Narrative reviews

? Cognitive biases in decision making may make it difficult for clinicians to reconcile evidence of overuse with highly ingrained prior beliefs and intuition

Ian A Scott · Jason Soon · Adam G Elshaug · Robyn Lindner

Recent evolution in the clinical, pathological and genetic understanding of MND is progressively unmasking the multifactorial nature of this complex condition

Thanuja Dharmadasa · Robert D Henderson · Paul S Talman · Richard AL Macdonell · Susan Mathers · David W Schultz · Merrillee Needham · Margaret Zoing · Steve Vucic · Matthew C Kiernan

The brain–computer interface is an exciting advance in neuroscience and engineering

Jeffrey V Rosenfeld · Yan Tat Wong

We are diagnosing CAP too often and treating it for too long

Sarah Sparham · Patrick GP Charles

Rickettsial infections are the most common, but ongoing research will likely reveal new tick-borne viral, bacterial and protozoal infections

Stephen R Graves · John Stenos

Back pain is a symptom and not a diagnosis

Lynn D Bardin · Peter King · Chris G Maher

SLE should be considered in anyone with inflammatory joint pain with extra-articular features

Vera Golder · Alberta Hoi

While there is no cure for rheumatoid arthritis, treatment has improved to the point where many patients can approach a normal quality of life

Graeme Jones · Peter Nash · Stephen Hall

Rheumatic diseases are frequently complicated by extra-articular manifestations, often affecting the eye; some ocular complications may be rapidly sight-threatening

Colby Hart · Merv Ferdinands · Leslie Barnsley

Is it really possible to prescribe a target caesarean section rate applicable to all 194 WHO member countries?

Stephen J Robson · Caroline M de Costa

Contaminated heater-cooler units pose a rare but serious risk, and careful management is required

Andrew J Stewardson · Rhonda L Stuart · Allen C Cheng · Paul DR Johnson

A promising new approach in treating chronic respiratory diseases

Peter G Gibson · Matthew J Peters · Claire E Wainwright

Natural is not necessarily safer: closer control of herbal preparations will secure safety and trust

Roger W Byard · Ian Musgrave · Garth Maker · Michael Bunce

The physical health of patients with schizophrenia requires serious national attention

Leonard Kritharides · Vincent Chow · Tim JR Lambert

Given the psychosocial impacts of acne, systemic therapy may be appropriate if topical and general measures have failed

Victoria Rebecca Harris · Alan J Cooper

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

There is no convincing evidence that classic Lyme disease occurs in Australia

Peter J Collignon · Gary D Lum · Jennifer MB Robson

New immunotherapies are helping in the fight against advanced cancers but also present new adverse event management challenges

Jack M Bourke · Michael O'Sullivan · Muhammad A Khattak

Despite demonstrated benefits of midwife-led continuity of care for women and babies, implementation is proving challenging

Caroline SE Homer

Funding is needed for developing culturally competent maternity care

Sue Kildea · Sally Tracy · Juanita Sherwood · Fleur Magick-Dennis · Lesley Barclay

Cancer progression risks are lower than previously reported but pose a challenge for clinical management

David C Whiteman · Bradley J Kendall

A potentially fatal disease associated with warm, non-chlorinated water in rural areas

Claire L Nicholls · Fiona Parsonson · Lawrence EK Gray · Adele Heyer · Steven Donohue · Greg Wiseman · Robert Norton

Older adults with sarcopenia are at risk of developing type 2 diabetes, while those with diabetes show accelerated loss of muscle mass and function

David Scott · Barbora de Courten · Peter R Ebeling