MJA
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    Ultrasound as a treatment modality for neurological diseases

    Gerhard Leinenga, Rebecca M Nisbet and Jürgen Götz
    Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.01013
    Published online: 19 June 2017

    Neurological disorders are a particular challenge for therapeutic intervention — ultrasound has emerged as a novel approach with a broad range of applications

    With an ageing population, neurological disorders present an increasing challenge to our health care systems. Although antibodies are increasingly being explored for therapeutic intervention,1 the inefficiency of their uptake by the brain means that the estimated cost of a vaccine to treat neurodegenerative disorders such as Alzheimer disease (AD) will exceed US$25 000 per patient per year.2 Not only is this expected to challenge the health care systems of many countries, it also raises ethical issues associated with making these vaccines available to every patient.

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      Psilocybin-assisted therapy for anxiety and depression: implications for euthanasia

      Nigel Strauss
      Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00081
      Published online: 19 June 2017

      Contemporary research suggests potential benefits of psychedelic drugs in treatment-resistant depression and terminally ill patients

      Despite their stigmatisation, psychedelic drugs are once again being clinically researched in Europe and North America. This long-awaited renaissance is showing very promising results and, unlike the pioneering research that occurred before these drugs were outlawed over 30 years ago, the current methodology is rigorous and of a very high standard.


      • Millswyn Clinic, Melbourne, VIC


      Correspondence: drnigel@bigpond.net.au
      Acknowledgements: 

      I thank Martin Williams for his assistance in the preparation and revision of this manuscript.

      Competing interests:

      No relevant disclosures.

      • 1. Mithoefer MC, Wagner MT, Mithoefer AT, et al. Durability of improvement in post-traumatic stress disorder symptoms and absence of harmful effects or drug dependency after 3,4-methylenedioxymethamphetamine-assisted psychotherapy: a prospective long-term follow-up study. J Psychopharmacol 2013; 27: 28-39.
      • 2. Carhart-Harris RL, Bolstridge M, Rucker J, et al. Psilocybin with psychological support for treatment-resistant depression: an open-label feasibility study. Lancet Psychiatry 2016; 3: 619-627.
      • 3. Ross S, Bossin A, Guss J, et al. Rapid and sustained symptom reduction following psilocybin treatment for anxiety and depression in patients with life-threatening cancer: a randomized controlled trial. J Psychopharmacol 2016; 30: 1165-1180.
      • 4. Griffiths RR, Johnson MW, Carducci MA, et al. Psilocybin produces substantial and sustained decreases in depression and anxiety in patients with life-threatening cancer: a randomized double-blind trial. J Psychopharmacol 2016; 30: 1181-1197.
      • 5. Widera E, Block S. Managing grief and depression at the end of life. Am Fam Physician 2012; 86: 259-264.
      • 6. Hasler F, Grimberg U, Benz MA, et al. Acute psychological and physiological effects of psilocybin in healthy humans: a double-blind, placebo-controlled dose-effect study. Psychopharmacology (Berl) 2004; 172: 145-156.
      • 7. Hofmann A. LSD: my problem child. Oxford: Oxford University Press; 2013.
      • 8. Pahnke WM. Drugs and mysticism: an analysis of the relationship between psychedelic drugs and the mystical consciousness. Cambridge, MA: Harvard University Press; 1963.
      • 9. Miller WR. The phenomenon of quantum change. J Clin Psychol 2004; 60: 453-460.
      • 10. Royal Australian and New Zealand College of Psychiatrists. The economic cost of serious mental illness and comorbidities in Australia and New Zealand. Melbourne: RANZCP, 2016. https://www.ranzcp.org/Files/Publications/RANZCP-Serious-Mental-Illness.aspx (accessed Apr 2017).
      • 11. Thienpont L, Verhofstadt M, Van Loon T, et al. Euthanasia requests, procedures and outcomes for 100 Belgian patients suffering from psychiatric disorders: a retrospective, descriptive study. BMJ Open 2015; 5: e007454.
      • 12. Emanuel E. Euthanasia and physician-assisted suicide: focus on the data. Med J Aust 2017; 206: 339-340. <MJA full text>
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        The disparity between changes in the prevalence of mental illness and disability support rates in Australia

        Harvey A Whiteford
        Med J Aust 2017; 206 (11): . || doi: 10.5694/mja17.00274
        Published online: 19 June 2017

        Clarifying the type of support needed by people with a psychiatric disability must be a priority

        One major focus of Australia’s national mental health strategy has been to increase access to treatment for those with common mental disorders, particularly anxiety and depressive disorders. Despite indications that treatment rates have increased in Australia,1 there is little evidence that the population prevalence of these disorders has declined, a phenomenon also reported in other high income countries where increased treatment has been made available.2


        • 1 University of Queensland, Brisbane, QLD
        • 2 Queensland Centre for Mental Health Research, Brisbane, QLD
        • 3 Institute of Health Metrics and Evaluation, University of Washington, Seattle, USA


        Correspondence: h.whiteford@sph.uq.edu.au
        Competing interests:

        No relevant disclosures.

        • 1. Whiteford HA, Buckingham WJ, Harris MG, et al. Estimating treatment rates for mental disorders in Australia. Aust Health Rev 2014; 38: 80-85.
        • 2. Jorm AF, Patten SB, Brugha TS, et al. Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry 2017; 16: 90-99.
        • 3. Harvey SB, Deady M, Wang M-J, et al. Is the prevalence of mental illness increasing in Australia? Evidence from national health surveys and administrative data, 2001–2014. Med J Aust 2017; 206: 490-493.
        • 4. Slade T, Johnson A, Oakley-Browne MA, et al. 2007 National Survey of Mental Health and Wellbeing: methods and key findings. Aust N Z J Psychiatry 2009; 43: 594-605.
        • 5. Baxter AJ, Scott K, Ferrari AJ, et al. Challenging the myth of an “epidemic” of common mental disorders: trends in the global prevalence of anxiety and depression between 1990 and 2010. Depress Anxiety 2014; 31: 506-516.
        • 6. Morgan VA, Waterreus A, Jablensky A, et al. People living with psychotic illness in 2010: the second Australian national survey of psychosis. Aust N Z J Psychiatry 2012; 46: 735-752.
        • 7. Parliament of Australia. The provision of services under the NDIS for people with psychosocial disabilities related to a mental health condition. Joint Standing Committee on the NDIS — Mental Health Terms of Reference [webpage]. http://www.aph.gov.au/Parliamentary_Business/Committees/Joint/National_Disability_Insurance_Scheme/MentalHealth (accessed Mar 2017).
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          Is the prevalence of mental illness increasing in Australia? Evidence from national health surveys and administrative data, 2001–2014

          Samuel B Harvey, Mark Deady, Min-Jung Wang, Arnstein Mykletun, Peter Butterworth, Helen Christensen and Philip B Mitchell
          Med J Aust 2017; 206 (11): . || doi: 10.5694/mja16.00295
          Published online: 19 June 2017

          Abstract

          Objectives: To assess changes in the prevalence rates of probable common mental disorders (CMDs) and in rates of disability support pensions (DSPs) for people with psychiatric disorders in Australia between 2001 and 2014.

          Design, setting and participants: Secondary analysis of data from five successive Australian national health surveys of representative samples of the working age population (18–65 years of age) and national data on DSP recipients.

          Main outcome measures: Prevalence of probable CMDs with very high symptom level (defined by a Kessler Psychological Distress Scale [K10] score of 30 or more) or with high symptom level (K10 score of 22 or more); the proportion of working age Australians receiving DSPs for psychiatric conditions.

          Results: There was no change in the prevalence rate of probable CMDs with very high symptom levels between 2001 and 2014, but a slight decrease in the prevalence of probable CMDs with high symptoms levels, particularly among those under 45 years of age. Over the same period, the proportion of working age individuals receiving DSPs for psychiatric conditions increased by 51% (for trend, P < 0.001), equivalent to one additional DSP for every 182 working age Australians.

          Conclusions: Contrary to popular belief, the prevalence of probable CMDs in Australia was stable between 2001 and 2014. However, the proportion of the working age population receiving DSPs for psychiatric conditions increased dramatically over the same period. This conundrum is a major public health problem that should be further examined.

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          • 1 University of New South Wales, Sydney, NSW
          • 2 Black Dog Institute, Sydney, NSW
          • 3 St George Hospital, Sydney, NSW
          • 4 Norwegian Institute of Public Health, Oslo, Norway
          • 5 University of Tromsø, Tromsø, Norway
          • 6 Center for Work and Mental Health, Nordland Hospital Trust, Bodø, Norway
          • 7 Centre for Mental Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC
          • 8 Melbourne Institute of Applied Economic and Social Research, University of Melbourne, Melbourne, VIC


          Correspondence: s.harvey@unsw.edu.au
          Competing interests:

          No relevant disclosures.

          • 1. Angell M. The epidemic of mental illness: why? The New York Review of Books [online]; 23 June 2011. http://www.nybooks.com/articles/2011/06/23/epidemic-mental-illness-why/ (accessed Mar 2017).
          • 2. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197-2223.
          • 3. McManus P, Mant A, Mitchell PB, et al. Recent trends in the use of antidepressant drugs in Australia, 1990–1998. Med J Aust 2000; 173: 458-461. <MJA full text>
          • 4. Middleton N, Gunnell D, Whitley E, et al. Secular trends in antidepressant prescribing in the UK, 1975–1998. J Public Health Med 2001; 23: 262-267.
          • 5. Olfson M, Marcus SC. National patterns in antidepressant medication treatment. Arch Gen Psychiatry 2009; 66: 848-856.
          • 6. Knudsen AK, Øverland S, Aakvaag HF, et al. Common mental disorders and disability pension award: seven year follow-up of the HUSK study. J Psychosom Res 2010; 69: 59-67.
          • 7. Harvey SB, Henderson M, Lelliott P, Hotopf M. Mental health and employment: much work still to be done. Br J Psychiatry 2009; 194: 201-203.
          • 8. LaMontagne AD SK, Cocker F. Estimating the economic benefits of eliminating job strain as a risk factor for depression. Melbourne: Victorian Heath Promotion Foundation (VicHealth), 2010. https://www.vichealth.vic.gov.au/media-and-resources/publications/economic-cost-of-job-strain (accessed Mar 2017).
          • 9. Henderson M, Harvey SB, Overland S, et al. Work and common psychiatric disorders. J R Soc Med 2011; 104: 198-207.
          • 10. Goldney RD, Eckart KA, Hawthorne G, Taylor AW. Changes in the prevalence of major depression in an Australian community sample between 1998 and 2008. Aust N Z J Psychiatry 2010; 44: 901-910.
          • 11. Kessler RC, Demler O, Frank RG, et al. Prevalence and treatment of mental disorders, 1990 to 2003. N Engl J Med 2005; 352: 2515-2523.
          • 12. de Graaf R, ten Have M, van Gool C, van Dorsselaer S. Prevalence of mental disorders and trends from 1996 to 2009. Results from the Netherlands Mental Health Survey and Incidence Study-2. Soc Psychiatry Psychiatr Epidemiol 2012; 47: 203-213.
          • 13. Australian Bureau of Statistics. 4364.0.55.001. Australian Health Survey: first results, 2011–12. Issued Oct 2012. http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/4364.0.55.001main+features12011-12 (accessed Mar 2017).
          • 14. Andrews G, Slade T. Interpreting scores on the Kessler Psychological Distress Scale (K10). Aust N Z J Public Health 2001; 25: 494-497.
          • 15. Kessler RC, Andrews G, Colpe LJ, et al. Short screening scales to monitor population prevalences and trends in non-specific psychological distress. Psychol Med 2002; 32: 959-976.
          • 16. Australian Bureau of Statistics. 4326.0. National Survey of Mental Health and Wellbeing: summary of results. Issued Oct 2008. http://www.abs.gov.au/ausstats/abs@.nsf/mf/4326.0 (accessed Mar 2017).
          • 17. Australian Government, Department of Families, Housing, Community Services and Indigenous Affairs. Characteristics of disability support pension recipients. June 2011. Canberra: DFHCSIA, 2011. https://www.dss.gov.au/sites/default/files/documents/05_2012/dsp_characteristics_june2011.pdf (accessed Mar 2017).
          • 18. Knudsen AK, Hotopf M, Skogen JC, et al. The health status of nonparticipants in a population-based health study: the Hordaland Health Study. Am J Epidemiol 2010; 172: 1306-1314.
          • 19. Waghorn G, Sukanta S, Harvey C, et al. Earning and learning in those with psychotic disorders: the second Australian national survey of psychosis. Aust N Z J Psychiatry 2012; 46: 774-785.
          • 20. Australian Institute of Health and Welfare. National Drug Strategy Household Survey detailed report 2013 (AIHW Cat. No. PHE 183; Drug Statistics Series No. 28). Canberra: AIHW, 2014.
          • 21. Brugha TS, Bebbington PE, Singleton N, et al. Trends in service use and treatment for mental disorders in adults throughout Great Britain. Br J Psychiatry 2004; 185: 378-384.
          • 22. Black DC. Working for a healthier tomorrow. London: The Stationery Office, 2008. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/209782/hwwb-working-for-a-healthier-tomorrow.pdf (accessed Mar 2017).
          • 23. Butterworth P, Burgess P, Whiteford H. The changing profile of mental disorders among Disability Support Pension recipients. Med J Aust 2011; 195: 53-54. <MJA full text>
          • 24. Nieuwenhuijsen K, Bültmann U, Neumeyer-Gromen A, et al. Interventions to improve occupational health in depressed people. Cochrane Database Syst Rev 2008; (2): CD006237.
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            The sugar content of soft drinks in Australia, Europe and the United States

            Pia Varsamis, Robyn N Larsen, David W Dunstan, Garry LR Jennings, Neville Owen and Bronwyn A Kingwell
            Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.01316
            Published online: 5 June 2017

            Despite recommendations by the World Health Organization and the National Health and Medical Research Council to limit the drinking of sugar-sweetened beverages (SSBs), Australians are particularly high consumers of such products.1 In the report of the Australian Health Survey, 39% of males and 29% of females over 2 years of age had consumed SSBs on the day prior to the interview in 2011–2012,1 and these drinks were the largest sources of sugar in the Australian diet.2

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            • 1 Baker Heart and Diabetes Institute, Melbourne, VIC
            • 2 Monash University, Melbourne, VIC
            • 3 Sydney Medical School, University of Sydney, Sydney, NSW
            • 4 Swinburne University, Melbourne, VIC


            Correspondence: pia.varsamis@baker.edu.au
            Acknowledgements: 

            This work was funded by a National Health and Medical Research Council Program grant and the Victorian Government Operational Infrastructure Support scheme.

            Competing interests:

            No relevant disclosures.

            • 1. Australian Bureau of Statistics. 4364.0.55.007. Australian Health Survey: Nutrition first results — foods and nutrients, 2011–12. Table 18: Consumption of sweetened beverages. May 2014. http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/4364.0.55.0072011-12?OpenDocument (accessed Mar 2017).
            • 2. Australian Bureau of Statistics. 4804.0. National Nutrition Survey: foods eaten, Australia, 1995 [website]. Jan 1999. http://www.abs.gov.au/AUSSTATS/abs@.nsf/0/9A125034802F94CECA2568A9001393CE (accessed Mar 2017).
            • 3. Jameel F, Phang M, Wood LG, Garg ML. Acute effects of feeding fructose, glucose and sucrose on blood lipid levels and systemic inflammation. Lipids Health Dis 2014; 13: 195.
            • 4. Bantle JP, Raatz SK, Thomas W, Georgopoulos A. Effects of dietary fructose on plasma lipids in healthy subjects. Am J Clin Nutr 2000; 72: 1128-1134.
            • 5. Chong MF, Fielding BA, Frayn KN. Mechanisms for the acute effect of fructose on postprandial lipemia. Am J Clin Nutr 2007; 85: 1511-1520.
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              Preparedness for practice: the perceptions of graduates of a regional clinical school

              Jenny Barr, Kathryn J Ogden, Kim Rooney and Iain Robertson
              Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00845
              Published online: 5 June 2017

              Abstract

              Objective: To assess graduates’ self-reported preparedness with reference to a range of clinical practice capabilities, including those related to patient-centred care.

              Design: A retrospective survey of self-reported preparedness for practice, based on a survey developed by the Peninsula Medical School (United Kingdom) and adapted to account for Australian circumstances and to provide more information about patient-centred care-related capabilities.

              Setting and participants: Launceston Clinical School, a regional clinical school for undergraduate medical students. Medical students who had graduated during 2005–2014 and were contactable by email were invited to participate in the study.

              Main outcome measures: Graduates’ self-reported preparedness for practice in 44 practice areas, measured on a 5-point Likert scale.

              Results: Responses from 135 graduates (50% of invited graduates, 38% of the eligible graduate population) were received. Most graduates felt prepared in 41 of the 44 practice areas; 80% felt at least well prepared in 17 areas. After clustering the 44 areas into six thematic groups, no differences were found between men and women who had graduated in the past 4 years. As male graduates become more experienced (5–10 years after graduation), retrospective perceptions of preparedness in some areas differed from those of more recent graduates; this was not found for female graduates.

              Conclusion: The survey identified strengths and weaknesses in the preparation of doctors for practice. It could be more broadly applied in Australia to obtain longitudinal data for assessing the quality of learning for curriculum planning purposes, and for aligning graduates’ needs and expectations with those of the medical training and health care employment sectors.

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              • University of Tasmania, Launceston, TAS


              Correspondence: Jenny.barr@utas.edu.au
              Acknowledgements: 

              We acknowledge the contributions of Michelle Horder, research assistant for data collection, and Jessica Woodroffe, research fellow and contributor to methodological discussions.

              Competing interests:

              Kim Rooney is an Australian Medical Council Director, and Director of the Launceston Clinical School at the University of Tasmania.

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                Reducing cardiovascular disease risk in diabetes: a randomised controlled trial of a quality improvement initiative

                Santhi Chalasani, David P Peiris, Tim Usherwood, Julie Redfern, Bruce C Neal, David R Sullivan, Stephen Colagiuri, Nicholas A Zwar, Qiang Li and Anushka Patel
                Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00332
                Published online: 5 June 2017

                Abstract

                Objectives: To describe the management of cardiovascular disease (CVD) risk in Australian patients with diabetes; to compare the effectiveness of a quality improvement initiative for people with and without diabetes.

                Research design and methods: Subgroup analyses of patients with and without diabetes participating in a cluster randomised trial.

                Setting and participants: Indigenous people (≥ 35 years old) and non-Indigenous people (≥ 45 years old) who had attended one of 60 Australian primary health care services at least three times during the preceding 24 months and at least once during the past 6 months.

                Intervention: Quality improvement initiative comprising point-of-care electronic decision support with audit and feedback tools.

                Main outcome measures: Adherence to CVD risk screening and prescribing guidelines.

                Results: Baseline rates of guideline-recommended screening were higher for 8829 patients with diabetes than for 44 335 without diabetes (62.0% v 39.5%; P < 0.001). Baseline rates of guideline-recommended prescribing were greater for patients with diabetes than for other patients at high risk of CVD (55.5% v 39.6%; P < 0.001). The proportions of patients with diabetes not attaining recommended treatment targets for blood pressure, low-density lipoprotein-cholesterol or HbA1c levels who were not prescribed the corresponding therapy at baseline were 28%, 44% and 24% respectively. The intervention was associated with improved screening rates, but the effect was smaller for patients with diabetes than for those without diabetes (rate ratio [RR], 1.14 v 1.28; P = 0.01). It was associated with improved guideline-recommended prescribing only for undertreated individuals at high risk; the effect size was similar for those with and without diabetes (RR, 1.63 v 1.53; P = 0.28).

                Conclusions: Adherence to CVD risk management guidelines was better for people with diabetes, but there is room for improvement. The intervention was modestly effective in people with diabetes, but further strategies are needed to close evidence–practice gaps.

                Australian and New Zealand Clinical Trials Registry number: ACTRN12611000478910.

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                • 1 The George Institute for International Health, University of Sydney, Sydney, NSW
                • 2 Sydney Medical School, University of Sydney, Sydney, NSW
                • 3 Royal Prince Alfred Hospital, Sydney, NSW
                • 4 Boden Institute of Obesity, Nutrition and Exercise, University of Sydney, Sydney, NSW
                • 5 UNSW Australia, Sydney, NSW


                Correspondence: shanth_c@hotmail.com
                Acknowledgements: 

                We gratefully acknowledge the support of the general practices and Aboriginal Community Controlled Health Services that participated in this study. We also acknowledge the support of the Queensland Aboriginal and Islander Health Council, the Aboriginal Health and Medical Research Council, and the Western Sydney, Inner West Sydney, South Eastern Sydney, Eastern Sydney, South Western Sydney and Nepean–Blue Mountains Medicare Locals. We acknowledge Maria Agaliotis, Sharon Parker, Genevieve Coorey, Lyn Anderson and Melvina Mitchell for supporting the execution of the study. We thank Pen Computer Systems for their support in developing the software tools, and the Improvement Foundation for their support in developing and hosting the quality improvement portal. The National Health and Medical Research Council (NHMRC) and the New South Wales Department of Health funded the study, but had no role in its design or conduct, in the collection, management, analysis, and interpretation of the data, or in the preparation, review, or approval of this article. David Peiris was supported by an NHMRC Translating Research into Practice fellowship and is now an NHMRC Postdoctoral Fellow (1054754). Anushka Patel is supported by an NHMRC Senior Research Fellowship (632938). Julie Redfern is funded by an NHMRC Career Development Fellowship (1061793) co-funded with a National Heart Foundation Future Fellowship (G160523).

                Competing interests:

                No relevant disclosures.

                • 1. Wild S, Roglic G, Green A, et al. Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004; 27: 1047-1053.
                • 2. Access Economics, for Diabetes Australia. The growing cost of obesity in 2008: three years on. Canberra: Diabetes Australia, 2008. https://static.diabetesaustralia.com.au/s/fileassets/diabetes-australia/7b855650-e129-4499-a371-c7932f8cc38d.pdf (accessed Mar 2017).
                • 3. Cholesterol Treatment Trialists Collaborators; Kearney PM, Blackwell L, Collins R, et al. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008; 371: 117-125.
                • 4. Emdin CA, Rahimi K, Neal B, et al. Blood pressure lowering in type 2 diabetes: a systematic review and meta-analysis. JAMA 2015; 313: 603-615.
                • 5. National Vascular Disease Prevention Alliance. Guidelines for the management of absolute cardiovascular disease risk. Canberra: National Vascular Disease Prevention Alliance, 2012. https://www.heartfoundation.org.au/images/uploads/publications/Absolute-CVD-Risk-Full-Guidelines.pdf (accessed Mar 2017).
                • 6. Furler J, Hii JW, Liew D, et al. The “cost” of treating to target: cross-sectional analysis of patients with poorly controlled type 2 diabetes in Australian general practice. BMC Fam Pract 2013; 14: 32.
                • 7. Wan Q, Harris MF, Jayasinghe UW, et al. Quality of diabetes care and coronary heart disease absolute risk in patients with type 2 diabetes mellitus in Australian general practice. Qual Saf Health Care 2006; 15: 131-135.
                • 8. Saydah SH, Fradkin J, Cowie CC. Poor control of risk factors for vascular disease among adults with previously diagnosed diabetes. JAMA 2004; 291: 335-342.
                • 9. McFarlane SI, Jacober SJ, Winer N, et al. Control of cardiovascular risk factors in patients with diabetes and hypertension at urban academic medical centers. Diabetes Care 2002; 25: 718-723.
                • 10. Braga M, Casanova A, Teoh H, et al. Treatment gaps in the management of cardiovascular risk factors in patients with type 2 diabetes in Canada. Can J Cardiol 2010; 26: 297-302.
                • 11. Peiris D, Usherwood T, Panaretto K, et al. Effect of a computer-guided, quality improvement program for cardiovascular disease risk management in primary health care: the treatment of cardiovascular risk using electronic decision support cluster-randomized trial. Circ Cardiovasc Qual Outcomes 2015; 8: 87-95.
                • 12. Peiris D, Usherwood T, Panaretto K, et al. The Treatment of cardiovascular Risk in Primary care using Electronic Decision suppOrt (TORPEDO) study-intervention development and protocol for a cluster randomised, controlled trial of an electronic decision support and quality improvement intervention in Australian primary healthcare. BMJ Open 2012; 2: e002177.
                • 13. Peiris DP, Joshi R, Webster RJ, et al. An electronic clinical decision support tool to assist primary care providers in cardiovascular disease risk management: development and mixed methods evaluation. J Med Internet Res 2009; 11: e51.
                • 14. National Vascular Disease Prevention Alliance. Australian absolute cardiovascular risk calculator. http://www.cvdcheck.org.au/ (accessed Aug 2016).
                • 15. Peiris D, Agaliotis M, Patel B, Patel A. Validation of a general practice audit and data extraction tool. Aust Fam Physician 2013; 42: 816-819.
                • 16. Prevost G, Phan TM, Mounier-Vehier C, Fontaine P. Control of cardiovascular risk factors in patients with type 2 diabetes and hypertension in a French national study (Phenomen). Diabetes Metab 2005; 31: 479-485.
                • 17. Webster RJ, Heeley EL, Peiris DP, et al. Gaps in cardiovascular disease risk management in Australian general practice. Med J Aust 2009; 191: 324-329. <MJA full text>
                • 18. Peiris DP, Patel AA, Cass A, et al. Cardiovascular disease risk management for Aboriginal and Torres Strait Islander peoples in primary health care settings: findings from the Kanyini Audit. Med J Aust 2009; 191: 304-309. <MJA full text>
                • 19. Kellow N, Khalil H. A review of the pharmacological management of type 2 diabetes in a rural Australian primary care cohort. Int J Pharm Pract 2013; 21: 297-304.
                • 20. Hoerger TJ, Segel JE, Gregg EW, Saaddine JB. Is glycemic control improving in US adults? Diabetes Care 2008; 31: 81-86.
                • 21. Pentakota SR, Rajan M, Fincke BG, et al. Does diabetes care differ by type of chronic comorbidity? An evaluation of the Piette and Kerr framework. Diabetes Care 2012; 35: 1285-1292.
                • 22. Higashi T, Wenger NS, Adams JL, et al. Relationship between number of medical conditions and quality of care. N Engl J Med 2007; 356: 2496-2504.
                • 23. Owen AJ, Retegan C, Rockell M, et al. Inertia or inaction? Blood pressure management and cardiovascular risk in diabetes. Clin Exp Pharmacol Physiol 2009; 36: 643-647.
                • 24. Tricco AC, Ivers NM, Grimshaw JM, et al. Effectiveness of quality improvement strategies on the management of diabetes: a systematic review and meta-analysis. Lancet 2012; 379: 2252-2261.
                • 25. Morgan MA, Coates MJ, Dunbar JA, et al. The TrueBlue model of collaborative care using practice nurses as case managers for depression alongside diabetes or heart disease: a randomised trial. BMJ Open 2013; 3: e002171.
                • 26. Primary Health Care Advisory Group. Better outcomes for people with chronic and complex health conditions. Report of the Primary Health Care Advisory Group, December 2015. Canberra: Department of Health, 2016. http://www.health.gov.au/internet/main/publishing.nsf/Content/76B2BDC12AE54540CA257F72001102B9/$File/Primary-Health-Care-Advisory-Group_Final-Report.pdf (accessed Apr 2016).
                • 27. Osborn R, Moulds D, Schneider EC, et al. Primary care physicians in ten countries report challenges caring for patients with complex health needs. Health Aff (Millwood) 2015; 34: 2104-2112.
                • 28. Australian Institute of Health and Welfare. Aboriginal and Torres Strait Islander health services report 2011–12. Online services report: key results. Canberra: AIHW, 2013.
                • 29. Royal Australian College of General Practitioners. Cholesterol and other lipids (RACGP guidelines for preventive activities in general practice. 9th edition) [website]. http://www.racgp.org.au/your-practice/guidelines/redbook/8-prevention-of-vascular-and-metabolic-disease/83-cholesterol-and-other-lipids/ (accessed July 2016).
                • 30. Sacco RL, Roth GA, Reddy KS, et al. The Heart of 25 by 25: achieving the goal of reducing global and regional premature deaths from cardiovascular diseases and stroke: a modeling study from the American Heart Association and World Heart Federation. Circulation 2016; 133: e674-e690.
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                  Hip arthroscopy for femoroacetabular impingement: use escalating beyond the evidence

                  Flavia M Cicuttini, Andrew J Teichtahl and Yuanyuan Wang
                  Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00821
                  Published online: 5 June 2017

                  There is a concerning lack of data comparing surgical with non-surgical management of femoroacetabular impingement

                  Femoroacetabular impingement (FAI) is a common cause of groin pain in physically active young adults, accompanied by limited hip movements. It occurs when bony anatomical abnormalities of the femoral head-neck junction (cam deformity) and acetabular rim (pincer deformity) result in abnormal contact between the two joint surfaces during hip motion. Radiological evidence of FAI is present in about 25% of asymptomatic young adults in the general community.1 FAI increases the risk of end-stage hip osteoarthritis (OA) in later life and is a long term risk factor for joint replacement;2 it may be very disabling. The quality of life of young adults with FAI is comparable to that of older adults who had a total hip replacement for OA.3


                  • 1 Monash University, Melbourne, VIC
                  • 2 Baker IDI Heart and Diabetes Institute, Melbourne, VIC
                  • 3 Alfred Health, Melbourne, VIC


                  Correspondence: flavia.cicuttini@monash.edu
                  Acknowledgements: 

                  Andrew Teichtahl is the recipient of a National Health and Medical Research Council (NHMRC) Early Career Fellowship (no. 1073284). Yuanyuan Wang is the recipient of an NHMRC Career Development Fellowship (Clinical Level 1, no. 1065464).

                  Competing interests:

                  No relevant disclosures.

                  • 1. Ergen FB, Vudali S, Sanverdi E, et al. CT assessment of asymptomatic hip joints for the background of femoroacetabular impingement morphology. Diagn Interv Radiol 2014; 20: 271-276.
                  • 2. Nicholls AS, Kiran A, Pollard TC, et al. The association between hip morphology parameters and nineteen-year risk of end-stage osteoarthritis of the hip: a nested case–control study. Arthritis Rheum 2011; 63: 3392-3400.
                  • 3. Davis AM, Perruccio AV, Canizares M, et al. Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthritis Cartilage 2009; 17: 843-847.
                  • 4. Montgomery SR, Ngo SS, Hobson T, et al. Trends and demographics in hip arthroscopy in the United States. Arthroscopy 2013; 29: 661-665.
                  • 5. Palmer AJ, Malak TT, Broomfield J, et al. Past and projected temporal trends in arthroscopic hip surgery in England between 2002 and 2013. BMJ Open Sport Exerc Med 2016; 2: e000082.
                  • 6. Fairley J, Wang Y, Teichtahl AJ, et al. Management options for femoroacetabular impingement: a systematic review of symptom and structural outcomes. Osteoarthritis Cartilage 2016; 24: 1682-1696.
                  • 7. Harris JD, Erickson BJ, Bush-Joseph CA, Nho SJ. Treatment of femoroacetabular impingement: a systematic review. Curr Rev Musculoskelet Med 2013; 6: 207-218.
                  • 8. Nwachukwu BU, Rebolledo BJ, McCormick F, et al. Arthroscopic versus open treatment of femoroacetabular impingement: a systematic review of medium- to long-term outcomes. Am J Sports Med 2016; 44: 1062-1068.
                  • 9. Wall PD, Fernandez M, Griffin DR, Foster NE. Nonoperative treatment for femoroacetabular impingement: a systematic review of the literature. PM R 2013; 5: 418-426.
                  • 10. Siebenrock KA, Ferner F, Noble PC, et al. The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop Relat Res 2011; 469: 3229-3240.
                  • 11. Teichtahl AJ, Wang Y, Smith S, et al. Bone geometry of the hip is associated with obesity and early structural damage - a 3.0 T magnetic resonance imaging study of community-based adults. Arthritis Res Ther 2015; 17: 112.
                  • 12. Moseley JB, O’Malley K, Petersen NJ, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med 2002; 347: 81-88.
                  • 13. Bohensky MA, Sundararajan V, Andrianopoulos N, et al. Trends in elective knee arthroscopies in a population-based cohort, 2000–2009. Med J Aust 2012; 197: 399-403. <MJA full text>
                  • 14. Hawker G, Guan J, Judge A, Dieppe P. Knee arthroscopy in England and Ontario: patterns of use, changes over time, and relationship to total knee replacement. J Bone Joint Surg Am 2008; 90: 2337-2345.
                  • 15. Kim S, Bosque J, Meehan JP, et al. Increase in outpatient knee arthroscopy in the United States: a comparison of National Surveys of Ambulatory Surgery, 1996 and 2006. J Bone Joint Surg Am 2011; 93: 994-1000.
                  • 16. Katz JN, Losina E. Surgery versus physical therapy for meniscal tear and osteoarthritis. N Engl J Med 2013; 369: 677-678.
                  • 17. Wang Y, Dempsey AR, Lloyd DG, et al. Patellofemoral and tibiofemoral articular cartilage and subchondral bone health following arthroscopic partial medial meniscectomy. Knee Surg Sports Traumatol Arthrosc 2012; 20: 970-978.
                  • 18. Mezhov V, Teichtahl AJ, Strasser R, et al. Meniscal pathology — the evidence for treatment. Arthritis Res Ther 2014; 16: 206.
                  • 19. Larson CM, Giveans MR, Stone RM. Arthroscopic debridement versus refixation of the acetabular labrum associated with femoroacetabular impingement: mean 3.5-year follow-up. Am J Sports Med 2012; 40: 1015-1021.
                  • 20. Sihvonen R, Paavola M, Malmivaara A, et al. Arthroscopic partial meniscectomy versus sham surgery for a degenerative meniscal tear. N Engl J Med 2013; 369: 2515-2524.
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                    Primum non nocere: rethinking our policies on out-of-home care in Australia

                    Peter D Jones
                    Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00864
                    Published online: 5 June 2017

                    Are our child protection policies causing more harm to our most vulnerable children?

                    In Australia, there were 43 399 children in out-of-home care (OOHC) on 30 June 2015 (Box).1 Over the past 18 years, the rate at which Indigenous children have been placed in care has more than tripled and more than doubled for non-Indigenous children.1-3 This is disturbing, and particularly so for Indigenous children where one in 19 are in OOHC.1 A recent review of child maltreatment across various countries, including Australia, concluded that 40 years after contemporary child protection policies were introduced in the 1970s, there has been “no clear evidence for an overall decrease in child maltreatment”.4 Despite the call by this review for more evidence,4 there have been no studies planned to assess the effectiveness of our current OOHC policy in Australia.

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                    • Bond University, Gold Coast, QLD


                    Correspondence: pejones@bond.edu.au
                    Competing interests:

                    No relevant disclosures.

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                      Premature deaths of nursing home residents: an epidemiological analysis

                      Joseph E Ibrahim, Lyndal Bugeja, Melissa Willoughby, Marde Bevan, Chebiwot Kipsaina, Carmel Young, Tony Pham and David L Ranson
                      Med J Aust 2017; 206 (10): . || doi: 10.5694/mja16.00873
                      Published online: 5 June 2017

                      Abstract

                      Objectives: To conduct a descriptive epidemiological analysis of external cause deaths (premature, usually injury-related, and potentially preventable) of nursing home residents in Australia.

                      Design: Retrospective study of a cohort of nursing home residents, using coronial data routinely recorded by the National Coronial Information System.

                      Setting and participants: Residents of accredited Australian nursing homes, whose deaths were reported to coroners between 1 July 2000 and 30 June 2013, and determined to have resulted from external causes.

                      Main outcome measures: Causes of death, analysed by sex and age group, and by location of incidents leading to death and location of death. Rates of death were estimated on the basis of Australian Bureau of Statistics population and Australian Institute of Health and Welfare nursing home data.

                      Results: Of 21 672 deaths of nursing home residents, 3 289 (15.2%) resulted from external causes. The most frequent mechanisms of death were falls (2 679 cases, 81.5%), choking (261 cases, 7.9%) and suicide (146 cases, 4.4%). The incidents leading to death usually occurred in the nursing home (95.8%), but the deaths more frequently occurred outside the nursing home (67.1%). The annual number of external cause deaths in nursing homes increased during the study period (from 1.2 per 1000 admissions in 2001–02 to 5.3 per 1000 admissions in 2011–12).

                      Conclusion: The incidence of premature and potentially preventable deaths of nursing home residents has increased over the past decade. A national policy framework is needed to reduce the incidence of premature deaths among Australians living in nursing homes.

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                      • 1 Monash University, Melbourne, VIC
                      • 2 Victorian Institute of Forensic Medicine, Melbourne, VIC


                      Correspondence: Joseph.Ibrahim@monash.edu
                      Acknowledgements: 

                      This work was supported by the federal Department of Social Services, the Victorian Department of Health and Human Services (Ageing and Aged Care Branch), and the Department of Forensic Medicine, Monash University. None of the funders influenced the design, methods, subject recruitment, data collection, analysis or preparation of the paper.

                      Competing interests:

                      We are affiliated with or employed by the Department of Forensic Medicine, Monash University, which was also a funding source.

                      • 1. Ibrahim J, Murphy B, Bugeja L, Ranson D. Nature and extent of external-cause deaths of nursing home residents in Victoria, Australia. J Am Geriatr Soc 2015; 63: 954-962.
                      • 2. Hitchen T, Ibrahim J, Woolford M, Bugeja L. Premature and preventable deaths in frail, older people: a new perspective. Ageing Soc 2016; doi:10.1017/S0144686X16000428.
                      • 3. Stoeckel KJ, Porell FW. Do older adults anticipate relocating? The relationship between housing relocation expectations and falls. J Appl Gerontol 2010; 29: 231-250.
                      • 4. Hallberg D, Lagergren M. Moving in and out of public old age care among the very old in Sweden. Eur J Ageing 2009; 6: 137-145.
                      • 5. Saito T, Lee H, Kai I. Health and motivation of elderly relocating to a suburban area in Japan. Arch Gerontol Geriatr 2007; 45: 217-232.
                      • 6. McClure RJ, Davis E, Yorkston E, et al. Special issues in injury prevention research: developing the science of program implementation. Injury 2010; 41: S16-S19.
                      • 7. Swerissen H, Duckett S. Dying well (Grattan Institute Report No. 2014-10). Melbourne: The Grattan Institute, 2014. https://grattan.edu.au/wp-content/uploads/2014/09/815-dying-well.pdf (accessed Mar 2017).
                      • 8. World Health Organization. Improving the quality and use of birth, death and cause-of-death information: guidance for a standards-based review of country practices. Geneva: WHO, 2010. http://www.who.int/healthinfo/tool_cod_2010.pdf (accessed Mar 2017).
                      • 9. National Coroners Information System. About NCIS [website]. www.ncis.org.au/data-collection/ (accessed Mar 2017).
                      • 10. National Coroners Information System. Data dictionary for the National Coronial Information System. Version 3b. Melbourne: NCIS, 2014. http://www.ncis.org.au/wp-content/uploads/2014/06/DataDictionary-Version3b-revised.pdf (accessed Mar 2017).
                      • 11. Australian Bureau of Statistics. 3101.0. Australian demographic statistics, Jun 2016. Population by age and sex, Australia, states and territories. Dec 2016. http://www.abs.gov.au/ausstats/abs@.nsf/0/1CD2B1952AFC5E7ACA257298000F2E76?OpenDocument (accessed Mar 2017).
                      • 12. Australian Government, Productivity Commission. Report on government services 2015. 13. Aged care services. http://www.pc.gov.au/research/ongoing/report-on-government-services/2015/community-services/aged-care-services (accessed Mar 2017).
                      • 13. Australian Government, Department of Health. Aged Care Service List — 30 June 2014 — Australia. https://agedcare.health.gov.au/ageing-and-aged-care-overview/about-aged-care/aged-care-service-list-30-june-2014-australia (accessed Mar 2017).
                      • 14. Australian Institute of Health and Welfare. Residential aged care in Australia 2010–11: a statistical overview. Canberra: AIHW, 2012.
                      • 15. Broad JB, Gott M, Kim H, et al. Where do people die? An international comparison of the percentage of deaths occurring in hospital and residential aged care settings in 45 populations, using published and available statistics. Int J Public Health 2013; 58: 257-267.
                      • 16. Kalisch B, Landstrom G, Williams R. Missed nursing care: errors of omission. Nurs Outlook 2009; 57: 3-9.
                      • 17. World Health Organization. International statistical classification of diseases and related health problems. Geneva: WHO, 2006.
                      • 18. World Health Organization. More than words: conceptual framework for the international classification for patient safety. Version 1.1. Geneva: WHO, 2009. www.who.int/patientsafety/taxonomy/icps_full_report.pdf (accessed Mar 2017).
                      • 19. Berry C, Heaton-Armstrong A. A review of the coroner system in England and Wales: a commentary. Clin Med 2005; 5: 455-459.
                      • 20. Gjertsen F, Johansson LA. Changes in statistical methods affected the validity of official suicide rates. J Clin Epidemiol 2011; 64: 1102-1108.
                      • 21. Australian Bureau of Statistics. One in four Australians aged 65 years and over by 2056: ABS [media release]. 4 Sept 2008. http://www.abs.gov.au/ausstats/abs@.nsf/mediareleasesbyTopic/2CA2134677EF9D03CA257C2E0017283B?OpenDocument (accessed Mar 2016).
                      • 22. Australian Government, Productivity Commission. Caring for older Australians. Inquiry report. Canberra: PC, 2011. http://www.pc.gov.au/inquiries/completed/aged-care/report#contents (accessed Mar 2017).
                      • 23. Bugeja L, Ibrahim J, Ferrah N, et al. The utility of medico-legal databases for public health research: a systematic review of peer-reviewed publications using the National Coronial Information System. Health Res Policy Syst 2016; 14: 28.
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