Volume 206 Issue 11

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

Nigel Strauss

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

Gerhard Leinenga · Rebecca M Nisbet · Jürgen Götz

Cognitive behaviour therapy is an effective strategy for overcoming the challenges of health anxiety

Jill M Newby · Gavin Andrews

A 73-year-old farmer presented with a finger injury after the spontaneous rupture of a hydraulic hose

Anna T Ryan · Bruce R Johnstone

Social media and the tools that help us use it can facilitate both medical education and practice

Victoria Brazil · Casey Parker

In the previous article on confounding in this series,1 we presented the traditional explanation of a confounder. Over the past few decades, it has become clear that this definition has many limitations. For example, confounding can be induced by a network of variables rather than just a single variable, and adjusting for potential confounders can paradoxically increase confounding. What are directed acyclic graphs? One of the few true innovations in epidemiological methods has been the emergence of directed acyclic graphs (DAGs) to identify confounding. This development began in the early 1990s with work by Pearl and Robins based on formal logic and machine learning.2-4 DAGs are a formal system of mapping variables and the direction of causal relationships among them. “Directed” refers to arrows indicating the direction of causality between variables, and “acyclic” means that it should not be possible to start from any one variable and follow a series of arrows back to the original variable. Entire books are devoted to this method,2-4 but just a few highlights are sufficient to help clinicians understand confounding.5 In the example of smoking (exposure) and dementia (outcome) that we used in the previous article, we postulated that alcohol might be a confounder.1 These relationships are illustrated using a simple DAG in Box 1. Drinking alcohol may increase the risk of smoking — hence the arrow pointing from alcohol to smoking — and may also increase the risk of developing dementia — hence the arrow pointing from alcohol to dementia — but alcohol is not an intermediate between smoking and dementia. Smoking leads to cardiovascular disease (CVD), which also increases the risk of dementia; in this case, CVD is an intermediate between smoking and dementia. Alcohol is likewise causally related to CVD. If we observe a relationship between smoking and dementia, it is therefore not clear whether this is valid or whether it is spurious because of the effect of the other variables. How to read a DAG The steps to take in interpreting a DAG are as follows: Remove all arrows emanating from the exposure of interest. Look for any remaining path, called a “backdoor path”, that links the outcome to the exposure. A path is defined by successive arrows regardless of the direction of the arrowheads. A backdoor path is “closed” if any variable on that path is a “collider”, which is a variable with two arrowheads pointing into it from other variables on the same path. If a backdoor path can be traced and is “open” (ie, it does not include a collider), then adjusting for any variable on that path will close the backdoor path and remove confounding. Adjusting for a collider will reopen the backdoor path and increase confounding. In our example (Box 1), when we remove the arrows pointing from the exposure (smoking), we can no longer trace a path from dementia through CVD to smoking. This means that CVD is not a confounder but a mediator. Adjusting for CVD could therefore remove part of the effect of smoking that we are trying to detect; this is called over-adjustment bias.6 However, we can still trace a path from dementia through alcohol to smoking. This path does not include a collider and is thus open. By adjusting for alcohol, we can close this backdoor path and remove confounding due to alcohol. Note that another backdoor path exists from dementia through CVD to alcohol and then smoking. Adjusting for alcohol has therefore closed two backdoor paths at once. Using DAGs may seem like a convoluted process, with little benefit, compared with the old definition of confounding we presented in the previous article.1 This is certainly true when models are as simple as this one. But what happens when we want to tackle more complicated models? Let us assume we add the variables of socio-economic status (SES), diet, sex and age to the model, as shown in Box 2. How does the old definition of confounding apply here? Should we just adjust for everything? The DAG helps us sort out these relationships and decide on covariates to include in regression models. Open backdoor paths in this model include: Dementia – CVD – diet – SES – smoking Dementia – alcohol – SES – smoking Dementia – CVD – age – sex – smoking We should therefore adjust for a variable on these paths to remove confounding (eg, adjusting for SES closes the first two backdoor paths and adjusting for age closes the third backdoor path). Note that CVD remains a mediator. Another backdoor path that can be traced is: Dementia – CVD – age – sex – alcohol – SES – smoking This is already a closed path because alcohol is a collider on this path (ie, two arrows point into alcohol along this path, from sex and SES). Note that alcohol is a collider on this path but not necessarily on other paths. As this path is already closed, we do not need to adjust for any variables on it; indeed, if we were to adjust for alcohol (the collider), we would reopen a route for confounding! It takes reading and practice to become familiar with these rules, but they are extremely powerful in teasing out complex causal pathways. The astute reader will realise that trying to reduce confounding by adjusting for one variable along an open backdoor path could increase confounding if that variable is also a collider on another backdoor path. For example, as we saw above, adjusting for alcohol could close the backdoor path of dementia – alcohol – smoking, but it could also reopen the closed path of dementia – CVD – diet – SES – alcohol – sex – smoking, because alcohol is a collider on this pathway (Box 2). A tool to help readers learn to draw and interpret DAGs is a free software program called DAGitty (http://www.dagitty.net/dags.html).7 This program is reasonably intuitive, flexible and fast to learn. It allows the user to easily draw DAGs and, as a bonus, “reads” the DAG to provide the minimum set of variables for which it is essential to adjust to remove confounding. Other similar programs are also available, such as TETRAD (http://www.phil.cmu.edu/projects/tetrad), DAG (https://epi.dife.de/dag), and dagR, a set of functions for the statistical software R. The power of DAGs DAGs are powerful in that they lead us to several observations: Identifying confounders depends on the underlying causal model that is assumed. Confounding can be due to a network of variables, not just a single variable. Assumptions (model) must be drawn before conclusions (analysis) are drawn. The relationship between variables can be specified in many different ways (ie, the direction of the arrows can influence decisions made for analysis). All backdoor paths must ultimately have one variable with an arrowhead leading into the exposure; this means that confounding in complex webs of causation can be analysed by looking for the few variables that have arrows pointing to the exposure. Many routes of confounding can potentially be closed by adjusting for just one or two variables. Adjusting for confounding It could be argued that one should just adjust for all potential variables — the so-called kitchen sink approach — rather than taking any chances on specifying a potentially incorrect model. Although often appealing because of its simplicity, there are two main reasons why this approach is not recommended. The first is inefficiency: every variable that is added to the model uses degrees of freedom, which are the currency of power. This is particularly a problem for small studies, where problems such as over-fitting due to data sparsity and collinearity may arise.8 Adjusting for variables that are not confounders wastes power and may reduce the ability to detect an association. (There is a separate argument for including variables on the basis that they help explain the outcome and hence increase power; this can be thought of as “mopping up” some of the variance in the outcome so that there is more power to detect the contribution of the exposure, but this consideration is separate from confounding.) The second reason is bias: as we have seen, adjusting for a variable that is a collider reopens a backdoor path and increases the potential for confounding. Ideally, every study should make explicit the causal model behind the analysis. Residual confounding Unfortunately, even accurate specification of the causal model and expert use of DAGs do not completely remove confounding. This situation is called residual confounding, which occurs for three reasons. First, longitudinal data may not be available. With cross-sectional data, we can never be sure about the direction of causality (ie, the “chicken and egg” problem). Second, as we are not able to measure most variables perfectly, even adjusting for a variable cannot fully remove its effect. If we think of confounding as a flow of water that travels along the backdoor path, our inability to accurately measure SES, for example, means that we are unable to fully turn off the tap at that point. This is an argument for possibly adjusting for multiple variables along a backdoor path, so that the flow of confounding is reduced at multiple points instead of one point only. Third, in any observational study, we can never be sure that we have included and measured all the relevant potential confounders. What other variables have we not thought of, and not included on the diagram, that could create a backdoor path between our outcome and our exposure? As we saw in the previous article,1 the ultimate solution to confounding is a randomised controlled trial. When this is possible, it means that all known and unknown confounders are evenly balanced across the arms of the trial, thus removing their ability to affect the outcome. Box 1 – Simple causal diagram of smoking and dementia, with effect of alcohol (potential confounder) and cardiovascular disease (mediator)* People who drink alcohol are also more likely to smoke; alcohol may affect risk of dementia and CVD; and CVD may influence risk of dementia (eg, through subclinical infarcts). Green arrows radiating from the exposure are ignored when reading the pathways for potential confounding. CVD = cardiovascular disease. *Figure originally drawn with DAGitty (http://www.dagitty.net/dags.html). Box 2 – Causal diagram of smoking and dementia, with effect of alcohol (potential confounder) and cardiovascular disease (mediator), plus sex, age, socio-economic status and diet* Sex influences alcohol consumption, smoking and age (men are more likely than women to drink alcohol and smoke, and women live longer than men); SES influences alcohol consumption, smoking and diet; diet influences CVD; and age influences risk of CVD and dementia. As in the simple model in , we have to adjust for alcohol to close the dementia – alcohol – smoking path. However, doing this reopens the dementia – CVD – diet – SES – alcohol – sex – smoking path, because alcohol is a collider on this path. So we have to also adjust for sex or SES, or both, to reclose this path. Adjusting for sex, alcohol and SES would therefore be sufficient to remove confounding in this analysis of smoking and dementia. CVD = cardiovascular disease. SES = socio-economic status. *Figure originally drawn with DAGitty (http://www.dagitty.net/dags.html).

John R Attia · Christopher Oldmeadow · Elizabeth G Holliday · Michael P Jones

Interpreting positive cytomegalovirus serology requires caution, and follow-up testing is important

Alana Christensen · Anushia Ashokan · David L Gordon

It’s time for Victoria to follow the lead of New South Wales and establish a supervised injecting facility

Ines M Rio · Jonathan Epstein

Psychiatry in practice: education, experience and expertise

Cherrie A Galletly

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

Harvey A Whiteford

We are still seriously failing to resource and integrate mental health into the mainstream of the health care system

Patrick D McGorry · Matthew P Hamilton

The increasing costs and disability associated with mental ill-health are not correlated with any increase in its prevalence

Samuel B Harvey · Mark Deady · Min-Jung Wang · Arnstein Mykletun · Peter Butterworth · Helen Christensen · Philip B Mitchell

Acupuncture is accepted by patients, and its analgesic effect in some conditions is comparable with that of pharmacotherapy

Marc M Cohen · De Villiers Smit · Nick Andrianopoulos · Michael Ben-Meir · David McD Taylor · Shefton J Parker · Chalie C Xue · Peter A Cameron

An increasingly popular ancient practice can be hazardous

Marc A Seifman · K Skaria Alexander · Cheng H Lo · Heather Cleland

This update to the 2005 RANZCP guidelines has a greater emphasis on psychosocial treatments, physical health comorbidities and vocational rehabilitation

David J Castle · Cherrie A Galletly · Frances Dark · Verity Humberstone · Vera A Morgan · Eóin Killackey · Jayashri Kulkarni · Patrick McGorry · Olav Nielssen · Nga T Tran · Assen Jablensky

To the Editor:We commend Milner and colleagues on their most important and timely study, which investigated the age-standardised rates and methods of suicide by health professionals compared with other occupational groups.1 They established that suicide rates for female health professionals, including medical professionals, were higher than for women in other occupations. While suicide rates were higher for male nurses and midwives, those for male medical practitioners were not significantly higher compared with other occupational groups.1 Milner and colleagues considered sex-related stressors in their discussion, in an attempt to understand the gender differences in suicide rates among medical professionals. The authors considered that women working in male-dominated areas face “considerable gender role stress” and may feel pressure to undertake traditional household roles and family responsibilities.1 It is highly conceivable that the abovementioned sex-related stressors may contribute to the sex differential in suicide rates. However, sexual harassment is an important sex-related stressor2 that was not included in their discussion or in Goldney’s accompanying editorial on this topic.3 There is overwhelming evidence to suggest that sexual harassment disproportionately affects women and is an entrenched problem in the medical profession.4,5 Indeed, sexual harassment has been demonstrated to be associated with suicide attempts among female doctors.5 Goldney argues that “ensuring good workplace relationships and equal opportunity, eliminating bullying [and] reducing access to means of suicide” are important pragmatic approaches to overcoming the problem of suicide among health care professionals.3 We propose that redressing sexual inequalities in medicine and eliminating sexual harassment might represent some additional approaches.

Nikki R Adler · Kimberley A Adler

In reply:In their comment on our article,1 Adler and Adler are correct in noting that sexual harassment is a significant issue facing female doctors, as it is for women in many occupations.2 Those who experience sexual harassment are also more likely to experience bullying and other forms of workplace incivility.3 Workplace bullying has also been found to be related to higher risk of suicidality.4 In view of this, we agree that these would be worthwhile targets for prevention initiatives. But the question remains as to whether sexual harassment and the problems regarding gender role stress discussed in our article1 all stem from the same set of causes. A meta-analysis3 noted two systematic sources of sexual harassment: (i) organisational context, including a climate that permits sexual harassment, and policies that do not support the reporting of and action against perpetrators; and (ii) the context of gender in the workplace — for example, the extent to which traditional gender roles are able to be maintained, such as through gender differences in the organisation of work, and the overall proportion of women employed in the job. In our article, we specifically highlighted the maintenance of gender-normative behaviour in medicine as potential stressors for suicide. While we agree that sexual harassment is a significant issue that needs to be addressed, we suggest that this be incorporated into a wider and overall strategy to overcome gender inequality in medicine. This strategy should target the negative personal and organisational (eg, organisation commitment, work withdrawal, job satisfaction) outcomes of harassment,3 and include measures to allow both male and female doctors to care for their families. In addition, to align with best practice in workplace suicide prevention,5 we would also support a stigma reduction campaign, access to treatment for health practitioners who experience poor mental health and suicidal ideation, and support for colleagues and families following bereavement from suicide within the medical profession.

Allison J Milner · Matthew J Spittal · Marie M Bismark

In reply:I thank Adler and Adler for their comment on my editorial on suicide by health care professionals.1 Their proposal of “redressing sexual inequalities in medicine and eliminating sexual harassment” appears to be encompassed in my statement about “ensuring good workplace relationships and equal opportunity [and] eliminating bullying”,1 which they quote in their letter. Regrettably, sexual harassment is common and not unique to medicine, with an estimated prevalence in the workplace of 35–50%.2 Although Adler and Adler refer to the work of Frank and colleagues3 in demonstrating an association between sexual harassment and suicide attempts in female doctors, they do not mention the caveats that the study authors noted. These include that it was “a relationship we cannot determine”; that earlier studies were “based on small numbers and the subject of considerable controversy”; and that “these problems are not unique to women physicians”. Bearing in mind the low base rate discussed in my article, ensuring that equal opportunity, good workplace relations and anti-bullying approaches are standard for health practitioners, and that health practitioners can access general and mental health care, are more realistic and achievable goals that are more likely to return dividends.

Robert Goldney

Professor Roger Strasser is an Australian rural health educator and academic, running one of the most successful training programs in the world, the Northern Ontario School of Medicine, in Canada

Cate Swannell

n/a

Swannell

This list is updated regularly. If you have an event you would like to add please send details to cswannell@mja.com.au 2017 JULY 6-9 Australia and New Zealand Society of Neuroradiology ASM 2017, Darwin, NT 7-8 2017 Rural SIG Meeting, Broome, WA 7-9 ODMA 2017, Sydney, NSW 11-13 Interventional Radiology Society of Australasia ASM 2017, Port Douglas, QLD 11-14 Australian and New Zealand Association for Health Professional Educators 2017 Conference, Adelaide, SA 11-14 Australian and New Zealand Society of the History of Medicine 15th Biennial Conference, Melbourne, VIC 13-14 WA Mental Health Conference and Awards 2017, Perth, WA 13-15 RANZCO Paediatric Special Interest Group Scientific Meeting, Noosa, QLD 15-16 12th International Conference on Medical, Medicine and Health Sciences, Sydney, NSW 16-18 The Australian and New Zealand Urogenital and Prostate ASM, Melbourne, VIC 17-19 12th Asian Obesity Specialists and Endocrinologists Annual Meeting, Melbourne, VIC 17-19 9th World Congress on BA/BE Studies and Biowaivers, Melbourne, VIC 20 CICM Fellow Education workshop, NSW 20-22 Effective Management of Anaesthetic Crises (EMAC), Melbourne, VIC 20-22 Diabetes Asia Pacific 2017: 12th Asia Pacific Diabetes Conference and Expo, Melbourne, VIC 22 Medical Imaging Anatomy Course, Melbourne VIC 22-23 Emergency Skills Ultrasound, Melbourne, VIC 22-23 General Practice Conference and Exhibition, Perth, WA 23-26 Cardiac Thoracic Vascular and Perfusion SIG Meeting, Queenstown, NZ 23 Focused Cardiac Ultrasound TOE, Queenstown, NZ 23 Focused Cardiac Ultrasound TTE, Queenstown, NZ 23 Lung Ultrasound, Queenstown, NZ 24-25 17th International Conference and Exhibition on Nanomedicine and Nanotechnology in Health Care, Brisbane, QLD 24-26 8th World Conference on Pharmacology and Toxicology, 10th Asia-Pacific Pharma Congress, Melbourne, VIC 24-26 World Congress on Nursing Care 2017, Melbourne, VIC 24-28 Missioncraft 2017: Leadership in Disaster Relief, Melbourne, VIC 26-28 Effective Management of Anaesthetic Crises (EMAC) Course, Wellington, NZ 26-29 Australasian College for Emergency Medicine Winter Symposium, Rowland Flat, SA 26-29 APCCN 2017 – Asia Pacific Conference on Clinical Nutrition, Adelaide, SA 27-28 The Australian Winter School Conference: Connecting the alcohol and drugs sector, Brisbane, QLD 27-28 ANZBMS/IFMRS/JSBMR Combined meeting, Brisbane, QLD 27-30 RNZCGP Conference for General Practice and Quality Symposium, Dunedin, NZ 28 QRME Ltd Mental Health Skills Training: equip participants with the knowledge and skills to effectively assess and manage patients presenting with mental health concerns, Toowoomba, QLD 28-29 Lancet Summit: COPD and lung cancer, Perth, WA 29 Ageing 2017: A conversation, Sydney, NSW 29-30 NZCCP 28th National Conference, Queenstown, NZ 29-30 Ophthalmology Updates! Conference 2017, Sydney, NSW 31 Jul-2 Aug World Congress on Microbiology and Infectious Diseases, Melbourne, VIC 31 Jul-2 Aug International Meeting on Nursing Research and Evidence-based Practice, Melbourne, VIC 31 Jul-2 Aug Pharmaceutics Meeting 2017 – Global experts meeting on pharmaceutics and drug delivery systems, Melbourne, VIC AUGUST 2-6 Australian Society of Cataracts and Refractive Surgeons, Hamilton Island, QLD 4 Anaesthetic Emergency Responses Workshop (ALS + CICO), Sunshine, VIC 4-5 RANZP Section of Child and Adolescent Forensic Psychiatry Conference 2017, Melbourne, VIC 4-5 ASPOG 43rd Annual Scientific Meeting, Brisbane, QLD 4-5 AGES XVII Pelvic Floor Symposium: Challenging Times, Adelaide, SA 4-6 2017 RANZCR NZ Branch ASM, Nelson, NZ 5-8 41st Human Genetics Society of Australasia ASM, Brisbane, QLD 6 Human Genetics Society of Australasia General Practice Education Day, Brisbane, QLD 6-9 Health Informatics Society of Australia, Brisbane, QLD 6-9 Australasian Radiation Protection Society Conference 2017, Wollongong, NSW 7-8 ANZICS 2017 Safety and Quality Conference: The deteriorating patient, Sydney, NSW 9 Peri-Arrest, Melbourne, VIC 10-11 AVHEC – Australasian Viral Hepatitis Elimination Conference 2017, Cairns, QLD 10-12 Pathology Horizons, Cairns, QLD 11-13 ACD Rural Dermatology Meeting, Broome, WA 16 ANZCA Approved Anaphylaxis & CICO Emergency Response Workshop, Frankston, VIC 16 FUSE Vascular, Melbourne, VIC 16-19 NZDSI Annual Conference, Queenstown, NZ 17-18 Colorectal Cancer Conference 2017, Melbourne, VIC 19-20 iHeartScan Advanced, Melbourne, VIC 19-23 2017 Australia and New Zealand Society of Occupational Medicine ASM, Fremantle, WA 21-23 2017 Australian Diabetes Society/Australian Diabetes Educators Association Annual Scientific Meeting, Perth, WA 21-23 18th International Mental Health Conference, Gold Coast, QLD 21-25 CT-Acute Medical and Surgical Interpretation 2017, Queenstown, NZ 21-27 Be Medicinewise Week 22 RANZCO Human Research Ethics Committee Meeting, Sydney, NSW 22-23 Healthcare Leaders Forum, Sydney, NSW 23-25 27th Annual Scientific Meeting of the Stroke Society of Australasia 2017, Queenstown, NZ 24 Paediatric Anaesthesia Crisis Management Course (PACMaC), Wellington, NZ 24-26 2017 Annual Meeting of the Neurodevelopmental and Behavioural Paediatric Society of Australasia, Auckland, NZ 25-27 38th Australasian Dermatopathology Society ASM, Melbourne, VIC 26-27 Focused Cardiac Ultrasound/ECHO Workshop, Melbourne, VIC 28-30 DFTB17: Making a difference, Brisbane, QLD 29 CICM Communication course, Melbourne, VIC 30 Aug-2 Sep 18th Asia-Pacific Prostate Cancer Conference, Melbourne, VIC 31 Aug-2 Sep 5th World Congress on Controversies, Debates and Consensus in Bone, Muscle and Joint Diseases, Gold Coast, QLD SEPTEMBER 1 Epworth HealthCare Eighth Obstetrics & Gynaecology Clinical Institute Symposium, Melbourne, VIC 1 QRME Ltd Cultural Safety Training: Developing positive, respectful relationships with Aboriginal and Torres Strait Islander people, create a culturally safe practice, administer the PIP – Indigenous Health Incentive, Toowoomba, QLD 1-2 Australia and New Zealand Academy for Eating Disorders, Darling Harbour, NSW 1-2 Australasian Academy of Facial Plastic Surgery (AAFPS) & Blepharoplasty Australia Masters’ Symposium on Blepharoplasty and Facial Rejuvenation, Sydney, NSW 1-2 2017 Medico Legal Society Meeting, Sydney, NSW 1-3 Managing Obstetric Emergencies & Trauma (MOET) Course, Wellington, NZ 1-3 General Practice Conference and Exhibition, Brisbane, QLD 2-3 QRME Ltd Advanced Lift Support: build participants’ knowledge, skills and confidence when responding to rural general practice emergencies, Toowoomba, QLD 5-7 11th National Aboriginal and Torres Strait Islander Environmental Health Conference, Cairns, QLD 6-7 6th Annual International Emergency Care Conference, Melbourne, VIC 6-8 Effective Management of Anaesthetic Crises (EMAC) Course, Wellington, NZ 6-8 2017 Australian Palliative Care Conference: Connection with community, Adelaide, SA 6-8 10th ANZSIN Meeting, Darwin, NT 8 The Alfred Emergency and Trauma Centre Resuscitation Update, Melbourne, VIC 8-10 Joint Neuroanaesthesia and Trauma SIG Meeting, Byron Bay, NSW 8-10 International Cornea and Contact Lens Congress, Sydney, NSW 9-10 ANZCA/ASA SA NT Burnell Jose Visiting Professionals ASM, Rowland Flat, SA 12-14 AACB 55th Annual Scientific Conference: Time sensitive testing, Melbourne, VIC 13-14 Big Data and Analytics Innovation Summit: Maximise the Potential of Your Big Data Initiatives, Sydney, NSW 13-15 28th Annual Conference of the Australasian Society of Clinical Immunology and Allergy, Auckland, NZ 14 RUOK? Day 14 CICM Fellow Education workshop, TAS 14-15 3rd Australian Nursing and Midwifery Conference, Newcastle, NSW 14-16 Australasian Doctors’ Health Conference, Sydney, NSW 14-16 Internal Medicine Society of Australia and New Zealand Annual Conference 2017, Hobart, TAS 14-17 Neuro-Ophthalmology Society of Australia 33rd Clinical and Scientific Meeting and NeuroVision Training Weekend, Sydney, NSW 15 Crisis Management in Obstetric Anaesthesia and Neonatal Resuscitation, Sunshine, VIC 15-17 RANZP Faculty of Psychotherapy Conference 2017, Ayers Rock, NT 15-17 ASBDD Biennial Conference, Melbourne, VIC 16 Epworth Healthcare Perioperative Medicine Symposium, Melbourne, VIC 16-17 ANZAAG Symposium, Auckland, NZ 20-22 6th APAC Forum: Lead the change you want to see, Gold Coast, QLD 20-23 AIDA Conference 2017: Family, unity, success, 20 years strong, Pokolbin, NSW 23 Trauma Radiology Course, Brisbane, QLD 25-27 RANZP New Zealand National Conference 2017, Tauranga, NZ 27-29 Joint 2017 ACHSM/ACHS Asia-Pacific Congress, Sydney, NSW 29-30 ASM and Education Meeting of the Paediatric Society of Queensland, Brisbane, QLD OCTOBER 2-4 16th Global Pathologists Annual Meeting, Melbourne, VIC 4 FUSE Vascular, Melbourne, VIC 4-6 Global Alcohol Policy Conference, Melbourne, VIC 4-6 Australasian Gastro-intestinal Trials Group 19th Annual Scientific Meeting, Cairns, QLD 4-6 2017 Obesity Surgery Society of Australia and New Zealand Conference, Adelaide, SA 6-8 AORA ASM 2017, Adelaide, SA 7-10 ASA National Scientific Congress 2017, Perth, WA 8-12 AOA 77th ASM and AGM, Adelaide, SA 9-13 Activity Based Funding Conference 2017 and 33rd Patient Classification Systems International Conference 2017, Sydney, NSW 11-13 42nd Australian and New Zealand ASM in Intensive Care and the 23rd Annual Paediatric and Neonatal Intensive Care Conference: ICU: Thinking outside the flags, Gold Coast, QLD 12-14 The Australian and New Zealand Head and Neck Cancer Society ASM, Brisbane, QLD 12-15 2017 Combined Orthopaedic Knee Societies Meeting, Noosa, QLD 13-16 RCPA 47th Annual Scientific and Business Meeting, Canberra, ACT 12-14 EMAC (Effective Management of Anaesthetic Crises) Course, Melbourne, VIC 12-14 APELSO 2017: ECMO and beyond (the future of mechanical support), Gold Coast, QLD 16 Focused Cardiac Ultrasound TTE, Melbourne, VIC 16-18 3rd International Conference on Antimicrobial Agents and Chemotherapy, Melbourne, VIC 17-19 Queensland Hand Surgery Society Conference, Noosa, QLD 18-19 National Borderline Personality Disorder Conference 2017, Perth, WA 18-21 9th World Congress of Melanoma and 14th International Congress of the Society for Melanoma Research, Brisbane, QLD 18-21 RACMA 2017 Conference: Past reflections, future directions, Melbourne, VIC 19-22 RANZP Faculty of Child and Adolescent Psychiatry 2017, Adelaide, SA 19-22 2017 RANZCR ASM, Perth, WA 20 Crisis Management in Obstetric Anaesthesia and Neonatal Resuscitation, Sunshine, VIC 20-22 QRME Ltd OSCE Intensive Examination & Communication Workshop: helps candidates focus on their communication skill, Toowoomba, QLD 21-22 Focused Cardiac Ultrasound/ECHO Workshop, Sydney, NSW 23 10th Asian Conference on Pharmacoepidemiology, Brisbane, QLD 24-27 Australian Association of Practice Managers National Conference, Perth, WA 26-28 GP17 RACGP Annual conference, Sydney, NSW 26-28 SPANZA 2017 Conference, Perth, WA 28 Epworth HealthCare Seventh Cardiac Sciences Clinical Institute Symposium, Melbourne, VIC 28 Oct-1 Nov 49th RANZCO Annual Scientific Congress, Perth, WA 29 Oct-1 Nov RANZCOG Annual Scientific Meeting, Auckland, NZ NOVEMBER 1-3 10th Health Services and Policy Research Conference, Gold Coast, QLD 1-3 Effective Management of Anaesthetic Crises (EMAC) Course, Wellington, NZ 1-3 Epilepsy Society of Australia 31st Annual Scientific Meeting, Perth, WA 2-4 Perioperative Medicine SIG Congress 2017 8-11 NZ Anaesthesia ASM 2017, Rotorua, NZ 8-11 RANZP Faculty of Psychiatry of Old Age Conference 2017, Queenstown, NZ 10 Anaesthetic Emergency Responses Workshop (ALS + CICO), Sunshine, VIC 10-12 General Practice Conference and Exhibition, Melbourne, VIC 12-15 The 22nd Australian and New Zealand Prevocational Medical Education Forum, Brisbane, QLD 13-15 Clinical Oncology Society of Australia 2017 ASM, Sydney, NSW 13-19 Antibiotic Awareness Week 15 Focused Cardiac Ultrasound TOE, Melbourne, VIC 15-17 Hospital in the Home Society of Australasia ASM, Melbourne, VIC 16 RANZCOG AGM, Melbourne, VIC 16-18 EMAC (Effective Management of Anaesthetic Crises) course, Melbourne, VIC 17-19 National Histology Conference, Hobart, TAS 18-19 iHeartScan, Melbourne, VIC 19-23 Australasian College for Emergency Medicine, 34th ASM, Sydney, NSW (provisional dates) 20-21 11th International Conference on Immunopharmacology and Immunotoxicology, Melbourne, VIC 20-22 Psychiatry and Mental Health 2017, Melbourne, VIC 20-24 Psychiatry Update 2017, Christchurch, NZ 21-23 Effective Management of Anaesthetic Crises (EMAC), Melbourne, VIC 23-26 Asian Pacific Society of Respirology Congress 2017, Sydney, NSW 26-29 APCCN 2017 – Asia Pacific Conference on Clinical Nutrition, Adelaide, SA 27-28 New Anaesthetic Registrars Crisis Management (NARCM) Course, Wellington, NZ 27-28 Innovate Cancer 2017 – Cancer research, Brisbane, QLD 29-30 Innovate Alzheimers – Alzheimers and Dementia, Brisbane, QLD 29-30 International summit on medical, pharma and drug studies, Brisbane, QLD 30 Nov-2 Dec Mercy Perinatal Global Obstetrics Update 2017, Melbourne, VIC DECEMBER 1-2 International summit on infectious diseases and antibiotics, Brisbane, QLD 2-3 Focused Cardiac Ultrasound/ECHO Workshop, Melbourne, VIC 3-6 Australasian Neuroscience Society annual meeting, Sydney, NSW 6 AHHA Data and Innovation Collaboration Network Meeting, Dubbo, NSW 7-8 CPET and Prehabilitation Symposium: Incorporating POETTS (UK) accredited CPET course, Melbourne, VIC 7-12 Melbourne Neuro and Orthopaedic MRI Course, Melbourne, VIC 8-10 Entheogenesis Australis Outdoor Psychedelic Symposium, Eildon, VIC 9-10 Perioperative Medicine Symposium, Melbourne, VIC 2018 FEBRUARY 4-8 World Congress on Phlebology, Melbourne, VIC 9-10 4th International 4 Corners of Cardiology Meeting, Melbourne, VIC 23-24 PICET Obstetric Intensive Care Symposium, Adelaide, SA 25-28 WPA 2018 Thematic Conference, Melbourne, VIC MARCH 2-4 Pathology Update 2018, Sydney, NSW 8-11 APSCVIR 2018, Auckland, NZ APRIL 11-13 2nd International Selection in the Health Professions Conference, Melbourne, VIC 22-27 Hunter Paediatric Society Conference, Palm Cove, QLD MAY 7-11 Royal Australasian College of Surgeons Annual Scientific Congress 2018 with the ANZ College of Anaesthetists, Sydney, NSW 13-17 RANZP Congress 2018, Auckland, NZ 18-22 Australasian College of Dermatologists ASM, Gold Coast, QLD 20-23 5th Asian and Oceanic Regional Congress on Radiation Protection, Melbourne, VIC AUGUST 15-18 World Congress on Cancers of the Skin, Sydney, NSW SEPTEMBER 13-14 NOSA Annual Meeting 2018, Melbourne, VIC 15-16 Neurovision, Melbourne, VIC OCTOBER 6-9 ASA National Scientific Congress 2018, Adelaide, SA 10-12 2018 World Hospital Congress, Brisbane, QLD 25-28 2018 RANZCR ASM, Canberra, ACT NOVEMBER 7-10 New Zealand Anaesthesia Annual Scientific Meeting 2018, Auckland, NZ 13-15 Clinical Oncology Society of Australia 2018 ASM, Perth, WA 18-22 Australasian College for Emergency Medicine, 35th ASM, Perth, WA 2019 NOVEMBER 17-19 10th World Congress of Itch, Sydney, NSW 2021 NOVEMBER 10-13 XIII International Congress of Dermatology, Melbourne, VIC DECEMBER TBA FIGO World Congress of Gynaecology and Obstetrics, Sydney, NSW

Cate Swannell