J, Tolosa E. Idiopathic rapid eye movement sleep behaviour disorder: diagnosis, management, and the need for neuroprotective interventions. Lancet Neurol 2016; 15: 405-419.
      • 3. Postuma RB, Gagnon JF, Montplaisir J. Rapid eye movement sleep behavior disorder as a biomarker for neurodegeneration: the past 10 years. Sleep Med 2013; 14: 763-767.
      • 4. Fernandez-Arcos A, Iranzo A, Serradell M, et al. The clinical phenotype of idiopathic rapid eye movement sleep behavior disorder at presentation: a study in 203 consecutive patients. Sleep 2016; 39: 121-132.
      • 5. Boeve BF, Molano JR, Ferman TJ, et al. Validation of the Mayo Sleep Questionnaire to screen for REM sleep behavior disorder in a community-based sample. J Clin Sleep Med 2013; 9: 475-480.
      • 6. Postuma RB, Arnulf I, Hogl B, et al. A single-question screen for rapid eye movement sleep behavior disorder: a multicenter validation study. Mov Disord 2012; 27: 913-916.
      • 7. Stiasny-Kolster K, Mayer G, Schafer S, et al. The REM sleep behavior disorder screening questionnaire–a new diagnostic instrument. Mov Disord 2007; 22: 2386-2393.
      • 8. Li SX, Wing YK, Lam SP, et al. Validation of a new REM sleep behavior disorder questionnaire (RBDQ-HK). Sleep Med 2010; 11: 43-48.
      • 9. Boeve BF, Molano JR, Ferman TJ, et al. Validation of the Mayo Sleep Questionnaire to screen for REM sleep behavior disorder in an aging and dementia cohort. Sleep Med 2011; 12: 445-453.
      • 10. Montplaisir J, Gagnon JF, Fantini ML, et al. Polysomnographic diagnosis of idiopathic REM sleep behavior disorder. Mov Disord 2010; 25: 2044-2051.
      • 11. Frauscher B, Iranzo A, Gaig C, et al. Normative EMG values during REM sleep for the diagnosis of REM sleep behavior disorder. Sleep 2012; 35: 835-847.
      • 12. Stefani A, Gabelia D, Mitterling T, et al. A prospective video-polysomnographic analysis of movements during physiological sleep in 100 healthy sleepers. Sleep 2015; 38: 1479-1487.
      • 13. Nielsen T, Svob C, Kuiken D. Dream-enacting behaviors in a normal population. Sleep 2009; 32: 1629-1636.
      • 14. Nielsen T, Paquette T. Dream-associated behaviors affecting pregnant and postpartum women. Sleep 2007; 30: 1162-1169.
      • 15. Iranzo A, Santamaria J. Severe obstructive sleep apnea/hypopnea mimicking REM sleep behavior disorder. Sleep 2005; 28: 203-206.
      • 16. Derry C. Nocturnal frontal lobe epilepsy vs parasomnias. Curr Treat Options Neurol 2012; 14: 451-463.
      • 17. Avidan AY. Parasomnias and movement disorders of sleep. Semin Neurol 2009; 29: 372-392.
      • 18. Kang SH, Yoon IY, Lee SD, et al. REM sleep behavior disorder in the Korean elderly population: prevalence and clinical characteristics. Sleep 2013; 36: 1147-1152.
      • 19. Chiu HF, Wing YK, Lam LC, et al. Sleep-related injury in the elderly–an epidemiological study in Hong Kong. Sleep 2000; 23: 513-517.
      • 20. Ohayon MM, Caulet M, Priest RG. Violent behavior during sleep. J Clin Psychiatry 1997; 58: 369-376; quiz 377.
      • 21. Boeve BF. REM sleep behavior disorder: updated review of the core features, the REM sleep behavior disorder-neurodegenerative disease association, evolving concepts, controversies, and future directions. Ann N Y Acad Sci 2010; 1184: 15-54.
      • 22. Schenck CH, Hurwitz TD, Mahowald MW. Symposium: Normal and abnormal REM sleep regulation: REM sleep behaviour disorder: an update on a series of 96 patients and a review of the world literature. J Sleep Res 1993; 2: 224-231.
      • 23. Zhou J, Zhang J, Li Y, et al. Gender differences in REM sleep behavior disorder: a clinical and polysomnographic study in China. Sleep Med 2015; 16: 414-418.
      • 24. Olson EJ, Boeve BF, Silber MH. Rapid eye movement sleep behaviour disorder: demographic, clinical and laboratory findings in 93 cases. Brain 2000; 123(Pt 2): 331-339.
      • 25. Bodkin CL, Schenck CH. Rapid eye movement sleep behavior disorder in women: relevance to general and specialty medical practice. J Womens Health (Larchmt) 2009; 18: 1955-1963.
      • 26. Wing YK, Lam SP, Li SX, et al. REM sleep behaviour disorder in Hong Kong Chinese: clinical outcome and gender comparison. J Neurol Neurosurg Psychiatry 2008; 79: 1415-1416.
      • 27. Zhou J, Zhang J, Du L, et al. Characteristics of early- and late-onset rapid eye movement sleep behavior disorder in China: a case-control study. Sleep Med 2014; 15: 654-660.
      • 28. Kotagal S. Rapid eye movement sleep behavior disorder during childhood. Sleep Med Clin 2015; 10: 163-167.
      • 29. Scaglione C, Vignatelli L, Plazzi G, et al. REM sleep behaviour disorder in Parkinson’s disease: a questionnaire-based study. Neurol Sci 2005; 25: 316-321.
      • 30. Gagnon JF, Bedard MA, Fantini ML, et al. REM sleep behavior disorder and REM sleep without atonia in Parkinson’s disease. Neurology 2002; 59: 585-589.
      • 31. Boeve BF, Silber MH, Ferman TJ, et al. Clinicopathologic correlations in 172 cases of rapid eye movement sleep behavior disorder with or without a coexisting neurologic disorder. Sleep Med 2013; 14: 754-762.
      • 32. Boeve BF, Silber MH, Ferman TJ, et al. Association of REM sleep behavior disorder and neurodegenerative disease may reflect an underlying synucleinopathy. Mov Disord 2001; 16: 622-630.
      • 33. Ferman TJ, Boeve BF, Smith GE, et al. Inclusion of RBD improves the diagnostic classification of dementia with Lewy bodies. Neurology 2011; 77: 875-882.
      • 34. Vetrugno R, Provini F, Cortelli P, et al. Sleep disorders in multiple system atrophy: a correlative video-polysomnographic study. Sleep Med 2004; 5: 21-30.
      • 35. Arnulf I, Merino-Andreu M, Bloch F, et al. REM sleep behavior disorder and REM sleep without atonia in patients with progressive supranuclear palsy. Sleep 2005; 28: 349-354.
      • 36. Abbott SM, Videnovic A. Sleep disorders in atypical Parkinsonism. Mov Disord Clin Pract 2014; 1: 89-96.
      • 37. D’Abreu A, Franca M, Jr, Conz L, et al. Sleep symptoms and their clinical correlates in Machado-Joseph disease. Acta Neurol Scand 2009; 119: 277-280.
      • 38. Manni R, Terzaghi M. REM behavior disorder associated with epileptic seizures. Neurology 2005; 64: 883-884.
      • 39. Caminero A, Bartolome M. Sleep disturbances in multiple sclerosis. J Neurol Sci 2011; 309: 86-91.
      • 40. Manni R, Ratti PL, Terzaghi M. Secondary ‘‘incidental’’ REM sleep behavior disorder: do we ever think of it? Sleep Med 2011; 12 Suppl 2: S50-S53.
      • 41. Ebben MR, Shahbazi M, Lange DJ, Krieger AC. REM behavior disorder associated with familial amyotrophic lateral sclerosis. Amyotroph Lateral Scler 2012; 13: 473-474.
      • 42. Arnulf I, Nielsen J, Lohmann E, et al. Rapid eye movement sleep disturbances in Huntington disease. Arch Neurol 2008; 65: 482-488.
      • 43. Schenck CH, Mahowald MW, Anderson ML, et al. Lewy body variant of Alzheimer’s disease (AD) identified by postmortem ubiquitin staining in a previously reported case of AD associated with REM sleep behavior disorder. Biol Psychiatry 1997; 42: 527-528.
      • 44. Thirumalai SS, Shubin RA, Robinson R. Rapid eye movement sleep behavior disorder in children with autism. J Child Neurol 2002; 17: 173-178.
      • 45. Trajanovic NN, Voloh I, Shapiro CM, Sandor P. REM sleep behaviour disorder in a child with Tourette’s syndrome. Can J Neurol Sci 2004; 31: 572-575.
      • 46. Compta Y, Iranzo A, Santamaria J, et al. REM sleep behavior disorder and narcoleptic features in anti-Ma2-associated encephalitis. Sleep 2007; 30: 767-769.
      • 47. Iranzo A, Graus F, Clover L, et al. Rapid eye movement sleep behavior disorder and potassium channel antibody-associated limbic encephalitis. Ann Neurol 2006; 59: 178-181.
      • 48. Vale TC, Fernandes do Prado LB, do Prado GF, et al. Rapid eye movement sleep behavior disorder in paraneoplastic cerebellar degeneration: improvement with immunotherapy. Sleep 2016; 39: 117-120.
      • 49. Tang WK, Hermann DM, Chen YK, et al. Brainstem infarcts predict REM sleep behavior disorder in acute ischemic stroke. BMC Neurol 2014; 14: 88.
      • 50. McCarter SJ, Tippmann-Peikert M, Sandness DJ, et al. Neuroimaging-evident lesional pathology associated with REM sleep behavior disorder. Sleep Med 2015; 16: 1502-1510.
      • 51. Dauvilliers Y, Jennum P, Plazzi G. Rapid eye movement sleep behavior disorder and rapid eye movement sleep without atonia in narcolepsy. Sleep Med 2013; 14: 775-781.
      • 52. Winkelman JW, James L. Serotonergic antidepressants are associated with REM sleep without atonia. Sleep 2004; 27: 317-321.
      • 53. Gagnon JF, Postuma RB, Mazza S, et al. Rapid-eye-movement sleep behaviour disorder and neurodegenerative diseases. Lancet Neurol 2006; 5: 424-432.
      • 54. Morrison I, Frangulyan R, Riha RL. Beta-blockers as a cause of violent rapid eye movement sleep behavior disorder: a poorly recognized but common cause of violent parasomnias. Am J Med 2011; 124: e11.
      • 55. Schenck CH, Mahowald MW. Motor dyscontrol in narcolepsy: rapid-eye-movement (REM) sleep without atonia and REM sleep behavior disorder. Ann Neurol 1992; 32: 3-10.
      • 56. Postuma RB, Berg D. Advances in markers of prodromal Parkinson disease. Nat Rev Neurol 2016; 12: 622-634.
      • 57. Schenck CH, Bundlie SR, Mahowald MW. Delayed emergence of a parkinsonian disorder in 38% of 29 older men initially diagnosed with idiopathic rapid eye movement sleep behaviour disorder. Neurology 1996; 46: 388-393.
      • 58. Schenck CH, Boeve BF, Mahowald MW. Delayed emergence of a parkinsonian disorder or dementia in 81% of older men initially diagnosed with idiopathic rapid eye movement sleep behavior disorder: a 16-year update on a previously reported series. Sleep Med 2013; 14: 744-748.
      • 59. Iranzo A, Fernandez-Arcos A, Tolosa E, et al. Neurodegenerative disorder risk in idiopathic REM sleep behavior disorder: study in 174 patients. PLoS One 2014; 9: e89741.
      • 60. Postuma RB, Iranzo A, Hogl B, et al. Risk factors for neurodegeneration in idiopathic rapid eye movement sleep behavior disorder: a multicenter study. Ann Neurol 2015; 77: 830-839.
      • 61. Iranzo A, Lomena F, Stockner H, et al. Decreased striatal dopamine transporter uptake and substantia nigra hyperechogenicity as risk markers of synucleinopathy in patients with idiopathic rapid-eye-movement sleep behaviour disorder: a prospective study [corrected]. Lancet Neurol 2010; 9: 1070-1077.
      • 62. Iranzo A, Valldeoriola F, Lomena F, et al. Serial dopamine transporter imaging of nigrostriatal function in patients with idiopathic rapid-eye-movement sleep behaviour disorder: a prospective study. Lancet Neurol 2011; 10: 797-805.
      • 63. Hanyu H, Inoue Y, Sakurai H, et al. Voxel-based magnetic resonance imaging study of structural brain changes in patients with idiopathic REM sleep behavior disorder. Parkinsonism Relat Disord 2012; 18: 136-139.
      • 64. Unger MM, Belke M, Menzler K, et al. Diffusion tensor imaging in idiopathic REM sleep behavior disorder reveals microstructural changes in the brainstem, substantia nigra, olfactory region, and other brain regions. Sleep 2010; 33: 767-773.
      • 65. Rodrigues Brazete J, Montplaisir J, Petit D, et al. Electroencephalogram slowing in rapid eye movement sleep behavior disorder is associated with mild cognitive impairment. Sleep Med 2013; 14: 1059-1063.
      • 66. Holtbernd F, Gagnon JF, Postuma RB, et al. Abnormal metabolic network activity in REM sleep behavior disorder. Neurology 2014; 82: 620-627.
      • 67. Manni R, Sinforiani E, Pacchetti C, et al. Cognitive dysfunction and REM sleep behavior disorder: key findings in the literature and preliminary longitudinal findings. Int J Psychophysiol 2013; 89: 213-217.
      • 68. Gagnon JF, Vendette M, Postuma RB, et al. Mild cognitive impairment in rapid eye movement sleep behavior disorder and Parkinson’s disease. Ann Neurol 2009; 66: 39-47.
      • 69. Wan Y, Luo Y, Gan J, et al. Clinical markers of neurodegeneration in Chinese patients with idiopathic rapid eye movement sleep behavior disorder. Clin Neurol Neurosurg 2016; 150: 105-109.
      • 70. Postuma RB, Gagnon JF, Vendette M, Montplaisir JY. Markers of neurodegeneration in idiopathic rapid eye movement sleep behaviour disorder and Parkinson’s disease. Brain 2009; 132(Pt 12): 3298-3307.
      • 71. Li Y, Kang W, Yang Q, et al. Predictive markers for early conversion of iRBD to neurodegenerative synucleinopathy diseases. Neurology 2017; 88: 1493-1500.
      • 72. Sprenger FS, Stefanova N, Gelpi E, et al. Enteric nervous system alpha-synuclein immunoreactivity in idiopathic REM sleep behavior disorder. Neurology 2015; 85: 1761-1768.
      • 73. Vilas D, Iranzo A, Tolosa E, et al. Assessment of alpha-synuclein in submandibular glands of patients with idiopathic rapid-eye-movement sleep behaviour disorder: a case-control study. Lancet Neurol 2016; 15: 708-718.
      • 74. Boeve BF, Dickson DW, Olson EJ, et al. Insights into REM sleep behavior disorder pathophysiology in brainstem-predominant Lewy body disease. Sleep Med 2007; 8: 60-64.
      • 75. Peever J, Luppi PH, Montplaisir J. Breakdown in REM sleep circuitry underlies REM sleep behavior disorder. Trends Neurosci 2014; 37: 279-288.
      • 76. Braak H, Del Tredici K, Rub U, et al. Staging of brain pathology related to sporadic Parkinson’s disease. Neurobiol Aging 2003; 24: 197-211.
      • 77. Iranzo A, Tolosa E, Gelpi E, et al. Neurodegenerative disease status and post-mortem pathology in idiopathic rapid-eye-movement sleep behaviour disorder: an observational cohort study. Lancet Neurol 2013; 12: 443-453.
      • 78. Thannickal TC, Moore RY, Nienhuis R, et al. Reduced number of hypocretin neurons in human narcolepsy. Neuron 2000; 27: 469-474.
      • 79. Mahowald MW, Bundlie SR, Hurwitz TD, Schenck CH. Sleep violence–forensic science implications: polygraphic and video documentation. J Forensic Sci 1990; 35: 413-432.
      • 80. Aurora RN, Zak RS, Maganti RK, et al. Best practice guide for the treatment of REM sleep behavior disorder (RBD). J Clin Sleep Med 2010; 6: 85-95.
      • 81. Howell MJ. Parasomnias: an updated review. Neurotherapeutics 2012; 9: 753-775.
      • 82. Devnani P, Fernandes R. Management of REM sleep behavior disorder: an evidence based review. Ann Indian Acad Neurol 2015; 18: 1-5.
      • 83. Schenck CH, Bundlie SR, Ettinger MG, Mahowald MW. Chronic behavioral disorders of human REM sleep: a new category of parasomnia. Sleep 1986; 9: 293-308.
      • 84. Schenck CH, Bundlie SR, Patterson AL, Mahowald MW. Rapid eye movement sleep behavior disorder. A treatable parasomnia affecting older adults. JAMA 1987; 257: 1786-1789.
      • 85. Schenck CH, Mahowald MW. REM sleep behavior disorder: clinical, developmental, and neuroscience perspectives 16 years after its formal identification in SLEEP. Sleep 2002; 25: 120-138.
      • 86. Anderson KN, Shneerson JM. Drug treatment of REM sleep behavior disorder: the use of drug therapies other than clonazepam. J Clin Sleep Med 2009; 5: 235-239.
      • 87. McCarter SJ, Boswell CL, St Louis EK, et al. Treatment outcomes in REM sleep behavior disorder. Sleep Med 2013; 14: 237-242.
      • 88. Boeve BF, Silber MH, Ferman TJ. Melatonin for treatment of REM sleep behavior disorder in neurologic disorders: results in 14 patients. Sleep Med 2003; 4: 281-284.
      • 89. Vertrees S, Greenough GP. Ethical considerations in REM sleep behavior disorder. Continuum (Minneap Minn) 2013; 19(1 Sleep Disorders): 199-203.
      • 90. Schenck CH, Montplaisir JY, Frauscher B, et al. Rapid eye movement sleep behavior disorder: devising controlled active treatment studies for symptomatic and neuroprotective therapy–a consensus statement from the International Rapid Eye Movement Sleep Behavior Disorder Study Group. Sleep Med 2013; 14: 795-806.
      • 91. Berg D, Postuma RB, Adler CH, et al. MDS research criteria for prodromal Parkinson’s disease. Mov Disord 2015; 30: 1600-1611.

      Author
      remove_circle_outline Delete Author
      add_circle_outline Add Author
      Comment
      Do you have any competing interests to declare? *
      I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
      I/we agree to the Terms of use of the Medical Journal of Australia *
      Email me when people comment on this article
      Online responses are no longer available. Please refer to our instructions for authors page for more information.

        The value of inpatient rehabilitation after uncomplicated knee arthroplasty: a propensity score analysis

        Justine Maree Naylor, Andrew Hart, Rajat Mittal, Ian Harris and Wei Xuan
        Med J Aust 2017; 207 (6): . || doi: 10.5694/mja16.01362
        Published online: 18 September 2017

        Abstract

        Objective: To compare the effectiveness of rehabilitation after total knee arthroplasty (TKA) in models with or without an inpatient rehabilitation component.

        Design, setting and participants: A propensity score-matched cohort of privately insured patients with osteoarthritis who underwent primary, unilateral TKA in one of 12 Australian hospitals between August 2013 and January 2015 were included. Those discharged to an inpatient facility because of poor progress or who experienced significant complications within 90 days of surgery were excluded.

        Intervention: Discharge after surgery to an inpatient rehabilitation facility or home.

        Main outcome measures: Patient-reported knee pain and function (Oxford Knee Score; at 90 and 365 days after surgery) and health rating (EuroQol “today” health scale; at 35, 90 and 365 days). Inpatient and community-based rehabilitation provider charges were also assessed.

        Results: 258 patients (129 pairs) from a sample of 332 were matched according to their propensity scores for receiving inpatient rehabilitation; covariates used in the matching included age, sex, body mass index, and markers of health and impairment. The only significant difference in outcomes was that EuroQol health scores were better on Day 35 for patients not undergoing inpatient rehabilitation (median difference, 5; IQR, –10 to 19; P = 0.01). Median rehabilitation provider charges were significantly higher for those discharged to inpatient therapy (total costs: median difference, $9500; IQR, $7000–11 497; P < 0.001; community therapy costs: median difference, $749; IQR, $0–1980; P < 0.001).

        Conclusions: Rehabilitation pathways incorporating inpatient rehabilitation did not achieve better joint-specific outcomes or health scores than alternatives not including inpatient rehabilitation. Given the substantial cost differences, better value alternatives should be considered for patients after uncomplicated TKA.

        Please login with your free MJA account to view this article in full

        LOGIN
        CREATE AN ACCOUNT

        Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

        View on Wiley Online Library

        • 1 South Western Sydney Clinical School, University of New South Wales, Sydney, NSW
        • 2 Ingham Institute of Applied Medical Research, Sydney, NSW
        • 3 South Western Sydney Local Health District, Sydney, NSW


        Acknowledgements: 

        This study was partially supported by a grant from the HCF Research Foundation to Justine Naylor, Ian Harris and Wei Xuan. We acknowledge the contribution made by Helen Badge, project manager of the larger investigation in which this study was nested.

        Competing interests:

        This study was partially funded by a grant awarded by the HCF Research Foundation, but the funder had no influence on the study design or the research plan.

        • 1. Australian Orthopaedic Association. National Joint Replacement Registry: hip, knee and shoulder arthroplasty annual report 2016. Adelaide: AOA, 2016. https://aoanjrr.sahmri.com/documents/10180/275066/Hip%2C%20Knee%20%26%20Shoulder%20Arthroplasty (accessed June 2017).
        • 2. Hart A, Bergeron SG, Epure L, et al. Comparison of US and Canadian perioperative outcomes and hospital efficiency after total hip and knee arthroplasty. JAMA Surg 2015; 150: 990-998.
        • 3. Briggs T. A national review of adult elective orthopaedic services in England: getting it right first time. London: British Orthopaedic Association, 2015. https://www.boa.ac.uk/wp-content/uploads/2015/03/GIRFT-National-Report-MarN.pdf (accessed Mar 2017).
        • 4. Peel TN, Cheng AC, Liew D, et al. Direct hospital cost determinants following hip and knee arthroplasty. Arthritis Care Res 2015; 67: 782-790.
        • 5. Health Insurance Consultants Australia. The growing cost of hip and knee replacements [media release]. 13 Feb 2014. http://www.hica.com.au/health-insurance-news/the-growing-cost-of-hip-and-knee-replacements (accessed Mar 2017).
        • 6. Health Insurance Consultants Australia. New prostheses list advisory committee could reduce private insurance costs [media release]. 12 Sept 2016. http://www.hica.com.au/health-insurance-news/new-prostheses-list-advisory-committee-could-reduce-private-insurance-costs (accessed Mar 2017).
        • 7. Buhagiar, MA, Naylor JM, Harris IA, et al. Hospital Inpatient versus HOme-based rehabilitation after knee arthroplasty (the HIHO study): study protocol for a randomized controlled trial. Trials 2013; 14: 432.
        • 8. Buhagiar, MA, Naylor JM, Harris IA, et al. Effect of inpatient rehabilitation vs a monitored home program on mobility in patients with total knee arthroplasty: the HIHO randomized clinical trial. JAMA 2017; 317: 1037-1046.
        • 9. Mahomed NN, Davis AM, Hawker G, et al. Inpatient compared with home-based rehabilitation following primary unilateral total hip or knee replacement: a randomized controlled trial. J Bone Joint Surg Am 2008; 90: 1673-1680.
        • 10. Rosenbaum PR, Rubin DB. The central role of the propensity score in observational studies for causal effects. Biometrika 1983; 70: 41-55.
        • 11. Austin PC. An introduction to propensity score methods for reducing the effects of confounding in observational studies. Multivariate Behav Res 2011; 46: 399-424.
        • 12. D’Agostino RB. Tutorial in biostatistics. Propensity score methods for bias reduction in the comparison of a treatment to a non-randomized control group. Stat Med 1998; 17: 2265-2281.
        • 13. Austin PC. Balance diagnostics for comparing the distribution of baseline covariates between treatment groups in propensity-score matched samples. Stat Med 2009; 28: 3083-3107.
        • 14. Naylor JM, Descallar J, Grootemaat M, et al. Is satisfaction with the acute-care experience higher amongst consumers treated in the private sector? A survey of public and private sector arthroplasty recipients. PLoS One 2016; 11: e0159799.
        • 15. Clavien PA, Barkun J, de Oliveira ML, et al. The Clavien-Dindo classification of surgical complications. Ann Surg 2009; 250; 187-196.
        • 16. Murray DW, Fitzpatrick R, Rogers K, et al. The use of the Oxford hip and knee scores. J Bone Joint Surg Br 2007; 89-B: 1010-1014.
        • 17. Chatterji R, Naylor JM, Harris IA, Descallar J. An equivalence study: are patient-completed and telephone interview equivalent modes of administration for the EuroQol survey? Health Qual Life Outcomes 2017; 15: 18.
        • 18. Australian Bureau of Statistics. 6401.0. Consumer price index inflation calculator 2015. http://www.abs.gov.au/websitedbs/d3310114.nsf/home/Consumer+Price+Index+Inflation+Calculator (accessed Mar 2017).
        • 19. Norman GR, Sloan JA, Wyrwich KW. Interpretation of changes in health-related quality of life: the remarkable universality of half a standard deviation. Med Care 2003; 41: 582-592.
        • 20. Ko V, Naylor J, Harris I, et al. One-to-one therapy is not superior to group or home-based therapy after total knee arthroplasty: a randomized, superiority trial. J Bone Joint Surg Am 2013; 95: 1942-1949.
        • 21. Christells N, Wallace S, Sage CE, et al. An enhanced recovery after surgery program for hip and knee arthroplasty. Med J Aust 2015; 202: 363-369. <MJA full text>
        • 22. Hofstede SN, Nouta KA, Jacobs W, et al. Mobile bearing vs fixed bearing prostheses for posterior cruciate retaining total knee arthroplasty for postoperative functional status in patients with osteoarthritis and rheumatoid arthritis. Cochrane Database Syst Rev 2015; (2): CD003130.
        • 23. Verra WC, van den Boom LGH, Jacobs W, et al. Retention versus sacrifice of the posterior cruciate ligament in total knee arthroplasty for treating osteoarthritis. Cochrane Database Syst Rev 2013; (10): CD004803.

        Author
        remove_circle_outline Delete Author
        add_circle_outline Add Author
        Comment
        Do you have any competing interests to declare? *
        I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
        I/we agree to the Terms of use of the Medical Journal of Australia *
        Email me when people comment on this article
        Online responses are no longer available. Please refer to our instructions for authors page for more information.

          Von Meyenburg complexes in a patient with obstructive jaundice

          Vipin Gupta and Govind Makharia
          Med J Aust 2017; 207 (6): . || doi: 10.5694/mja16.01344
          Published online: 18 September 2017

          Biliary hamartomas were an incidental finding in a 33-year-old man who was investigated for recurrent episodes of biliary colic. A T2-weighted coronal image showed multiple small hyperintense lesions of similar size scattered in both lobes of the liver (Figure). Biliary microhamartomas (von Meyenburg complexes) are rare and usually multiple. They occur because of ductal plate malformation and are composed of dilated intralobular and interlobular bile ducts.1 They generally remain asymptomatic and do not affect liver functions, and are most commonly detected incidentally.2 Differential diagnosis of this rare clinical entity includes multiple simple liver cysts, Caroli disease and, less commonly, metastatic liver disease (with necrosis).


          • All India Institute of Medical Sciences, New Delhi, New Delhi, India


          Correspondence: govindmakharia@gmail.com
          Competing interests:

          No relevant disclosures.

          • 1. Desmet VJ. Ludwig symposium on biliary disorders — part I. Pathogenesis of ductal plate abnormalities. Mayo Clin Proc 1998; 73: 80-89.
          • 2. Brancatelli G, Federle MP, Vilgrain V, et al. Fibropolycystic liver disease: CT and MR imaging findings. Radiographics 2005; 25: 659-670.

          Author
          remove_circle_outline Delete Author
          add_circle_outline Add Author
          Comment
          Do you have any competing interests to declare? *
          I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
          I/we agree to the Terms of use of the Medical Journal of Australia *
          Email me when people comment on this article
          Online responses are no longer available. Please refer to our instructions for authors page for more information.

            Thunderstorm asthma outbreak of November 2016: a natural disaster requiring planning

            Steven J Lindstrom, Jeremy D Silver, Michael F Sutherland, Andrew BA Treloar, Ed Newbigin, Christine F McDonald and Jo A Douglass
            Med J Aust 2017; 207 (6): . || doi: 10.5694/mja17.00285
            Published online: 18 September 2017

            Learning from a tragedy to increase public awareness and improve responses in future thunderstorm asthma events

            Thunderstorm asthma is the occurrence of acute asthma either during or immediately after a thunderstorm and it is often characterised by a surge in emergency asthma presentations. The epidemic of thunderstorm asthma in Melbourne, Australia, on 21 November 2016 was the most extreme such event ever worldwide, with nine fatalities currently the subject of a coronial inquiry.1,2 Hospitals and ambulance services were placed under record pressure, and supplies of reliever medications were exhausted at some health services.1 Key tasks for the future are to predict the thunderstorms most likely to lead to asthma outbreaks and to define how best to respond. Further research to better anticipate these outbreaks is crucial and planning for the inevitable recurrence must occur at patient, institutional and state-wide levels.


            • 1 Austin Health, Melbourne, VIC
            • 2 University of Melbourne, Melbourne, VIC
            • 3 NSW Regional Office, Australian Bureau of Meteorology, Sydney, NSW
            • 4 Royal Melbourne Hospital, Melbourne, VIC


            Acknowledgements: 

            We thank Edwin Lampugnani (University of Melbourne) for kindly supplying the image in . Jeremy Silver's work was funded by the MacKenzie Postdoctoral Fellowship scheme at the University of Melbourne.

            Competing interests:

            In the past 5 years, Jo Douglass has received honoraria for educational presentations from AstraZeneca, GlaxoSmithKline, Stallergenes Greer, Novartis, Alphapharm, Shire, Mundipharma and Seqirus; has sat on advisory boards for Novartis, GlaxoSmithKline, Astra-Zeneca, Pieris, Stallergenes Greer and Seqirus; and has undertaken contracted and investigator-initiated research for GlaxoSmithKline, Novartis, AstraZeneca and Sanofi-Aventis. Jeremy Silver and Ed Newbigin are investigators on the National Medical and Health Research Council PBH grant 1116107, which partners with Stallergenes Greer. Christine McDonald has received honoraria for education presentations or advisory board participation from GlaxoSmithKline, Novartis and Pfizer.

            • 1. Inspector-General for Emergency Management. Review of response to the thunderstorm asthma event of 21–22 November 2016: final report. Melbourne: State of Victoria; 2017. http://www.igem.vic.gov.au/documents/CD/17/233820 (accessed June 2017).
            • 2. Victorian Department of Health and Human Services. The November 2016 Victorian epidemic thunderstorm asthma event: an assessment of the health impacts. The Chief Health Officer’s report, 27 April 2017. Melbourne: State of Victoria, 2017. https://www2.health.vic.gov.au/emergencies/thunderstorm-asthma-event/response (accessed June 2017).
            • 3. Queensland University of Technology. Final report: literature review on thunderstorm asthma and its implications for public health advice. https://www2.health.vic.gov.au/about/publications/researchandreports/thunderstorm-asthma-literature-review-may-2107 (accessed June 2017).
            • 4. Marks GB, Colquhoun JR, Girgis ST, et al. Thunderstorm outflows preceding epidemics of asthma during spring and summer. Thorax 2001; 56: 468-471.
            • 5. Girgis ST, Marks GB, Downs SH, et al. Thunderstorm-associated asthma in an inland town in south-eastern Australia. Who is at risk? Eur Respir J 2000; 16: 3-8.
            • 6. Adams RJ, Fuhlbrigge AL, Finkelstein JA, Weiss ST. Intranasal steroids and the risk of emergency department visits for asthma. J Allergy Clin Immunol 2002; 109: 636-642.
            • 7. Erbas B, Akram M, Dharmage SC, et al. The role of seasonal grass pollen on childhood asthma emergency department presentations. Clin Exp Allergy 2012; 42: 799-805.
            • 8. Egan P. Weather or not. Med J Aust 1985; 142: 330-330.
            • 9. Bellomo R, Gigliotti P, Treloar A, et al. Two consecutive thunderstorm associated epidemics of asthma in the city of Melbourne. The possible role of rye grass pollen. Med J Aust 1992; 156: 834-837.
            • 10. Howden ML, McDonald CF, Sutherland MF. Thunderstorm asthma — a timely reminder. Med J Aust 2011; 195: 512-513. <MJA full text>
            • 11. Eifan AO, Durham SR. Pathogenesis of rhinitis. Clin Exp Allergy 2016; 46: 1139-1151.
            • 12. Brożek JL, Bousquet J, Agache I, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines — 2016 revision. J Allergy Clin Immunol 2017; doi: 10.1016/j.jaci.2017.03.050 [Epub ahead of print].
            • 13. Peat JK, Tovey E, Mellis CM, et al. Importance of house dust mite and Alternaria allergens in childhood asthma: an epidemiological study in two climatic regions of Australia. Clin Exp Allergy 1993; 23: 812-820.
            • 14. Pulimood TB, Corden JM, Bryden C, et al. Epidemic asthma and the role of the fungal mold Alternaria alternata. J Allergy Clin Immunol 2007; 120: 610-617.
            • 15. Suissa S, Ernst P, Benayoun S, et al. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med 2000: 343: 332-336.
            • 16. National Asthma Council Australia [website]. Australian asthma handbook; version 1.2. Melbourne: National Asthma Council Australia, 2016. http://www.asthmahandbook.org.au (accessed Mar 2017).
            • 17. Abramson MJ, Puy RM, Weiner JM. Injection allergen immunotherapy for asthma. Cochrane Database Syst Rev 2010; 8: CD001186.

            Author
            remove_circle_outline Delete Author
            add_circle_outline Add Author
            Comment
            Do you have any competing interests to declare? *
            I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
            I/we agree to the Terms of use of the Medical Journal of Australia *
            Email me when people comment on this article
            Online responses are no longer available. Please refer to our instructions for authors page for more information.

              Public reporting of clinician-level data

              Rachel Canaway, Marie M Bismark, David Dunt and Margaret A Kelaher
              Med J Aust 2017; 207 (6): . || doi: 10.5694/mja16.01402
              Published online: 18 September 2017

              There is much debate about public disclosure of individual doctors’ performance to increase hospital quality and safety, but research is lacking

              In 2016, media coverage of a cluster of preventable deaths of babies born at a Victorian health service1 shone a spotlight in Australia on the role of public reporting of hospital performance data in assuring quality and safety. The subsequent Victorian government review2 suggested that the Victorian health system must develop a culture of candour with improved transparency at every level of the hospital system “through greater public reporting of outcomes data and support for a just culture in hospitals”.2 Other failures in hospital quality have similarly triggered inquiries and health system reform in Australia.3,4 For example, Queensland’s Bundaberg Hospital scandal in 2005 triggered changes to public reporting to further encourage cultures in hospitals to move away from the “name–shame–blame” approach.5


              • Centre for Health Policy, University of Melbourne, Melbourne, VIC


              Correspondence: mkelaher@unimelb.edu.au
              Competing interests:

              No relevant disclosures.

              • 1. Medew J. Hundreds more baby deaths revealed in Victorian hospitals. The Age 2017; 28 June. http://www.theage.com.au/victoria/hundreds-more-baby-deaths-revealed-in-victorian-hospitals-20160628-gpu0sh.html (accessed Aug 2017).
              • 2. Duckett S, Cuddihy M, Newnham H. Targeting zero: supporting the Victorian hospital system to eliminate avoidable harm and strengthen quality of care. Report of the Review of Hospital Safety and Quality Assurance in Victoria. Melbourne: Victorian Government, 2016.
              • 3. Scott IA, Ward M. Public reporting of hospital outcomes based on administrative data: risks and opportunities. Med J Aust 2006; 184: 571-575. <MJA full text>
              • 4. Marasco SF, Ibrahim JE, Oakley J. Public disclosure of surgeon-specific report cards: current status of the debate. ANZ J Surg 2005; 75: 1000-1004.
              • 5. Duckett SJ, Collins J, Kamp M, Walker K. An improvement focus in public reporting: the Queensland approach. Med J Aust 2008; 189: 616-617. <MJA full text>
              • 6. Shahian DM, Edwards FH, Jacobs JP, et al. Public reporting of cardiac surgery performance: Part 1-history, rationale, consequences. Ann Thorac Surg 2011; 92: S2-S11.
              • 7. Pearse J, Mazevska D. The impact of public disclosure of health performance data: a rapid review. Sydney: Sax Institute, 2012.
              • 8. Rechel B, McKee M, Haas M, et al. Public reporting on quality, waiting times and patient experience in 11 high-income countries. Health Policy 2016; 120: 377-383.
              • 9. Minami CA, Dahlke A, Bilimoria KY. Public reporting in surgery: an emerging opportunity to improve care and inform patients. Ann Surg 2015; 261: 241-242.
              • 10. Campanella P, Vukovic V, Parente P, et al. The impact of public reporting on clinical outcomes: a systematic review and meta-analysis. BMC Health Serv Res 2016; 16: 296.
              • 11. Hibbard JH, Stockard J, Tusler M. Hospital performance reports: impact on quality, market share, and reputation. Health Aff 2005; 24: 1150-1160.
              • 12. Oakley J. Surgeon report cards, clinical realities, and the quality of patient care. Monash Bioeth Rev 2009; 28: 21.1-21.6.
              • 13. Behrendt K, Groene O. Mechanisms and effects of public reporting of surgeon outcomes: A systematic review of the literature. Health Policy 2016; 120: 1151-1161.
              • 14. Faber M, Bosch M, Wollersheim H, et al. Public reporting in health care: how do consumers use quality-of-care information? A systematic review. Med Care 2009; 47: 1-8.
              • 15. Henderson A. Surgical report cards: the myth and the reality. Monash Bioeth Rev 2009; 28: 20.01-20.20.
              • 16. Mannion R, Braithwaite J. Unintended consequences of performance measurement in healthcare: 20 salutary lessons from the English National Health Service. Intern Med J 2012; 42: 569-574.
              • 17. Gallagher MP, Krumholz HM. Public reporting of hospital outcomes: a challenging road ahead. Med J Aust 2011; 194: 658-660. <MJA full text>
              • 18. Azzam DG, Neo CA, Itotoh FE, Aitken RJ. The Western Australian Audit of Surgical Mortality: outcomes from the first 10 years. Med J Aust 2013; 199: 539-542. <MJA full text>
              • 19. Ganai S. Disclosure of surgeon experience. World J Surg 2014; 38: 1622-1625.
              • 20. Sherman KL, Gordon EJ, Mahvi DM, et al. Surgeons’ perceptions of public reporting of hospital and individual surgeon quality. Med Care 2013; 51: 1069-1075.
              • 21. Shahian DM, Edwards FH, Jacobs JP, et al. Public reporting of cardiac surgery performance: Part 2 – implementation. Ann Thorac Surg 2011; 92: S12-S23.

              Author
              remove_circle_outline Delete Author
              add_circle_outline Add Author
              Comment
              Do you have any competing interests to declare? *
              I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
              I/we agree to the Terms of use of the Medical Journal of Australia *
              Email me when people comment on this article
              Online responses are no longer available. Please refer to our instructions for authors page for more information.

                Road safety: serious injuries remain a major unsolved problem

                Ben Beck, Peter A Cameron, Mark C Fitzgerald, Rodney T Judson, Warwick Teague, Ronan A Lyons and Belinda J Gabbe
                Med J Aust 2017; 207 (6): . || doi: 10.5694/mja17.00015
                Published online: 11 September 2017

                Abstract

                Objective: To investigate temporal trends in the incidence, mortality, disability-adjusted life-years (DALYs), and costs of health loss caused by serious road traffic injury.

                Design, setting and participants: A retrospective review of data from the population-based Victorian State Trauma Registry and the National Coronial Information System on road traffic-related deaths (pre- and in-hospital) and major trauma (Injury Severity Score > 12) during 2007–2015.

                Main outcomes and measures: Temporal trends in the incidence of road traffic-related major trauma, mortality, DALYs, and costs of health loss, by road user type.

                Results: There were 8066 hospitalised road traffic major trauma cases and 2588 road traffic fatalities in Victoria over the 9-year study period. There was no change in the incidence of hospitalised major trauma for motor vehicle occupants (incidence rate ratio [IRR] per year, 1.00; 95% CI, 0.99–1.01; P = 0.70), motorcyclists (IRR, 0.99; 95% CI, 0.97–1.01; P = 0.45) or pedestrians (IRR, 1.00; 95% CI, 0.97–1.02; P = 0.73), but the incidence for pedal cyclists increased 8% per year (IRR, 1.08; 95% CI; 1.05–1.10; P < 0.001). While DALYs declined for motor vehicle occupants (by 13% between 2007 and 2015), motorcyclists (32%), and pedestrians (5%), there was a 56% increase in DALYs for pedal cyclists. The estimated costs of health loss associated with road traffic injuries exceeded $14 billion during 2007–2015, although the cost per patient declined for all road user groups.

                Conclusions: As serious injury rates have not declined, current road safety targets will be difficult to meet. Greater attention to preventing serious injury is needed, as is further investment in road safety, particularly for pedal cyclists.

                Please login with your free MJA account to view this article in full

                LOGIN
                CREATE AN ACCOUNT

                Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

                View on Wiley Online Library

                • 1 Monash University, Melbourne, VIC
                • 2 Emergency and Trauma Centre, The Alfred Hospital, Melbourne, VIC
                • 3 National Trauma Research Institute, Melbourne, VIC
                • 4 Private Medical Centre, Royal Melbourne Hospital, Melbourne, VIC
                • 5 Royal Children's Hospital, Melbourne
                • 6 Farr Institute, Swansea University, Swansea, Wales, United Kingdom


                Correspondence: ben.beck@monash.edu
                Acknowledgements: 

                The Victorian State Trauma Registry (VSTR) is funded by the Department of Health and Human Services, the State Government of Victoria, and the Transport Accident Commission. Ben Beck received salary support from the National Health and Medical Research Council (NHRMC) Australian Resuscitation Outcomes Consortium (Aus-ROC) Centre of Research Excellence (1029983). Peter Cameron was supported by an NHMRC Practitioner Fellowship (545926) and Belinda Gabbe by an NHMRC Career Development Fellowship (GNT1048731). Warwick Teague’s role as director of trauma services at the Royal Children’s Hospital, Melbourne, is supported by a grant from the Royal Children’s Hospital Foundation. We thank the Victorian State Trauma Outcome Registry and Monitoring (VSTORM) group for providing VSTR data. We also thank Sue McLellan for her assistance with the data, Pam Simpson for her statistical support, and David Attwood from the Transport Accident Commission for his suggestions and advice.

                Competing interests:

                No relevant disclosures.

                • 1. Haagsma JA, Graetz N, Bolliger I, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global Burden of Disease study 2013. Inj Prev 2016; 22: 3-18.
                • 2. Henley G, Harrison JE. Trends in injury deaths, Australia: 1999–00 to 2009–10 (AIHW Cat. No. INJCAT 150; Injury Research and Statistics Series No. 74). Canberra: Australian Institute of Health and Welfare, 2015.
                • 3. Gabbe BJ, Lyons RA, Fitzgerald MC, et al. Reduced population burden of road transport-related major trauma after introduction of an inclusive trauma system. Ann Surg 2015; 261: 565-572.
                • 4. Cameron PA, Gabbe BJ, Cooper DJ, et al. A statewide system of trauma care in Victoria: effect on patient survival. Med J Aust 2008; 189: 546-550. <MJA full text>
                • 5. Gabbe BJ, Sutherland AM, Hart MJ, et al. Population-based capture of long-term functional and quality of life outcomes after major trauma: the experiences of the Victorian State Trauma Registry. J Trauma Acute Care Surg 2010; 69: 532-536.
                • 6. Henley G, Harrison JE. Trends in serious injury due to land transport accidents, Australia: 2000–01 to 2008–09 (AIHW Cat. No. INJCAT 142). Canberra: Australian Institute of Health and Welfare, 2012.
                • 7. Lyons RA, Ward H, Brunt H, et al. Using multiple datasets to understand trends in serious road traffic casualties. Accid Anal Prev 2008; 40: 1406-1410.
                • 8. Cameron PA, Finch CF, Gabbe BJ, et al. Developing Australia’s first statewide trauma registry: what are the lessons? ANZ J Surg 2004; 74: 424-428.
                • 9. Palmer CS, Gabbe BJ, Cameron PA. Defining major trauma using the 2008 Abbreviated Injury Scale. Injury 2016; 47: 109-115.
                • 10. Brooks R. EuroQol: the current state of play. Health Policy 1996; 37: 53-72.
                • 11. Dolan P. Modeling valuations for EuroQol health states. Med Care 1997; 35: 1095-1108.
                • 12. Gabbe BJ, Lyons RA, Sutherland AM, et al. Level of agreement between patient and proxy responses to the EQ-5D health questionnaire 12 months after injury. J Trauma Acute Care Surg 2012; 72: 1102-1105.
                • 13. Gabbe BJ, Lyons RA, Simpson PM, et al. Disability weights based on patient-reported data from a multinational injury cohort. Bull World Health Organ 2016; 94: 806-816.
                • 14. Australian Bureau of Statistics. 3302.0.55.001. Life tables, states, territories and Australia, 2013–2015. Oct 2016. http://www.abs.gov.au/ausstats/abs@.nsf/mf/3302.0.55.001 (accessed Dec 2016).
                • 15. Murray CJ, Acharya AK. Understanding DALYs. J Health Econ 1997; 16: 703-730.
                • 16. Prüss-Ustün A, Mathers C, Corvalán C, Woodward A. Introduction and methods: assessing the environmental burden of disease at national and local levels (Environmental Burden of Disease Series No. 1). Geneva: World Health Organization, 2003. http://www.who.int/quantifying_ehimpacts/publications/9241546204/en/ (accessed Dec 2016).
                • 17. Australian Government, Department of the Prime Minister and Cabinet, Office of Best Practice. Best practice regulation guidance note: Value of statistical life. Dec 2014. https://www.dpmc.gov.au/sites/default/files/publications/Value_of_Statistical_Life_guidance_note.pdf (accessed Dec 2016).
                • 18. Sanford T, McCulloch CE, Callcut RA, et al. Bicycle trauma injuries and hospital admissions in the United States, 1998–2013. JAMA 2015; 314: 947-949.
                • 19. Sikic M, Mikocka-Walus AA, Gabbe BJ, et al. Bicycling injuries and mortality in Victoria, 2001–2006. Med J Aust 2009; 190: 353-356.
                • 20. Australian Bicycle Council. Gearing up for active and sustainable communities. The Australian national cycling strategy 2011–2016 (Austroads Publication No. AP-C85/10). Sydney: Austroads, 2010. http://www.bicyclecouncil.com.au/files/publication/National-Cycling-Strategy-2011-2016.pdf (accessed Dec 2016).
                • 21. Walls HL, Curtis AJ, Stevenson CE, et al. Reductions in transport mortality in Australia: evidence of a public health success. Accid Anal Prev 2012; 49: 520-524.
                • 22. Belin M-Å, Tillgren P, Vedung E. Vision Zero — a road safety policy innovation. Int J Inj Contr Saf Promot 2012; 19: 171-179.
                • 23. Victorian State Government. Towards Zero 2016–2020: Victoria’s road safety strategy and action plan 2016. Melbourne: Victoria State Government, 2016. https://www.towardszero.vic.gov.au/__data/assets/pdf_file/0010/183556/STU_0206_RS_STRATEGY_2016_web.pdf (accessed July 2016).
                • 24. World Health Organization. Global status report on road safety 2013: supporting a decade of action. Geneva: World Health Organization, 2013. http://www.who.int/violence_injury_prevention/road_safety_status/2013/en/ (accessed Dec 2016).
                • 25. Lyons RA, Kendrick D, Towner EM, et al. Measuring the population burden of injuries — implications for global and national estimates: a multi-centre prospective UK longitudinal study. PLoS Med 2011; 8: e1001140.

                Author
                remove_circle_outline Delete Author
                add_circle_outline Add Author
                Comment
                Do you have any competing interests to declare? *
                I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                I/we agree to the Terms of use of the Medical Journal of Australia *
                Email me when people comment on this article
                Online responses are no longer available. Please refer to our instructions for authors page for more information.

                  Radiation therapy and early breast cancer: current controversies

                  John Boyages
                  Med J Aust 2017; 207 (5): . || doi: 10.5694/mja16.01020
                  Published online: 4 September 2017

                  Summary

                   

                  • Radiation therapy (RT) is an important component of breast cancer treatment.
                  • RT reduces local recurrence and breast cancer mortality after breast conservation for all patients and for node-positive patients after a mastectomy.
                  • Short courses of RT over 3–4 weeks are generally as effective as longer courses.
                  • A patient subgroup where RT can be avoided after conservative surgery has not been consistently identified.
                  • A radiation boost reduces the risk of a recurrence in the breast but may be omitted for older patients with good prognosis tumours with clear margins.
                  • Axillary recurrences can take a long time to appear, with 35% occurring after 5 years.
                  • Leaving disease untreated in regional nodes is associated with reduced survival.
                  • Not all patients require radiation after neoadjuvant chemotherapy and a subsequent mastectomy.
                  • Modern RT equipment and techniques will further improve survival rates.

                   


                  • Macquarie University, Sydney, NSW


                  Correspondence: john.boyages@mq.edu.au
                  Acknowledgements: 

                  I thank Ellen Tailby for research assistance, Philippa Sutton for editing and managing earlier versions of the manuscript, and Sergio Duque and Lesley Baker for the volumetric modulated arc therapy plan of the patient shown in Box 5.

                  Competing interests:

                  No relevant disclosures.

                  • 1. Grubbé EH. Priority in the therapeutic use of X-rays. Radiology 1933; 21: 156-162.
                  • 2. Keynes G. The Radium Treatment of Primary Carcinoma of the Breast. Can Med Assoc J 1934; 30: 24-30.
                  • 3. Halsted WS. I. The results of radical operations for the cure of carcinoma of the breast. Ann Surg 1907; 46: 1-19.
                  • 4. Ginzton EL, Nunan CS. History of microwave electron linear accelerators for radiotherapy. Int J Radiat Oncol Biol Phys 1985; 11: 205-216.
                  • 5. Darby S, McGale P, Correa C, et al. Effect of radiotherapy after breast-conserving surgery on 10-year recurrence and 15-year breast cancer death: meta-analysis of individual patient data for 10,801 women in 17 randomised trials. Lancet 2011; 378: 1707-1716.
                  • 6. McGale P, Taylor C, Correa C, et al. Effect of radiotherapy after mastectomy and axillary surgery on 10-year recurrence and 20-year breast cancer mortality: meta-analysis of individual patient data for 8135 women in 22 randomised trials. Lancet 2014; 383: 2127-2135.
                  • 7. Esposito E, Anninga B, Harris S, et al. Intraoperative radiotherapy in early breast cancer. Br J Surg 2015; 102: 599-610.
                  • 8. Fisher B, Anderson S, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. N Engl J Med 2002; 347: 1233-1241.
                  • 9. Winzer KJ, Sauer R, Sauerbrei W, et al. Radiation therapy after breast-conserving surgery; first results of a randomised clinical trial in patients with low risk of recurrence. Eur J Cancer 2004; 40: 998-1005.
                  • 10. Fyles AW, McCready DR, Manchul LA, et al. Tamoxifen with or without breast irradiation in women 50 years of age or older with early breast cancer. N Engl J Med 2004; 351: 963-970.
                  • 11. Hughes KS, Schnaper LA, Berry D, et al. Lumpectomy plus tamoxifen with or without irradiation in women 70 years of age or older with early breast cancer. N Engl J Med 2004; 351: 971-977.
                  • 12. Potter R, Gnant M, Kwasny W, et al. Lumpectomy plus tamoxifen or anastrozole with or without whole breast irradiation in women with favorable early breast cancer. Int J Radiat Oncol Biol Phys 2007; 68: 334-340.
                  • 13. Blamey RW, Bates T, Chetty U, et al. Radiotherapy or tamoxifen after conserving surgery for breast cancers of excellent prognosis: British Association of Surgical Oncology (BASO) II trial. Eur J Cancer 2013; 49: 2294-2302.
                  • 14. Kunkler IH, Williams LJ, Jack WJ, et al. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial. Lancet Oncol 2015; 16: 266-273.
                  • 15. Australian Government Actuary. Australian life tables 2010–12: females. http://www.aga.gov.au/publications/life_table_2010-12/05-ALT-Females.asp (accessed July 2017).
                  • 16. Early Breast Cancer Trialists' Collaborative Group (EBCTCG). Effects of chemotherapy and hormonal therapy for early breast cancer on recurrence and 15-year survival: an overview of the randomised trials. Lancet 2005; 365: 1687-1717.
                  • 17. Boyages J, Taylor R, Chua B, et al. A risk index for early node-negative breast cancer. Br J Surg 2006; 93: 564-571.
                  • 18. Mannino M, Yarnold JR. Local relapse rates are falling after breast conserving surgery and systemic therapy for early breast cancer: can radiotherapy ever be safely withheld? Radiother Oncol 2009; 90: 14-22.
                  • 19. Hernandez RK, Sorensen HT, Pedersen L, et al. Tamoxifen treatment and risk of deep venous thrombosis and pulmonary embolism: a Danish population-based cohort study. Cancer 2009; 115: 4442-4449.
                  • 20. Chakrabarti J, Kenny FS, Syed BM, et al. A randomised trial of mastectomy only versus tamoxifen for treating elderly patients with operable primary breast cancer-final results at 20-year follow-up. Crit Rev Oncol Hematol 2011; 78: 260-264.
                  • 21. Haviland JS, Owen JR, Dewar JA, et al. The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 2013; 14: 1086-1094.
                  • 22. Whelan TJ, Pignol JP, Levine MN, et al. Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 2010; 362: 513-520.
                  • 23. Bane AL, Whelan TJ, Pond GR, et al. Tumor factors predictive of response to hypofractionated radiotherapy in a randomized trial following breast conserving therapy. Ann Oncol 2014; 25: 992-998.
                  • 24. Australian Government Cancer Australia. Clinical practice recommendations and practice points. https://canceraustralia.gov.au/publications-and-resources/clinical-practice-guidelines/hypofractionated-radiotherapy-early-operable-breast-cancer/clinical-practice-recommendations-and-practice-points (accessed July 2017).
                  • 25. Smith BD, Bentzen SM, Correa CR, et al. Fractionation for whole breast irradiation: an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Int J Radiat Oncol Biol Phys 2011; 81: 59-68.
                  • 26. Harnett A, Smallwood J, Titshall V, et al. Diagnosis and treatment of early breast cancer, including locally advanced disease–summary of NICE guidance. BMJ 2009; 338: 598-600.
                  • 27. Shah C, Parsai S, Kotecha R, et al. Overview of outcomes with accelerated partial breast irradiation. In: Arthur DW, Vicini FA, Wazer DE, et al., editors. Short course breast radiotherapy. Cham: Springer, 2016; pp 229-244.
                  • 28. Coles CE, Yarnold JR. Accelerated partial breast irradiation: the new standard? Lancet 2016; 387: 201-202.
                  • 29. Strnad V, Ott OJ, Hildebrandt G, et al. 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. Lancet 2016; 387: 229-238.
                  • 30. Holland R, Connolly JL, Gelman R, et al. The presence of an extensive intraductal component following a limited excision correlates with prominent residual disease in the remainder of the breast. J Clin Oncol 1990; 8: 113-118.
                  • 31. Boyages J, Bosch C, Langlands AO, et al. Breast conservation: long-term Australian data. Int J Radiat Oncol Biol Phys 1992; 24: 253-260.
                  • 32. Boyages J, Recht A, Connolly JL, et al. Early breast cancer: predictors of breast recurrence for patients treated with conservative surgery and radiation therapy. Radiother Oncol 1990; 19: 29-41.
                  • 33. Connolly JL, Boyages J, Nixon AJ, et al. Predictors of breast recurrence after conservative surgery and radiation therapy for invasive breast cancer. Mod Pathol 1998; 11: 134-139.
                  • 34. Leong C, Boyages J, Jayasinghe UW, et al. Effect of margins on ipsilateral breast tumor recurrence after breast conservation therapy for lymph node-negative breast carcinoma. Cancer 2004; 100: 1823-1832.
                  • 35. Bartelink H, Maingon P, Poortmans P, et al. Whole-breast irradiation with or without a boost for patients treated with breast-conserving surgery for early breast cancer: 20-year follow-up of a randomised phase 3 trial. Lancet Oncol 2015; 16: 47-56.
                  • 36. Vrieling C, van Werkhoven E, Maingon P, et al. Prognostic factors for local control in breast cancer after long-term follow-up in the EORTC boost vs no boost trial: a randomized clinical trial. JAMA Oncol 2017; 3: 42-48.
                  • 37. Houssami N, Macaskill P, Marinovich ML, et al. Meta-analysis of the impact of surgical margins on local recurrence in women with early-stage invasive breast cancer treated with breast-conserving therapy. Eur J Cancer 2010; 46: 3219-3232.
                  • 38. Hunt KK, Ballman KV, McCall LM, et al. Factors associated with local-regional recurrence after a negative sentinel node dissection: results of the ACOSOG Z0010 trial. Ann Surg 2012; 256: 428-436.
                  • 39. Houssami N, Marinovich ML. Margins in breast-conserving surgery for early breast cancer: how much is good enough? Curr Breast Cancer Rep 2016; 8: 127-134.
                  • 40. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Int J Radiat Oncol Biol Phys 2014; 88: 553-564.
                  • 41. Bodilsen A, Bjerre K, Offersen BV, et al. Importance of margin width in breast-conserving treatment of early breast cancer. J Surg Oncol 2016; 113: 609-615.
                  • 42. Wang W, French J, Boyages J. Put the felt pen away: time to move on from a clinical mark-up for a breast boost. J Med Imaging Radiat Oncol 2012; 56: 375-378.
                  • 43. Recht A, Comen EA, Fine RE, et al. Postmastectomy radiotherapy: an American Society of Clinical Oncology, American Society for Radiation Oncology, and Society of Surgical Oncology focused guideline update. Pract Radiat Oncol 2016; 6: e219-e234.
                  • 44. Mamounas EP, Anderson SJ, Dignam JJ, et al. Predictors of locoregional recurrence after neoadjuvant chemotherapy: results from combined analysis of National Surgical Adjuvant Breast and Bowel Project B-18 and B-27. J Clin Oncol 2012; 30: 3960-3966.
                  • 45. Fisher B, Brown A, Mamounas E, et al. Effect of preoperative chemotherapy on local-regional disease in women with operable breast cancer: findings from National Surgical Adjuvant Breast and Bowel Project B-18. J Clin Oncol 1997; 15: 2483-2493.
                  • 46. Bear HD, Anderson S, Smith RE, et al. Sequential preoperative or postoperative docetaxel added to preoperative doxorubicin plus cyclophosphamide for operable breast cancer: National Surgical Adjuvant Breast and Bowel Project Protocol B-27. J Clin Oncol 2006; 24: 2019-2027.
                  • 47. Boughey JC, McCall LM, Ballman KV, et al. Tumor biology correlates with rates of breast-conserving surgery and pathologic complete response after neoadjuvant chemotherapy for breast cancer: findings from the ACOSOG Z1071 (Alliance) Prospective Multicenter Clinical Trial. Ann Surg 2014; 260: 608-614; discussion 614-606.
                  • 48. Fowble BL, Einck JP, Kim DN, et al. Role of postmastectomy radiation after neoadjuvant chemotherapy in stage II-III breast cancer. Int J Radiat Oncol Biol Phys 2012; 83: 494-503.
                  • 49. Truin W, Vugts G, Roumen RM, et al. Differences in response and surgical management with neoadjuvant chemotherapy in invasive lobular versus ductal breast cancer. Ann Surg Oncol 2016; 23: 51-57.
                  • 50. Abdulkarim BS, Cuartero J, Hanson J, et al. Increased risk of locoregional recurrence for women with T1-2N0 triple-negative breast cancer treated with modified radical mastectomy without adjuvant radiation therapy compared with breast-conserving therapy. J Clin Oncol 2011; 29: 2852-2858.
                  • 51. Lowery AJ, Kell MR, Glynn RW, et al. Locoregional recurrence after breast cancer surgery: a systematic review by receptor phenotype. Breast Cancer Res Treat 2012; 133: 831-841.
                  • 52. Voduc KD, Cheang MC, Tyldesley S, et al. Breast cancer subtypes and the risk of local and regional relapse. J Clin Oncol 2010; 28: 1684-1691.
                  • 53. Taghian AG, Jeong JH, Mamounas EP, et al. Low locoregional recurrence rate among node-negative breast cancer patients with tumors 5 cm or larger treated by mastectomy, with or without adjuvant systemic therapy and without radiotherapy: results from five National Surgical Adjuvant Breast and Bowel Project randomized clinical trials. J Clin Oncol 2006; 24: 3927-3932.
                  • 54. Bazan JG, White JR. The role of postmastectomy radiation therapy in patients with breast cancer responding to neoadjuvant chemotherapy. Semin Radiat Oncol 2016; 26: 51-58.
                  • 55. de Boer M, van Dijck JA, Bult P, et al. Breast cancer prognosis and occult lymph node metastases, isolated tumor cells, and micrometastases. J Natl Cancer Inst 2010; 102: 410-425.
                  • 56. Chua B, Ung O, Taylor R, et al. Treatment implications of a positive sentinel lymph node biopsy for patients with early-stage breast carcinoma. Cancer 2001; 92: 1769-1774.
                  • 57. Giuliano AE, McCall L, Beitsch P, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: the American College of Surgeons Oncology Group Z0011 randomized trial. Ann Surg 2010; 252: 426-432; discussion 432-423.
                  • 58. Giuliano AE, Ballman K, McCall L, et al. Locoregional recurrence after sentinel lymph node dissection with or without axillary dissection in patients with sentinel lymph node metastases: long-term follow-up from the American College of Surgeons Oncology Group (Alliance) ACOSOG Z0011 randomized trial. Ann Surg 2016; 264: 413-420.
                  • 59. Boyages J, Winch C. Axillary versus sentinel-lymph-node dissection for micrometastatic breast cancer. Lancet Oncol 2013; 14: e250-e251.
                  • 60. Coates AS, Winer EP, Goldhirsch A, et al. Tailoring therapies–improving the management of early breast cancer: St Gallen International Expert Consensus on the Primary Therapy of Early Breast Cancer 2015. Ann Oncol 2015; 26: 1533-1546.
                  • 61. Jagsi R, Chadha M, Moni J, et al. Radiation field design in the ACOSOG Z0011 (Alliance) Trial. J Clin Oncol 2014; 32: 3600-3606.
                  • 62. Fisher B, Jeong JH, Anderson S, et al. Twenty-five-year follow-up of a randomized trial comparing radical mastectomy, total mastectomy, and total mastectomy followed by irradiation. N Engl J Med 2002; 347: 567-575.
                  • 63. Donker M, van Tienhoven G, Straver ME, et al. Radiotherapy or surgery of the axilla after a positive sentinel node in breast cancer (EORTC 10981–22023 AMAROS): a randomised, multicentre, open-label, phase 3 non-inferiority trial. Lancet Oncol 2014; 15: 1303-1310.
                  • 64. Haffty BG, Hunt KK, Harris JR, et al. Positive sentinel nodes without axillary dissection: implications for the radiation oncologist. J Clin Oncol 2011; 29: 4479-4481.
                  • 65. Stibbe EP. The Internal Mammary Lymphatic Glands. J Anat 1918; 52: 257-264.
                  • 66. Putti F. Ricerche anatomiche sui linfonodi mammari interni. Chir Ital 1953; 7: 161-172.
                  • 67. Coombs NJ, Boyages J, French JR, et al. Internal mammary sentinel nodes: ignore, irradiate or operate? Eur J Cancer 2009; 45: 789-794.
                  • 68. Thorsen LB, Offersen BV, Dano H, et al. DBCG-IMN: a population-based cohort study on the effect of internal mammary node irradiation in early node-positive breast cancer. J Clin Oncol 2016; 34: 314-320.
                  • 69. Whelan TJ, Olivotto IA, Parulekar WR, et al. Regional nodal irradiation in early-stage breast cancer. N Engl J Med 2015; 373: 307-316.
                  • 70. Hennequin C, Bossard N, Servagi-Vernat S, et al. Ten-year survival results of a randomized trial of irradiation of internal mammary nodes after mastectomy. Int J Radiat Oncol Biol Phys 2013; 86: 860-866.
                  • 71. Chang JS, Park W, Kim YB, et al. Long-term survival outcomes following internal mammary node irradiation in stage II-III breast cancer: results of a large retrospective study with 12-year follow-up. Int J Radiat Oncol Biol Phys 2013; 86: 867-872.
                  • 72. Courdi A, Chamorey E, Ferrero JM, et al. Influence of internal mammary node irradiation on long-term outcome and contralateral breast cancer incidence in node-negative breast cancer patients. Radiother Oncol 2013; 108: 259-265.
                  • 73. Verma V, Vicini F, Tendulkar RD, et al. Role of internal mammary node radiation as a part of modern breast cancer radiation therapy: a systematic review. Int J Radiat Oncol Biol Phys 2016; 95: 617-631.

                  Author
                  remove_circle_outline Delete Author
                  add_circle_outline Add Author
                  Comment
                  Do you have any competing interests to declare? *
                  I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                  I/we agree to the Terms of use of the Medical Journal of Australia *
                  Email me when people comment on this article
                  Online responses are no longer available. Please refer to our instructions for authors page for more information.

                    Non-coeliac gluten or wheat sensitivity: emerging disease or misdiagnosis?

                    Michael DE Potter, Marjorie M Walker and Nicholas J Talley
                    Med J Aust 2017; 207 (5): . || doi: 10.5694/mja17.00332
                    Published online: 4 September 2017

                    Summary

                     

                    • Non-coeliac gluten or wheat sensitivity (NCG/WS) is a condition characterised by adverse gastrointestinal and/or extra-intestinal symptoms associated with the ingestion of gluten- or wheat-containing foods, in the absence of coeliac disease or wheat allergy.
                    • Up to one in 100 people in Australia may have coeliac disease but many more report adverse gastrointestinal and/or extra-intestinal symptoms after eating wheat products.
                    • In the absence of validated biomarkers, a diagnosis of NCG/WS can only be made by a double-blind, placebo-controlled, dietary crossover challenge with gluten, which is difficult to apply in clinical practice.
                    • Of people self-reporting gluten or wheat sensitivity, only a small proportion (16%) will have reproducible symptoms after a blinded gluten challenge of gluten versus placebo in a crossover dietary trial and fulfil the current consensus criteria for a diagnosis of NCG/WS.
                    • A wide range of symptoms are associated with NCG/WS, including gastrointestinal, neurological, psychiatric, rheumatological and dermatological complaints.
                    • The pathogenesis of NCG/WS is not well understood, but the innate immune system has been implicated, and there is overlap with coeliac disease and the functional gastrointestinal disorders (irritable bowel syndrome and functional dyspepsia).
                    • Identification of NCG/WS is important as gluten-free diets carry risks, are socially restricting and are costlier than regular diets.

                     

                    Please login with your free MJA account to view this article in full

                    LOGIN
                    CREATE AN ACCOUNT

                    Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

                    View on Wiley Online Library

                    • 1 University of Newcastle, Newcastle, NSW
                    • 2 Medical Journal of Australia, Sydney, NSW


                    Competing interests:

                    Nicholas Talley is Editor-in-Chief of the Medical Journal of Australia.

                    • 1. Schuppan D, Dennis MD, Kelly CP. Celiac disease: epidemiology, pathogenesis, diagnosis, and nutritional management. Nutr Clin Care 2005; 8: 54-69.
                    • 2. Biesiekierski JR. What is gluten? J Gastroenterol Hepatol 2017; 32 Suppl 1: 78-81.
                    • 3. Shewry PR, Halford NG, Belton PS, Tatham AS. The structure and properties of gluten: an elastic protein from wheat grain. Philos Trans R Soc Lond B Biol Sci 2002; 357: 133-142.
                    • 4. Fasano A, Catassi C. Clinical practice. Celiac disease. N Engl J Med 2012; 367: 2419-2426.
                    • 5. Walker MM, Ludvigsson JF, Sanders DS. Coeliac disease: review of diagnosis and management. Med J Aust 2017; 207: 173-178.
                    • 6. Anderson RP, Henry MJ, Taylor R, et al. A novel serogenetic approach determines the community prevalence of celiac disease and informs improved diagnostic pathways. BMC Med 2013; 11: 188.
                    • 7. Cabrera-Chavez F, Dezar GV, Islas-Zamorano AP, et al. Prevalence of self-reported gluten sensitivity and adherence to a gluten-free diet in Argentinian adult population. Nutrients 2017; 9: 81.
                    • 8. Spence D. Bad medicine: food intolerance. BMJ 2013; 346: f529.
                    • 9. Golley S, Corsini N, Topping D, et al. Motivations for avoiding wheat consumption in Australia: results from a population survey. Public Health Nutr 2015; 18: 490-499.
                    • 10. DiGiacomo DV, Tennyson CA, Green PH, Demmer RT. Prevalence of gluten-free diet adherence among individuals without celiac disease in the USA: results from the Continuous National Health and Nutrition Examination Survey 2009–2010. Scand J Gastroenterol 2013; 48: 921-925.
                    • 11. Aziz I, Lewis NR, Hadjivassiliou M, et al. A UK study assessing the population prevalence of self-reported gluten sensitivity and referral characteristics to secondary care. Eur J Gastroenterol Hepatol 2014; 26: 33-39.
                    • 12. van Gils T, Nijeboer P, IJssennagger CE, et al. Prevalence and characterization of self-reported gluten sensitivity in The Netherlands. Nutrients 2016; 8: E714.
                    • 13. Cabrera-Chavez F, Granda-Restrepo DM, Aramburo-Galvez JG, et al. Self-reported prevalence of gluten-related disorders and adherence to gluten-free diet in Colombian adult population. Gastroenterol Res Pract 2016; 2016: 4704309.
                    • 14. Ontiveros N, López-Gallardo J, Vergara-Jiménez M, Cabrera-Chávez F. Self-reported prevalence of symptomatic adverse reactions to gluten and adherence to gluten-free diet in an adult Mexican population. Nutrients 2015; 7: 6000-6015.
                    • 15. Volta U, Caio G, Karunaratne TB, et al. Non-coeliac gluten/wheat sensitivity: advances in knowledge and relevant questions. Expert Rev Gastroenterol Hepatol 2017; 11: 9-18.
                    • 16. Nanayakkara WS, Skidmore PM, O’Brien L, et al. Efficacy of the low FODMAP diet for treating irritable bowel syndrome: the evidence to date. Clin Exp Gastroenterol 2016; 9: 131-142.
                    • 17. Staudacher HM, Irving PM, Lomer MC, Whelan K. Mechanisms and efficacy of dietary FODMAP restriction in IBS. Nat Rev Gastroenterol Hepatol 2014; 11: 256-266.
                    • 18. Biesiekierski JR, Peters SL, Newnham ED, et alNo effects of gluten in patients with self-reported non-celiac gluten sensitivity after dietary reduction of fermentable, poorly absorbed, short-chain carbohydrates. Gastroenterology 2013; 145: 320-328.e1-e3.
                    • 19. Junker Y, Zeissig S, Kim SJ, et al. Wheat amylase trypsin inhibitors drive intestinal inflammation via activation of toll-like receptor 4. J Exp Med 2012; 209: 2395-2408.
                    • 20. Dalla Pellegrina C, Perbellini O, Scupoli MT, et al. Effects of wheat germ agglutinin on human gastrointestinal epithelium: insights from an experimental model of immune/epithelial cell interaction. Toxicol Appl Pharmacol 2009; 237: 146-153.
                    • 21. Catassi C, Elli L, Bonaz B, et al. Diagnosis of non-celiac gluten sensitivity (NCGS): the Salerno experts’ criteria. Nutrients 2015; 7: 4966-4977.
                    • 22. Molina-Infante J, Carroccio A. Suspected nonceliac gluten sensitivity confirmed in few patients after gluten challenge in double-blind, placebo-controlled trials. Clin Gastroenterol Hepatol 2017; 15: 339-348.
                    • 23. Gibson PR, Skodje GI, Lundin KE. Non-coeliac gluten sensitivity. J Gastroenterol Hepatol 2017; 32 Suppl 1: 86-89.
                    • 24. Husby S, Murray JA. Gluten sensitivity: celiac lite versus celiac like. J Pediatr 2014; 164: 436-438.
                    • 25. Volta U, Bardella MT, Calabro A, et al. Study Group for Non-Celiac Gluten Sensitivity. An Italian prospective multicenter survey on patients suspected of having non-celiac gluten sensitivity. BMC Med 2014; 12: 85.
                    • 26. Elli L, Tomba C, Branchi F, et al. Evidence for the presence of non-celiac gluten sensitivity in patients with functional gastrointestinal symptoms: results from a multicenter randomized double-blind placebo-controlled gluten challenge. Nutrients 2016; 8: 84.
                    • 27. Carroccio A, Mansueto P, Iacono G, et al. Non-celiac wheat sensitivity diagnosed by double-blind placebo-controlled challenge: exploring a new clinical entity. Am J Gastroenterol 2012; 107: 1898-1906; quiz 907.
                    • 28. Carroccio A, Soresi M, D’Alcamo A, et al. Risk of low bone mineral density and low body mass index in patients with non-celiac wheat-sensitivity: a prospective observation study. BMC Med 2014; 12: 230.
                    • 29. Carroccio A, D’Alcamo A, Cavataio F, et al. High proportions of people with nonceliac wheat sensitivity have autoimmune disease or antinuclear antibodies. Gastroenterology 2015; 149: 596-603.e1.
                    • 30. Ford AC, Talley NJ, Walker MM, Jones MP. Increased prevalence of autoimmune diseases in functional gastrointestinal disorders: case-control study of 23471 primary care patients. Aliment Pharmacol Ther 2014; 40: 827-834.
                    • 31. Hollon J, Puppa EL, Greenwald B, et al.Effect of gliadin on permeability of intestinal biopsy explants from celiac disease patients and patients with non-celiac gluten sensitivity. Nutrients 2015; 7: 1565-1576.
                    • 32. Uhde M, Ajamian M, Caio G, et al. Intestinal cell damage and systemic immune activation in individuals reporting sensitivity to wheat in the absence of coeliac disease. Gut 2016; 65: 1930-1937.
                    • 33. Sapone A, Lammers KM, Casolaro V, et al. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity. BMC Med 2011; 9: 23.
                    • 34. Brottveit M, Beitnes AC, Tollefsen S, et al. Mucosal cytokine response after short-term gluten challenge in celiac disease and non-celiac gluten sensitivity. Am J Gastroenterol 2013; 108: 842-850.
                    • 35. Nylund L, Kaukinen K, Lindfors K. The microbiota as a component of the celiac disease and non-celiac gluten sensitivity. Clinical Nutrition Experimental 2016; 6: 17-24.
                    • 36. Talley NJ, Walker MM, Aro P, et al. Non-ulcer dyspepsia and duodenal eosinophilia: an adult endoscopic population-based case-control study. Clin Gastroenterol Hepatol 2007; 5: 1175-1183.
                    • 37. Di Liberto D, Mansueto P, D’Alcamo A, et al. Predominance of type 1 innate lymphoid cells in the rectal mucosa of patients with non-celiac wheat sensitivity: reversal after a wheat-free diet. Clin Transl Gastroenterol 2016; 7: e178.
                    • 38. Biesiekierski JR, Newnham ED, Irving PM, et al. Gluten causes gastrointestinal symptoms in subjects without celiac disease: a double-blind randomized placebo-controlled trial. Am J Gastroenterol 2011; 106: 508-514; quiz 15.
                    • 39. Volta U, Tovoli F, Cicola R, et al. Serological tests in gluten sensitivity (nonceliac gluten intolerance). J Clin Gastroenterol 2012; 46: 680-685.
                    • 40. Troncone R, Ferguson A. Anti-gliadin antibodies. J Pediatr Gastroenterol Nutr 1991; 12: 150-158.
                    • 41. Molina-Infante J, Santolaria S, Sanders DS, Fernandez-Banares F. Systematic review: noncoeliac gluten sensitivity. Aliment Pharmacol Ther 2015; 41: 807-820.
                    • 42. Talley NJ, Walker MM. Celiac disease and nonceliac gluten or wheat sensitivity: The risks and benefits of diagnosis. JAMA Intern Med 2017; 177: 615-616.
                    • 43. Walker MM, Murray JA, Ronkainen J, et al. Detection of celiac disease and lymphocytic enteropathy by parallel serology and histopathology in a population-based study. Gastroenterology 2010; 139: 112-119.
                    • 44. Brown I, Mino-Kenudson M, Deshpande V, Lauwers GY. Intraepithelial lymphocytosis in architecturally preserved proximal small intestinal mucosa: an increasing diagnostic problem with a wide differential diagnosis. Arch Pathol Lab Med 2006; 130: 1020-1025.
                    • 45. Leffler D, Schuppan D, Pallav K, et al. Kinetics of the histological, serological and symptomatic responses to gluten challenge in adults with coeliac disease. Gut 2013; 62: 996-1004.
                    • 46. Rubio-Tapia A, Hill ID, Kelly CP, et al. American College of Gastroenterology. ACG clinical guidelines: diagnosis and management of celiac disease. Am J Gastroenterol 2013; 108: 656-676; quiz 77.
                    • 47. Ludvigsson JF, Bai JC, Biagi F, et al. Diagnosis and management of adult coeliac disease: guidelines from the British Society of Gastroenterology. Gut 2014; 63: 1210-1228.
                    • 48. Rosinach M, Fernandez-Banares F, Carrasco A, et al. Double-blind randomized clinical trial: gluten versus placebo rechallenge in patients with lymphocytic enteritis and suspected celiac Ddisease. PLoS One 2016; 11: e0157879.
                    • 49. Husby S, Koletzko S, Korponay-Szabo IR, et al. European Society for Pediatric Gastroenterology, Hepatology, and Nutrition guidelines for the diagnosis of coeliac disease. J Pediatr Gastroenterol Nutr 2012; 54: 136-160.
                    • 50. Ludvigsson JF, Leffler DA, Bai JC, et al. The Oslo definitions for coeliac disease and related terms. Gut 2013; 62: 43-52.
                    • 51. Lambert K, Ficken C. Cost and affordability of a nutritionally balanced gluten-free diet: Is following a gluten-free diet affordable? Nutr Diet 2016; 73: 36-42.
                    • 52. Hallert C, Grant C, Grehn S, et al. Evidence of poor vitamin status in coeliac patients on a gluten-free diet for 10 years. Aliment Pharmacol Ther 2002; 16: 1333-1339.
                    • 53. Theethira TG, Dennis M, Leffler DA. Nutritional consequences of celiac disease and the gluten-free diet. Expert Rev Gastroenterol Hepatol 2014; 8: 123-129.
                    • 54. Vici G, Belli L, Biondi M, Polzonetti V. Gluten free diet and nutrient deficiencies: a review. Clin Nutr 2016; 35: 1236-1241.
                    • 55. Missbach B, Schwingshackl L, Billmann A, et al. Gluten-free food database: the nutritional quality and cost of packaged gluten-free foods. PeerJ 2015; 3: e1337.
                    • 56. Miranda J, Lasa A, Bustamante MA, et al. Nutritional differences between a gluten-free diet and a diet containing equivalent products with gluten. Plant Foods Hum Nutr 2014; 69: 182-187.
                    • 57. Zanini B, Mazzoncini E, Lanzarotto F, et al. Impact of gluten-free diet on cardiovascular risk factors. A retrospective analysis in a large cohort of coeliac patients. Dig Liver Dis 2013; 45: 810-815.
                    • 58. Tortora R, Capone P, De Stefano G, et al. Metabolic syndrome in patients with coeliac disease on a gluten-free diet. Aliment Pharmacol Ther 2015; 41: 352-359.
                    • 59. Berti C, Riso P, Monti LD, Porrini M. In vitro starch digestibility and in vivo glucose response of gluten-free foods and their gluten counterparts. Eur J Nutr 2004; 43: 198-204.
                    • 60. Capristo E, Malandrino N, Farnetti S, et al. Increased serum high-density lipoprotein-cholesterol concentration in celiac disease after gluten-free diet treatment correlates with body fat stores. J Clin Gastroenterol 2009; 43: 946-949.
                    • 61. Bulka CM, Davis MA, Karagas MR, et al. The unintended consequences of a gluten-free diet. Epidemiology 2017; 28: e24-e25.
                    • 62. Munera-Picazo S, Ramirez-Gandolfo A, Burlo F, Carbonell-Barrachina AA. Inorganic and total arsenic contents in rice-based foods for children with celiac disease. J Food Sci 2014; 79: T122-T128.
                    • 63. Bonder MJ, Tigchelaar EF, Cai X, et al. The influence of a short-term gluten-free diet on the human gut microbiome. Genome Med 2016; 8: 45.
                    • 64. Sanz Y. Effects of a gluten-free diet on gut microbiota and immune function in healthy adult humans. Gut Microbes 2010; 1: 135-137.

                    Author
                    remove_circle_outline Delete Author
                    add_circle_outline Add Author
                    Comment
                    Do you have any competing interests to declare? *
                    I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                    I/we agree to the Terms of use of the Medical Journal of Australia *
                    Email me when people comment on this article
                    Online responses are no longer available. Please refer to our instructions for authors page for more information.

                      Testing for type 2 diabetes in Indigenous Australians: guideline recommendations and current practice

                      Christine L Paul, Paul Ishiguchi, Catherine A D'Este, Jonathan E Shaw, Rob W Sanson-Fisher, Kristy Forshaw, Alessandra Bisquera, Jennifer Robinson, Claudia Koller and Sandra J Eades
                      Med J Aust 2017; 207 (5): . || doi: 10.5694/mja16.00769
                      Published online: 4 September 2017

                      Abstract

                      Objectives: To determine the proportion of Aboriginal Controlled Community Health Service (ACCHS) patients tested according to three national diabetes testing guidelines; to investigate whether specific patient characteristics were associated with being tested.

                      Design, setting and participants: Cross-sectional study of 20 978 adult Indigenous Australians not diagnosed with diabetes attending 18 ACCHSs across Australia. De-identified electronic whole service data for July 2010 – June 2013 were analysed.

                      Main outcomes measures: Proportions of patients appropriately screened for diabetes according to three national guidelines for Indigenous Australians: National Health and Medical Research Council (at least once every 3 years for those aged 35 years or more); Royal Australian College of General Practitioners and Diabetes Australia (at least once every 3 years for those aged 18 years or more); National Aboriginal Community Controlled Health Organisation (annual testing of those aged 18 years or more at high risk of diabetes).

                      Results: 74% (95% CI, 74–75%) of Indigenous adults and 77% (95% CI, 76–78%) of 10 760 patients aged 35 or more had been tested for diabetes at least once in the past 3 years. The proportions of patients tested varied between services (range: all adults, 16–90%; people aged 35 years or more, 23–92%). 18% (95% CI, 18–19%) of patients aged 18 or more were tested for diabetes annually (range, 0.1–43%). Patients were less likely to be tested if they were under 50 years of age, were transient rather than current patients of the ACCHS, or attended the service less frequently.

                      Conclusions: Some services achieved high rates of 3-yearly testing of Indigenous Australians for diabetes, but recommended rates of annual testing were rarely attained. ACCHSs may need assistance to achieve desirable levels of testing.

                      Please login with your free MJA account to view this article in full

                      LOGIN
                      CREATE AN ACCOUNT

                      Please note: institutional and Research4Life access to the MJA is now provided through Wiley Online Library.

                      View on Wiley Online Library

                      • 1 University of Newcastle, Newcastle, NSW
                      • 2 Priority Research Centre for Health Behaviour, University of Newcastle, Newcastle, NSW
                      • 3 Hunter Medical Research Institute, Newcastle, NSW
                      • 4 Baker IDI Heart and Diabetes Institute, Melbourne, VIC
                      • 5 National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT


                      Correspondence: chris.paul@newcastle.edu.au
                      Acknowledgements: 

                      The authors gratefully acknowledge the generous support of the staff and patients from the following Aboriginal Community Controlled Health Services (in alphabetical order): Anyinginyi Health Aboriginal Corporation, Bega Garnbirringu Aboriginal Health Service, Danila Dilba Biluru Butji Binnilutum Health Service, Derbarl Yerrigan Health Service, Dhauwurd-Wurrung Elderly and Community Health Service, Kirrae Aboriginal Health Service, Mawarnkarra Health Service, Mildura Aboriginal Corporation, Mitwatj Health Aboriginal Corporation, Pika Wiya Health Service, Riverina Medical and Dental Aboriginal Corporation, South West Aboriginal Medical Service, Sunrise Health Service Aboriginal Corporation, Umoona Tjutagku Health Service, Winnunga Nimmityajah Aboriginal Health Service, Ampilatwatja Health Centre Aboriginal Corporation, Pius X Aboriginal Corporation, and Victorian Aboriginal Health Service.

                      Competing interests:

                      No relevant disclosures.

                      • 1. Australian Institute of Health and Welfare. Diabetes and disability: impairments, activity limitations, participation restrictions and comorbidities (AIHW Cat. No. CVD 63; Diabetes Series No. 20). Canberra: AIHW, 2013.
                      • 2. Public Health Agency of Canada. Diabetes in Canada: facts and figures from a public health perspective. Ottawa: Chronic Disease Surveillance and Monitoring Division, 2011. http://www.phac-aspc.gc.ca/cd-mc/publications/diabetes-diabete/facts-figures-faits-chiffres-2011/index-eng.php (accessed June 2017).
                      • 3. Centers for Disease Control and Prevention. 2014 National diabetes statistics report. Atlanta: US Department of Health and Human Services, 2014. https://www.cdc.gov/diabetes/data/statistics/2014statisticsreport.html (accessed June 2017).
                      • 4. Holman N, Young B, Gadsby R. Current prevalence of type 1 and type 2 diabetes in adults and children in the UK. Diabet Med 2015; 32: 1190-1120.
                      • 5. Zimmet P, Alberti K, Shaw J. Global and societal implications of the diabetes epidemic. Nature 2001; 414: 782-787.
                      • 6. Young TK, Reading J, Elias B. Type 2 diabetes mellitus in Canada’s First Nations: status of an epidemic in progress. CMAJ 2000; 163: 561-566.
                      • 7. Acton KJ, Ríos Burrows N, Moore K, et al. Trends in diabetes prevalence among American Indian and Alaska native children, adolescents, and young adults. Am J Public Health 2002; 92: 1485-1490.
                      • 8. Australian Institute of Health and Welfare. National key performance indicators for Aboriginal and Torres Strait Islander primary health care: results from December 2013 (AIHW Cat. No. IHW 146). Canberra: AIHW, 2014.
                      • 9. Australian Bureau of Statistics. 4727.0.55.003. Australian Aboriginal and Torres Strait Islander health survey: biomedical results, 2012–13. Sept 2014. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4727.0.55.0032012-13?OpenDocument (accessed June 2017).
                      • 10. Australian Bureau of Statistics. 4364.0.55.001. National Health Survey: first results, 2014–15. Dec 2015. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4364.0.55.001 (accessed June 2017).
                      • 11. Dunstan DW, Zimmet PZ, Welborn TA, et al. The rising prevalence of diabetes and impaired glucose tolerance: the Australian Diabetes, Obesity and Lifestyle study. Diabetes Care 2002; 25: 829-834.
                      • 12. O’Dea K, Cunningham J, Maple-Brown L, et al. Diabetes and cardiovascular risk factors in urban Indigenous adults: results from the DRUID study. Diabetes Res Clin Pract 2008; 80: 483-489.
                      • 13. Engelgau MM, Narayan K, Herman WH. Screening for type 2 diabetes. Diabetes Care 2000; 23: 1563-1580.
                      • 14. Waugh N, Scotland G, McNamee P, et al. Screening for type 2 diabetes: literature review and economic modelling. Health Technol Assess 2007; 11: iii-iv, ix-xi, 1-125.
                      • 15. Colagiuri S, Davies D, Girgis S, Colagiuri R. National evidence based guideline for case detection and diagnosis of type 2 diabetes. Canberra: Diabetes Australia, NHMRC, 2009. https://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/di17-diabetes-detection-diagnosis.pdf (accessed July 2017).
                      • 16. Bell K, Couzos S, Daniels J, et al. Aboriginal community controlled health services. In: Department of Health and Aged Care. General practice in Australia, 2000. Canberra: General Practice Branch, Health Services Division, Department of Health and Aged Care, 2000; pp. 74-103.
                      • 17. Diabetes Australia Guideline Development Consortium. National evidence based guidelines for the management of type 2 diabetes mellitus. Canberra: NHMRC, 2004. https://www.nhmrc.gov.au/guidelines-publications/di7-di8-di9-di10-di11-di12-di13 (accessed June 2017).
                      • 18. Royal Australian College of General Practitioners, Diabetes Australia. General practice management of type 2 diabetes — 2014–15. Melbourne: RACGP/DA, 2014. https://www.clinicalguidelines.gov.au/portal/2390/general-practice-management-type-2-diabetes-2014-15 (accessed June 2017).
                      • 19. Coleman J. Type 2 diabetes prevention and early detection. In: NACCHO/RACGP. National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people. 2nd edition. Melbourne: RACGP, 2012; pp. 229-238. http://www.racgp.org.au/your-practice/guidelines/national-guide/type-2-diabetes-prevention-and-early-detection/ (accessed June 2017).
                      • 20. Australian Institute of Health and Welfare. Indigenous health check (MBS 715) data tool. http://www.aihw.gov.au/indigenous-australians/indigenous-health-check-data-tool/ (accessed Dec 2016).
                      • 21. Australian Bureau of Statistics. 4727.0.55.001. Australian Aboriginal and Torres Strait islander health survey: first results, Australia (2012–2013). Nov 2013. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4727.0.55.001 (accessed July 2015).
                      • 22. Bloomgarden ZT. Type 2 diabetes in the young: the evolving epidemic. Diabetes Care 2004; 27: 998-1010.

                      Author
                      remove_circle_outline Delete Author
                      add_circle_outline Add Author
                      Comment
                      Do you have any competing interests to declare? *
                      I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
                      I/we agree to the Terms of use of the Medical Journal of Australia *
                      Email me when people comment on this article
                      Online responses are no longer available. Please refer to our instructions for authors page for more information.
                      Subscribe to