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Mandatory reporting of impaired doctors is compulsory in Australasia. Australian Health Practitioner Regulation Agency guidelines for notification claim high benchmark though the Royal Australasian College of Surgeons and the Royal Australasian College of Physicians suggest they still obstruct doctors seeking help. Western Australia excludes mandatory reporting of practitioner-patients. This study examines reporting, consequences and international experiences with notification. Depressed doctors avoid diagnosis and treatment, fearing consequences, yet are more prone to marital problems, substance dependence and needing psychotherapy. South African research confirms isolation of impaired doctors and delayed seeking help with definable characteristics of those at risk. New Zealand data acknowledge: errors occur; questionable contribution from mandatory reporting; issues concerning competence assessment; favouring reporting to senior colleagues or self-intervention to compliance with mandatory reporting. UK found an anaesthetist guilty of professional misconduct for not reporting and sanctioned doctors regarding Harold Shipman. Australians are reluctant to report, fearing legalistic intrusion into care. Australian research confirmed definable characteristics for doctors with psychiatric illness or alcohol abuse. Exposure to legal medicine evokes personal disenchantment for doctors involved. Medicine poses barriers for impaired doctors. Spanish and UK doctors do not use general practitioners and may have suboptimal care. US and European doctors self-medicate using samples. US drug-dependent doctors also prescribe for spouses. Junior doctors are losing empathy with the profession. UK doctors favour private care, avoiding public scrutiny. NZ and Brazil created specific services for doctors, which appear effective. Mandatory reporting may be counterproductive requiring reappraisal. [ABSTRACT FROM AUTHOR]

After 9 years, Austroads has published new guidelines for fitness to drive. The guidelines have a preamble, which includes a legal disclaimer denying any culpability for those who designed the guidelines. They also warn of the legal responsibility for health professionals to satisfy their obligations, the need to be current with both relevant medical and legal expectations and if in doubt to seek guidance from Medical Defence Organisations. The guidelines are divided into Parts A and B, with A providing broad overview and background information while B deals with specific entities, such as blackouts, epilepsy or sleep disorders. This paper examines the guidelines and offers an appraisal of their content, their relevance to health practitioners and an assessment of their role in assisting to improve road safety. [ABSTRACT FROM AUTHOR]

Background: The ABCD2 stroke risk score is recommended in national guidelines for stratifying care in transient ischaemic attack (TIA) patients, based on its prediction of early stroke risk. We had become concerned about the score accuracy and its clinical value in modern TIA cohorts. Methods: We identified emergency department-diagnosed TIA at two hospitals over 3 years (2004-2006). Cases were followed for stroke occurrence and ABCD2 scores were determined from expert record review. Sensitivity, specificity and positive predictive values (PPV) of moderate-high ABCD2 scores were determined. Results: There were 827 indexed TIA diagnoses and record review was possible in 95.4%. Admitted patients had lower 30-day stroke risk ( n= 0) than discharged patients ( n= 7; 3.1%) ( P < 0.0001). There was no significant difference in proportion of strokes between those with a low or moderate-high ABCD2 score at 30 (1.2 vs 0.8%), 90 (2.0 vs 1.9%) and 365 days (2.4 vs 2.4%) respectively. At 30 days the sensitivity, specificity and PPV of a moderate-high score were 57% (95% confidence interval (CI) 25.0-84.2), 32.2% (95% CI 29.1-35.6) and 0.75% (95% CI 0.29-1.91) respectively. Conclusions: Early stroke risk was low after an emergency diagnosis of TIA and significantly lower in admitted patients. Moderate-high ABCD2 scores did not predict early stroke risk. We suggest local validation of ABCD2 before its clinical use and a review of its place in national guidelines. [ABSTRACT FROM AUTHOR]

An association between inflammatory bowel disease (IBD) and multiple sclerosis (MS) has been described. The current study was undertaken to explore this association further. Personal records of patients with IBD and MS were reviewed. In addition, a search of medical records at a large tertiary teaching hospital in Sydney was carried out for the years 1996–2006. Four patients (three women and one man) with both ulcerative colitis and MS were identified. MS did not occur in any of our patients with Crohn’s disease. The association between ulcerative colitis and MS appears to be real and may help identify common factors involved in the cause of these two diseases. No association was found in this study between MS and Crohn’s disease, sparking consideration why such difference should occur. With the increasing use of biological therapies in IBD and their reported propensity to cause demyelination, recognition of an association is all the more important. [ABSTRACT FROM AUTHOR]

Following the decision in the Gillet Case it may no longer be safe to rely on the Austroads guidelines when considering fitness to drive. This paper examines the case and its implications. Although the Guidelines claimed ‘... the identification and application of world best-practice...’, they were disregarded by the court in Gillet. Both expert witnesses testified that on disclosure of epilepsy the accused would have been endorsed as fit for a licence application to the Roads & Traffic Authority, on the basis of 10 years of only nocturnal seizures, in accordance with the guidelines. The Court rejected this evidence and interpreted failure to disclose epilepsy as recognition of perceived risk and the previously undiagnosed sleep apnoea as the basis for that risk, despite being diagnosed after the accident. There needs to be greater certainty in the application of the guidelines, with legislative intervention and licenses should display a bold statement advising drivers of their responsibility to notify authorities of illnesses that could potentially affect driving. [ABSTRACT FROM AUTHOR]

Introduction: Austroads Guidelines for fitness to drive were promulgated in 2003. Epilepsy was one of the conditions included and this paper reports results of a survey of Australian neurologists regarding opinions and practices relevant to the guidelines. Methods: The survey was developed, piloted and Human Research Ethics Committee approved. Members of the Australian Association of Neurologists received three mailings and results were analysed. Results: Almost 70% of 236 surveyed indicated assessment of epilepsy and driving with <9% not doing so – establishing ∼77% response for eligible neurologists. Most questions achieved 90% response. Almost 90% respondents assessed epilepsy and 70% found the guidelines helpful. Seventy-seven per cent endorsed doctor assessors although half discounted General Practitioners as insufficiently knowledgeable and half advocated that only neurologists evaluate potential drivers with epilepsy. Most respondents supported reporting recalcitrant patients; yet only <30% did so. Three-quarters favoured licences carrying a warning to self-report and two-thirds felt that product information should identify driving implications. Although many questions attracted expected responses, the surprise was the large undecided numbers, which were greater than expected. Neurologists were more lenient than prescribed by the guidelines with neither consensus for controlled epilepsy nor mandatory driving restrictions. Conclusion: Respondents supplied predictable answers regarding ideal circumstances; yet most did not report recalcitrant patients. Most claimed to adhere to the guidelines and yet advocated more lenient driving restrictions that may allow preventable accidents. There was agreement between neurologists and guidelines for more rigourous restrictions for commercial drivers although again neurologists were more lenient. There is need for prospective research on epilepsy and driving. [ABSTRACT FROM AUTHOR]

AbstractGuidelines on fitness to drive were released by AUSTROADS and the National Road Transport Commission in September 2003. No recognised legal medical authority was cited. There are three parts in the document: (i) background information, (ii) specific medical conditions and (iii) appendices of relevant documents and contacts. This paper analyses the relevance of the guidelines for physicians and notes that the disclaimer exonerates its authors from potential repercussions. Guidelines for both private and commercial drivers are combined in the document and the basis for such delineation is defined. A lack of universal Australian standards with no State indicating the driver's responsibility to report changes in health standards on the issued licences is confirmed by the guidelines. Not all States indemnify physicians for reporting contrary to patients’ wishes, while South Australia and the Northern Territory mandate reporting those at risk. Much of the language is patronizing, expecting‘... conciliatory and supportive ...’ behaviour even with recalcitrant patients. No allowance is made for patients who may not fulfil the guidelines but whom the doctor may consider fit to drive. Ambiguity regarding responsibility to report, as identified in the background section, may leave the doctor vulnerable for not reporting a patient who subsequently may cause injury. Attempt is made to differentiate the role of the specialist from the family general practitioner (GP), advocating specialists for commercial drivers, although this is largely left to the discretion of the GP. There is an implied onus on doctors to report all patients with the conditions under review. Some diagnoses, such as syncope, are discussed in different sections with application of conflicting limitations. Inappropriate language, such as reference to a seizure being‘... an isolated non-epileptiform event ...’, or withdrawal of medications failing to be restricted to anti-epileptic medications confounds interpretation. Some sections, such as that on sleep and epilepsy, are effectively analysed, while illnesses such as dementia are considered superficially. The guidelines are an attempt to assess fitness to drive, but contain serious flaws and provide limited information upon which to base decisions. Ambiguous language complicates application of the guidelines and places the health care professional at risk, despite a disclaimer protecting its authors. (Intern Med J 2005; 35: 364–368) [ABSTRACT FROM AUTHOR]

Chromosome fragility was sought in a well-defined cohort of patients with Lennox-Gastaut epilepsy syndrome. Twenty-five patients plus 25 age- and sex-matched normal controls had cytogenetic studies performed. All patients were taking sodium valproate, and four were also on hydantoin. Blood cultures from both patients and controls were set up simultaneously in an appropriate medium designed to elicite fragile-sites. Harvesting took place after 96 h by standard techniques. In addition to routine banded analysis, at least 50 cells were scored for chromosome breaks and gaps from each patient and control. Results showed no difference between the patients and the control group in the overall occurrence of fragility or the type of aberration detected. No fragile-X syndrome was detected. This study found no effect due to sodium valproate on the occurrence of chomosome aberrations. [ABSTRACT FROM AUTHOR]

Aim: Develop and test a data collection tool—Neurological End‐Of‐Life Care Assessment Tool (NEOLCAT)—for extracting data from patient health records (PHRs) on end‐of‐life care of neurological patients in an acute hospital ward. Design: Instrument development and inter‐rater reliability (IRR) assessment. Method: NEOLCAT was constructed from patient care items obtained from clinical guidelines and literature on end‐of‐life care. Expert clinicians reviewed the items. Using percentage agreement and Fleiss' kappa we calculated IRR on 32 nominal items, out of 76 items. Results: IRR of NEOLCAT showed 89% (range 83%–95%) overall categorical percentage agreement. The Fleiss' kappa categorical coefficient was 0.84 (range 0.71–0.91). There was fair or moderate agreement on six items, and moderate or almost perfect agreement on 26 items. Conclusion: The NEOLCAT shows promising psychometric properties for studying clinical components of care of neurological patients at the end‐of‐life on an acute hospital ward but could be further developed in future studies. [ABSTRACT FROM AUTHOR]

A letter to the editor in response to the article "Changed constitution without change in brand name "the risk of generics in epilepsy" in a 2012 issue is presented. [ABSTRACT FROM AUTHOR]

A response from Beran R.G. the author of the article "Royal Australasian College of Physicians (RACP) approach to Fellows in difficulty" in the February 4, 2015 issue is presented.

A letter to the editor is presented in response to the article "Prolactinoma: are dopamine agonists still first choice," by C. M. Ogilvie and S. R. Milsom in the May 29, 2011 issue.

A letter to the editor is presented in response to the article "Medical Aspects of Fitness to Drive: What Do Public Hospital Doctors Know and Think," by E. M. Shanahan, R. M. Sladek and P. Phillips, published in a previous issue of this periodical.

Background Epilepsy is highly prevalent in people with intellectual disabilities and is associated with increased mortality and high healthcare usage. This systematic review summarizes research on service responses to people with intellectual disabilities and epilepsy. Method Studies published from 1990 were identified via electronic searches using Medline, Cinahl, Psyc INFO and Web of Science, email requests to researcher networks, and cross-citations. Information extracted from studies was reviewed narratively in relation to identified themes. Results Thirty-five studies met the inclusion criteria. Overall study quality was low, with no RCTs or similarly robust intervention study designs. Access to specialists was inconsistent. The importance of proxies and the need for education regarding epilepsy for staff, carers and people with intellectual disabilities were highlighted. Conclusion There are no methodologically robust studies on service-related interventions for people with intellectual disabilities and epilepsy. Further research on improving service delivery is required to substantiate findings reported here. [ABSTRACT FROM AUTHOR]

Objectives Multiple sclerosis ( MS) is a progressive disease with an unpredictable prognosis. Previous studies have reported health anxiety within the MS population. This study examines the effect of health anxiety on MS patients' quality of life (QoL) and evaluates the potential contribution of cognitive factors in maintaining health anxiety. Methods A total of 84 patients with relapsing remitting multiple sclerosis ( RRMS) were screened for health anxiety. From this sample, a group with relatively high and another group with low anxiety ( n = 21 in each group) were identified. A further 21 healthy controls were recruited for comparison. A measure of QoL was then completed. Cognitive biases were investigated by measuring perception and attribution of common bodily symptoms as well as appraisal of performance on neuropsychological and physical fatigue tests. Results The high health anxiety group reported poorer QoL relative to the other groups, independent of level of disability. They were also more likely to misattribute common bodily changes to MS, and perceive their (objectively intact) performance on tests of cognition and fatigue as being impaired, attributing the cause of impairment to MS. Conclusion Health anxiety may be a factor in mediating the psychosocial impact of MS. Skilled psychological treatment which changes misperception and misattribution may significantly benefit patients with MS and elevated health anxiety. Practitioner Points Clinical implications Health anxiety impacts on quality of life in patients with MS even when disability and other measures of psychological distress are taken into account., High levels of health anxiety distort perceptions of symptoms in patients with MS in line with the predictions made by the cognitive model of health anxiety., Limitations of study This study is limited to patients with RRMS within the relatively early stages of their disease and is based on a small sample size., Health anxiety is correlated with measures of generalized anxiety, depression, and worry, although it is found to have a unique impact on quality of life in patients with MS. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the prevalence, neuropsychiatric comorbidities, iron metabolism and potential risk factors of restless legs syndrome (RLS) in the elderly Korean population. As a community-based epidemiological study, a simple random sample of 1118 was drawn from a roster of 61 730 adult individuals aged 65 years and older and 714 participated. The diagnosis of RLS was established in face-to-face interviews using the four minimal diagnostic criteria for RLS recommended by National Institute of Health. Depressive symptoms, nocturnal sleep disturbances, daytime sleepiness and quality of life were evaluated. Laboratory tests of iron metabolism, markers of inflammation, renal and endocrine function, hormones and vitamins were performed. A total of 59 patients (42 women and 17 men) were diagnosed as RLS with a prevalence of 8.3% (95% confidence interval: 6.2–10.3%), with an almost twofold higher prevalence in women (10.2%) than in men (5.7%). Depression was more prevalent among the subjects with RLS than without RLS and poor nocturnal sleep and quality of life were also observed in subjects with RLS. Daytime sleepiness was observed in 32.8% of subjects with RLS. No significant differences were found in iron metabolism or other risk factors between the subjects with and without RLS. The prevalence of RLS in the Korean elderly population was comparable with that in the Caucasian population. RLS had undesirable effects on mood, sleep quality and general wellbeing of elderly individuals. [ABSTRACT FROM AUTHOR]

Research indicates that epilepsy is a misunderstood and stigmatizing disorder. The present study examined whether various levels and types of experience with epilepsy are related to attitudes about the disorder. It was hypothesized that certain types of direct experience with epilepsy (e.g., knowing people with epilepsy) are related to positive attitudes about the disorder, whereas other types of direct experience (e.g., witnessing seizures) are related to negative beliefs. As predicted, data from telephone interviews with 271 subjects indicate that individuals knowing someone with epilepsy held significantly more accepting attitudes than respondents who had never known an epileptic. The findings also suggest that witnessing epileptic seizures is an emotionally charged event, and, in the absence of other types of experience, this emotional impact might have a negative effect on attitudes toward people with epilepsy. The findings from this study have implications for the development of educational programs aimed at the general public, medical personnel, and people with epilepsy. [ABSTRACT FROM AUTHOR]

We compared the formal thought disorder ratings of 27 children with complex partial seizure disorder, 31 schizophrenic children and 58 normal children. The epileptic children with fullscale EQ, scores below 100 had significantly more formal thought disorder than normal children with a similar IQ. The severity of their formal thought disorder was related to the age of seizure onset, seizure control and a diagnosis of schizophrenia spectrum disorder. The schizophrenic children had thought disorder irrespective of IQ scores. The cognitive correlates of their formal thought disorder scores differed from those of the epileptic children. Possible anatomical substrates of thought disorder in childhood complex partial seizure disorder and schizophrenia are discussed. [ABSTRACT FROM AUTHOR]

A novel and robust two‐dimensional liquid chromatography with ultraviolet detection method (2D‐LC–UV) was developed and validated for high‐throughput determination of the concentrations of valproic acid (VPA) in human plasma. This 2D‐LC system was composed of a first‐dimensional LC column, a second‐dimensional LC column and an intermediate transfer column. The sample was directly injected into the 2D‐LC system after an easy protein precipitation treatment. After online preconcentration and primary separation by the first‐dimensional column, the target was captured by an intermediate column and then transferred to second‐dimensional column for analysis. The system transferred the target through "central cutting" mode whereby the drug peak was not subject to interference from the matrix. The analysis cycle time was completed within 7.0 min. Compared with other methods that have been developed, the analysis time was reduced and the operation was much easier without any derivatization. The calibration curve was linear over the 5.90–188.94 μg/ml range for the VPA concentrations. The intra‐day and inter‐day precisions were <5.6%. The recoveries were in the range from 95.2 to 98.0%. This method appears to be sensitive, precise, rapid and low‐cost for the quantification of VPA in serum sample. [ABSTRACT FROM AUTHOR]