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Gout continues to increase in prevalence in developed countries with Oceanic countries particularly affected. Both gout and hyperuricaemia are associated with the metabolic syndrome and its sequelae. Recently, the Australian Institute for Health and Welfare (AIHW) reported a prevalence rate of 0.8% which appeared incongruous with other published research. Thus, an updated systematic review was undertaken to review the literature on the prevalence of gout and hyperuricaemia in Australia from data published after 2011. A comprehensive, systematic search was conducted in MEDLINE, Embase and Web of Science in addition to relevant websites to identify research reporting the prevalence of gout and/or hyperuricaemia in Australia from May 2011 until June 2020. Crude gout and hyperuricaemia prevalence data was obtained and presented alongside case ascertainment, time-period, age range and stratified by gender if available. 118 full text articles were screened. 12 articles were included for analysis of gout prevalence. 4 articles were identified for the hyperuricaemia analysis. Wide variation in prevalence figures exist largely due study design and sample age range. Studies using a case definition of self-reported diagnosis of gout reported prevalence rates between 4.5% and 6.8%. The remaining studies used either electronic coding data from general practitioners or wastewater estimation of allopurinol consumption and documented adult prevalence rates between 1.5% and 2.9%. Prevalence increases with age, male sex and over time in keeping with global data. Hyperuricaemia prevalence ranged between 10.5% and 16.6% in Caucasian or an Australian representative population. AIHW estimates applied a chronic condition status, defined as current and lasted or expected to last more than six months, to cases of gout in the Australian National Health Survey. This likely results in an under-estimation in reported Australian gout prevalence rates. Gout is highly prevalent in Australia compared to global comparisons and continues to increase over time. Hyperuricaemia prevalence is also high although contemporary data is limited. [ABSTRACT FROM AUTHOR]

Background The incidence of non-invasive breast cancer has increased substantially over time. We aim to describe temporal trends in the incidence of carcinoma in situ of the breast in New South Wales (NSW), Australia. Methods Descriptive study of trends in the incidence of ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS) in women who received a diagnosis from 1972 to 2012, recorded in the NSW Cancer Registry. Results Carcinoma in situ as a proportion of all breast cancer was 0.4% during the prescreening period 1972 to 1987 and is currently 14.1% (2006 to 2012). Among 10,810 women diagnosed with DCIS, incidence across all ages rose from 0.15 per 100,000 during 1972 to 1983 to 16.81 per 100,000 over 2006 to 2012, representing a 100-fold increase (IRR 113.10; 95% CI 81.94 to 156.08). Among women in the target age group for screening (50–69 years) incidence rose from 0.27 per 100,000 to 51.96 over the same period (IRR 195.50; 95% CI 117.26 to 325.89). DCIS incidence peaks in women aged 60–69 years. DCIS incidence has not stabilized despite screening being well established for over 20 years, and participation rates in the target age range remaining stable. Conclusions Our findings raise questions about the value of the increasing detection of DCIS and aggressive treatment of these lesions, especially among older women, and support trials of de-escalated treatment. [ABSTRACT FROM AUTHOR]

Sedation is an important aspect of intensive care practice. Strategies for providing sedation, methods for assessing depth of sedation and various pharmacological options are discussed in this article. Delirium is common in the intensive care unit and is important to recognize because of the association with increases in both morbidity and mortality. Various strategies exist for identifying and managing delirium. This article examines how delirium can be diagnosed and identifies both pharmacological and non-pharmacological treatments. [ABSTRACT FROM AUTHOR]

Abstract: The aim of this study was to determine the impact of universal HER2 testing on the clinico-pathologic profile of HER2+ breast cancer. Data were extracted from breast cancer pathology reports spanning two periods: before (2003/4, n = 379), and after (2008/9, n = 560) the introduction of universal testing. In 2003/4, 43.3% of breast cancers were tested for HER2 with 16% of tested cases HER2+. In 2008/9, 98.4% of cases were tested with 14.7% HER2+. In 2008/9, HER2+ status was associated with younger age, higher grade, increased tumour size, lymph node involvement, negative oestrogen and/or progesterone receptor status. HER2+ cases diagnosed in 2003/4 were not significantly different in respect of these features. The rate of HER2+ breast cancer amongst screen detected cases in 2008/9 was 8.3%. The phenotype of HER2+ breast cancer was stable following the introduction of universal testing. The overall rate of HER2+ breast cancer was influenced by screen detection. [Copyright &y& Elsevier]

Purpose: EEG interpretation is a fundamental procedural skill in the practice of neurology, but there is no standardized method for educating residents. One-to-one instruction is commonly employed, but is time intensive for supervising physicians, provides arbitrary exposure to normal and abnormal EEG patterns, and often lacks immediate and detailed feedback on performance. Here, we investigated the effectiveness of a novel automated program to assist in educating neurology residents in EEG interpretation.Methods: An EEG teaching program was developed to provide neurology residents EEG training less dependent on attending supervision. Residents enter interpretations of full-length pre-selected EEGs and receive immediate feedback based on consensus interpretation of supervising epileptologists. Resident learning was assessed based on performance on matched pre- and post-tests covering common EEG findings including artifacts, normal variants, and abnormalities.Results: Twenty residents were included in this analysis: 12 post-graduate year (PGY) 3 and eight PGY 4 neurology residents. All residents showed improvement, from a mean score of 42.7% (95% CI 36.9-48.5%) on the pre-test to 75.4% (95% CI 70.7-80.2%) on the post-test (p<0.001). No significant difference was noted between the classes. Residents reported taking 16-30h to complete this teaching module spread over a 3-week rotation.Conclusion: This pilot study demonstrated the effectiveness of an automated EEG teaching program used by neurology residents in training. This tool could serve as an effective method of supplementing resident education. [ABSTRACT FROM AUTHOR]

Summary: Medical management and drug development for epilepsy emphasizes increasing pharmacological specificity to improve efficacy while minimizing side effects. However, growing evidence supports potential benefits of “magic shotgun” over “magic bullet” approaches to treatment of complex disease processes. We discuss experimental and theoretical evidence suggesting that seizures may be more amenable to a multi-target rather than a high-specificity approach, including evidence that individual anticonvulsants directly modulate a variety ion channel targets, the most direct determinants of neuronal excitability. Although the relevance of this promiscuity remains untested, it may contribute to anticonvulsant efficacy and should therefore be considered in drug development strategies and in therapeutic decision making. [Copyright &y& Elsevier]