Volume 205 Issue 10

When appropriately resourced, medical homes can deliver the system-wide benefits of truly integrated primary care

John M Dwyer · Stephen J Duckett

Long term outcomes primarily depend on left ventricular function

Hugh D Wolfenden · Greg Cranney

Providing patients with accurate information will help overcome obstacles to the use of an effective treatment for rheumatoid arthritis

Mark H Arnold · Jane Bleasel · Inam Haq

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Capucine Odouard · Chih-Hung Kuo · Yasser M Tariq · Jerome HI Ha · Brighu Swamy

N/A

Michelle T Leech · Stephen T Hall

Woe, oh woe is I

Kirsten Due

Better targeted therapies will reduce the burden of treatment, while improving the outcomes

Ian N Olver

Although evidence for increasing incidence has not yet been reported, we should be vigilant

Moe Kyaw · Joseph JY Sung

A comprehensive evidence base for informing efforts to improve services requires linked national data

David M Roder · Elizabeth Buckley

Broad descriptions of variation are a useful way of finding disparities, but to generate change they need to be carefully analysed and applied

Richard C Madden · Andrew Wilson · Philip Hoyle

The excess burden of cancer among Indigenous people will persist until lifestyle risks are mitigated

John R Condon · Xiaohua Zhang · Karen Dempsey · Lindy Garling · Steven Guthridge

Location of residence may negatively influence the quality of care received by patients with pancreatic cancer

Elizabeth A Burmeister · Dianne L O'Connell · Susan J Jordan · David Goldstein · Neil Merrett · David K Wyld · Vanessa L Beesley · Helen M Gooden · Monika Janda · Rachel E Neale

The incidence of CRC in people under 50 in NSW was steady during 2001–2008

Stephen Boyce · Natasha Nassar · Cathy Yuen Yi Lee · Michael KL Suen · Saleh Al Zahrani · Marc A Gladman

Meeting supportive care needs is key to maximising patients’ quality of life and minimising recurrence

Nicholas Zdenkowski · Stephanie Tesson · Janine Lombard · Melanie Lovell · Sandra Hayes · Prudence A Francis · Haryana M Dhillon · Frances M Boyle

Modifiable lifestyle factors may reduce the risk of developing breast cancer. Obesity is associated particularly with post-menopausal breast cancer. Diet is important, and exercise equivalent to running for up to 8 hours each week reduces the risk of breast cancer, both in its own right and through reducing obesity. Alcohol consumption may be responsible for 5.8% of breast cancers in Australia and it is recommended to reduce this to two standard drinks per day. Drinking alcohol and smoking increases the risk for breast cancer and, therefore, it is important to quit tobacco smoking. Prolonged use of combined oestrogen and progesterone hormone replacement therapy and oral contraceptives may increase breast cancer risk and this must be factored into individual decisions about their use. Ionising radiation, either from diagnostic or therapeutic radiation or through occupational exposure, is associated with a high incidence of breast cancer and exposure may be reduced in some cases. Tamoxifen chemoprevention may reduce the incidence of oestrogen receptor positive cancer in 51% of women with high risk of breast cancer. Uncommon but serious side effects include thromboembolism and uterine cancer. Raloxifene, which can also reduce osteoporosis, can be used in post-menopausal women and is not associated with the development of uterine cancer. Surgical prophylaxis with bilateral mastectomy and salpingo-oophorectomy can reduce the risk of breast cancer in patients carrying BRCA1 or BRCA2 mutations. For preventive treatments, mammographic screening can identify other women at high risk.

Ian N Olver

Maturity onset diabetes of the young (MODY), the most common monogenic form of diabetes, accounts for 1–2% of all diabetes diagnoses. Glucokinase (GCK)-MODY (also referred to as MODY2) constitutes 10–60% of all MODY cases and is inherited as an autosomal dominant heterozygous mutation, resulting in loss of function of the GCK gene. Patients with GCK-MODY generally have mild, fasting hyperglycaemia that is present from birth, are commonly leaner and diagnosed at a younger age than patients with type 2 diabetes, and rarely develop complications from diabetes. Hence, treatment is usually unnecessary and may be ceased. Therefore, genetic screening is recommended in all young patients (< 40 years) with an autosomal dominant family history of diabetes and who lack features of the metabolic syndrome and type 1 diabetes. Further, treatment discontinuation should be discussed with the patient as part of the informed consent process, as the realisation that prior treatment may have not been necessary — or that it could have been less burdensome — may have psychological implications for the patient. This is true for other forms of MODY, such as hepatocyte nuclear factor 1A mutations (MODY3) where hyperglycaemia is managed with low dose sulfonylurea rather than insulin. Patients with GCK-MODY, in line with trends in the general population, are becoming older and more overweight and obese, and are concomitantly developing features of insulin resistance and glucose intolerance. Therefore, controversy exists as to whether such “treatment-exempt” patients should be reassessed for treatment later in life. As testing becomes more accessible, clinicians and patients are likely to embrace genetic screening earlier in the course of diabetes, which may avert the consequences of delayed testing years after diagnosis and treatment initiation.

Ramy H Bishay · Jerry R Greenfield

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Monisha Gupta · Marius Rademaker · John R Sullivan · Peter Foley

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Betty SH Chan · Nicholas A Buckley

In reply

Rose Cairns · Jared A Brown · Nicholas A Buckley

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Megan Ann Sabine Penno · Rebecca Louise Thomson · Jennifer J Couper

Associate Professor Chris Karapetis has just cycled through Cambodia, raising funds for cancer research. It’s part of his determination to make a difference

Cate Swannell

Former University of Queensland (UQ) Parkinson’s researcher Caroline Barwood has been given a 2-year suspended sentence after being found guilty of fraud by a Brisbane jury, according to Retraction Watch. She was found guilty of five of the seven charges laid against her. “Earlier this year, Bruce Murdoch, a former colleague of Barwood’s at [UQ], pleaded guilty to 17 fraud-related charges, and earned himself the same sentence. In Barwood’s week-long trial, the court heard that she was previously in an intimate relationship with Murdoch. Both left the UQ in 2013.” One fraud charge against Barwood was related to obtaining a scholarship from the Lions Medical Research Foundation. Earlier in 2016, The Australian reported that UQ had returned part of a $300 000 grant to Barwood from the organisation. The other charge was a result of including her name on two studies without justification. Barwood, 31, was found to have tried to obtain up to $700 000 for a 2009 study about Parkinson’s disease that never took place. Two of the three charges of attempted fraud included trying to obtain funds by applying to early career fellowships. The other was for dishonestly trying to earn a travel grant of $2000 to travel to a conference and present a paper. UQ vice-chancellor and President Professor Peter Høj said in a statement that: “The University has been complimented for its proactive and open stance on this matter and I’m pleased that proceedings have now reached an end. UQ has ongoing educational programs to inform researchers of their obligations under University policy and the Australian Code for Responsible Conduct of Research to conduct their research with responsibility and integrity, and I am confident that the vast majority of our researchers take research integrity very seriously.” http://retractionwatch.com/2016/10/25/parkinsons-researcher-avoids-jail-following-fraud-conviction/ http://www.theaustralian.com.au/higher-education/exprofessor-found-guilty-of-fraud/news-story/7a6561bada1bf52f517d97164e140f35 The Nature Index has released its 2016 tables and the University of Queensland has finished highest among Australian research institutions. The Nature Index is a “database of author affiliation information collated from research articles published in an independently selected group of 68 high-quality science journals … and provides a close to real-time proxy for high-quality research output at the institutional, national and regional level”. UQ was the top-ranked Australian university, coming in at 105 on the Institutions table which was topped by the Chinese Academy of Sciences, with Harvard University second. Monash University came in at 110, ahead of the Australian National University (117), University of Melbourne (151), University of NSW (158), University of Sydney (167), University of WA (288), University of Adelaide (375), Curtin University (428), Macquarie University (476), and the University of Wollongong (480). The USA topped the Countries table, ahead of China, Germany and the UK, with Australia 12th. Harvard topped the Academic table, with UQ (89), Monash (93), ANU (100), University of Melbourne (130), UNSW (136), University of Sydney (143), UWA (241), Curtin (358), Macquarie (393), UOW (396), University of Tasmania (450), and RMIT University (500). On the Life Sciences table, UQ was again the top-ranked Australian university at 65, with no others in the top 100, which was led by Harvard. http://www.natureindex.com/annual-tables/2016 HIV/AIDS researcher Associate Professor Melissa Churchill has joined RMIT in a research-only professorial position after 27 years at the Burnet Institute, most recently as the Head of the HIV Neuropathogenesis Laboratory. During her career at Burnet, Associate Professor Churchill has been in various roles, as a research assistant, PhD student, junior fellow, senior fellow, lab co-head and finally lab head. Her research interests have been focused around HIV infection of the central nervous system and its implications for the development of HIV-associated dementia, as well as latent CNS viral infection. She has been recognised internationally for her research, which has been published in a number of high impact journals and has led to significant changes in the way neurocognitive disorders associated with HIV are now treated. Burnet Institute Director and CEO Brendan Crabb AC said Associate Professor Churchill embodied the unique culture of Burnet: “that rigorous scientific approach with humanitarian ideals”. https://www.burnet.edu.au/news/743_farewell_to_burnet_trailblazer_melissa_churchill The Deputy Head of Burnet Institute’s Centre for Biomedical Research, Associate Professor Heidi Drummer has been recognised with the Institute’s Frank Fenner Award for her landmark research into hepatitis C. Associate Professor Drummer’s laboratory conducts studies into hepatitis C virus (HCV) with a special focus on the development of a vaccine. To date, no vaccine exists for HCV, which is estimated to chronically infect 3% of the world’s population, causing 350 million deaths each year. Delivering the 2016 Frank Fenner Lecture, Associate Professor Drummer said a vaccine was desperately needed to work in concert with new direct acting antiviral drugs to achieve HCV elimination. The Frank Fenner Award acknowledges significant contribution to Burnet’s vision and mission in the areas of medical research and public health, and is named after the great Australian virologist, the late Professor Frank Fenner AC. https://www.burnet.edu.au/news/741_prestigious_2016_frank_fenner_award_for_heidi_drummer Diabetes researcher and Chief Scientific Officer at Baker IDI Heart and Diabetes Institute, Professor Mark Cooper, has become the first Australian to receive the prestigious Claude Bernard award from the European Association for the Study of Diabetes. The award recognises an individual’s innovative leadership and outstanding contributions to the advancement of knowledge in the field of diabetes mellitus and related metabolic diseases. In addition to leading a research group at Baker IDI in the field of diabetic complications, Professor Cooper heads the Joint National Health and Medical Research Council (NHMRC) Juvenile Diabetes Research Foundation International (JDRF) Diabetes Complications Centre of Research Excellence (DC-CRE), encompassing the Danielle Alberti Memorial Centre for Diabetes Complications that he established in 2003. Professor Cooper has made numerous important discoveries in the field of diabetes. In particular, his early work played a pivotal role in defining the protective effects of drugs which interrupt the renin-angiotensin system, a hormone system involved in the regulation of blood pressure. His recent major field of research endeavour has been exploring metabolic memory and its epigenetic origins. His key discoveries may partly explain the sustained ‘legacy’ of beneficial effects arising from improved glucose control in people with diabetes, as well as contribute to the irreversible legacy of vascular damage observed in some patients with longstanding type 2 diabetes. This aspect of research in diabetic complications is now an active area of research worldwide. https://www.bakeridi.edu.au/news/media-releases/MR-prestigious-international-award QIMR Berghofer Medical Research Institute has introduced an innovative financial assistance policy for working mothers. QIMR Berghofer’s Director and CEO, Professor Frank Gannon, said that women scientists whose careers were advancing to seniority and who had at least one child below high-school age could apply for financial assistance in addition to their salaries. The policy is one of several measures the institute has introduced to support working parents. These include offering flexible work hours, reserving places at a local childcare centre for children under two, and having a designated room at the institute for nursing mothers. “This funding will help to level the playing field by making it easier for women with young children to keep publishing research so they can continue to advance their careers,” Professor Gannon said. “The funds can be used at their discretion. For example, it could be used to pay for child care, or a research assistant to help with lab experiments, or it could be used to pay for parking close to work so it’s easier to get kids to and from day care. “Women postdoctoral scientists who are mothers and are at a slightly earlier stage of their careers will be able to apply for assistance for particular expenses. This could include paying for childcare while the scientist travels to an important conference, or paying the travel costs for a family member to attend the conference with the researcher and her baby.” http://www.qimrberghofer.edu.au/2016/10/qimr-berghofer-helps-women-scientists-rise-top/ The Australian Academy of Health and Medical Sciences has inducted 50 new Fellows, bringing its total Fellowship to 272. New Fellows are drawn from all states and territories of Australia, and from all aspects of health and medical science across clinical practice and allied health care, with representation from basic translational and clinical research, health economics, general practice and public health. The new Fellows are: Professor Kylie Ball (NHMRC Principal Research Fellow, Deakin University); Professor David Bowtell (Head, Cancer Genomics and Genetics Program, Peter MacCallum Cancer Centre); Professor Richard Bryant (NHMRC Senior Principal Research Fellow, University of NSW); Professor Roger Byard (Senior Specialist Forensic Pathologist, University of Adelaide); Professor Allan Cripps (Research Professor, Griffith University); Professor Susan Davis (Head, Women’s Health Research Program, Monash University); Professor Basil Donovan (Head, Sexual Health Program, Kirby Institute); Professor Greg Dore (Head, Viral Hepatitis Clinical Research Program, Kirby Institute); Professor Elizabeth Elliott (Professor of Paediatrics and Child Health and Consultant Paediatrician, University of Sydney); Professor Geoffrey Farrell (Professor of Hepatic Medicine, ANU Medical School); Professor Stephen Fox (Director of Pathology, Peter MacCallum Cancer Centre); Professor Simon Gandevia (Deputy Director, Neuroscience Research Australia); Professor Jürgen Götz (Foundation Chair of Dementia Research, Clem Jones Centre for Ageing Dementia Research, Queensland Brain Institute, University of Queensland); Professor Jane Gunn (Department of General Practice, University of Melbourne); Professor Jane Hall (Professor of Health Economics, University of Technology Sydney); Professor Graeme Hankey (Professor of Neurology, University of Western Australia); Professor Ian Harris (Professor of Orthopaedic Surgery, University of NSW); Professor Richard Harvey (Head, Developmental and Stem Cell Biology Division, Victor Chang Cardiac Research Institute); Professor Rob Herbert (Senior Principal Research Fellow, Neuroscience Research Australia); Professor Ken Ho (Chair, Division of Research, Metro South Health Service); Professor Maria Kavallaris (Head, Tumour Biology and Targeting Program, Children’s Cancer Institute); Professor Tom Kay (Director, St. Vincent’s Institute of Medical Research); Professor Richard Kefford (Head, Department of Clinical Medicine, Macquarie University); Professor Ben Kile (Head, ACRF Chemical Biology Division, Walter and Eliza Hall Institute of Medical Research); Professor Trevor Kilpatrick (Director, Melbourne Neuroscience Institute, University of Melbourne); Professor Jayashri Kulkarni (Director, Monash Alfred Psychiatry Research Centre); Professor Fabienne Mackay (Head, School of Biomedical Sciences, University of Melbourne); Professor Christine McDonald (Director, Department of Respiratory and Sleep Medicine, Austin Health); Professor Ross McKinnon (Professor in Cancer Research, Flinders University); Professor Catriona McLean (Alfred Health); Professor John McNeil (Head, School of Public Health (Monash University); Professor Jonathan Morris (Director, Kolling Institute Medical Research); Professor Robyn Norton (Principal Director, The George Institute for Global Health); Professor Terry O’Brien (James Stewart Professor of Medicine, University of Melbourne); Professor Ian Olver (Director, Sansom Institute for Health Research, University of South Australia); Professor Vlado Perkovic (Executive Director, George Institute for Global Health); Professor Rodney Phillips (Dean of Medicine, University of NSW); Professor Miles Prince (Director, Centre for Blood Cell Therapies, Peter MacCallum Cancer Centre); Professor William Rawlinson (Director of Serology, Virology and OTDS screening, NSW Health Pathology); Professor Linda Richards (Deputy Director of Research, Queensland Brain Institute); Professor Rob Sanson (Director, Priority Research Centre for Health Behaviour, University of Newcastle); Professor Christobel Saunders (Professor of Surgical Oncology and Head of General Surgery, University of WA); Professor Paul Scuffham (Director, Centre for Applied Health Economics, Griffith University); Professor Roland Stocker (Head, Vascular Biology Division, Victor Chang Cardiac Research Institute); Professor Andreas Strasser (Joint Division Head, Molecular Genetics of Cancer Division, Walter and Eliza Hall Institute of Medical Research); Professor Jane Visvader (Joint Head, Stem Cells and Cancer Division, Walter and Eliza Hall Institute of Medical Research); Professor Claire Wainwright (Consultant Paediatrician, Children’s Health Queensland); Professor Harvey Whiteford (Professor of Population Mental Health, Queensland Centre for Mental Health Research); Professor Ian Wicks (Head of Inflammation Division and Director Rheumatology Unit, Walter and Eliza Hall Institute of Medical Research); Professor Keryn Williams (Professor in Ophthalmology, Flinders University).

Cate Swannell

Med J Aust 2016; 205 (10 Suppl).