BACKGROUND:Lung cancer outcomes have been reported to be poorer in the indigenous population of the Northern Territory (NT). We examine whether longer diagnostic and treatment time frames contribute to the observed survival disparity. AIMS:Assess the time frames to diagnosis and treatment of lung cancer in the Top End, NT, Australia. METHODS:Demographic, clinical and survival data were assessed and compared between indigenous and non-indigenous patients diagnosed with lung cancer between January 2015 and December 2020. RESULTS:Out of 534 medical records assessed, 388 patients with complete data were included, of which 91 (23%, males 55%) were indigenous and 297 (77%, mles 65%) non-indigenous, with a mean age of 60 and 66 years, respectively. Median time from initial computed tomography (CT) scan to diagnosis (22 vs 23 days, P = 0.94) and initial CT to treatment were similar (61 vs 60 days, P = 0.61) in indigenous versus non-indigenous patients. Diagnostic and treatment time frames were shorter in remote compared to urban patients (initial CT to diagnosis 18 vs 27 days, P = 0.002; initial CT to treatment 46 vs 65 days, P = 0.15). Indigenous patients had lower 1-year median survival, and remote patients had lower 1- and 3-year median survival. Higher rates of inpatient evaluation were observed in indigenous and remote residing patients (indigenous 54% vs 46%, P = 0.2; remote 58% vs 45%, P = 0.038). CONCLUSION:Lung cancer care pathways are similar in indigenous and non-indigenous populations, even by remoteness. Lower survival rates among indigenous and remote patients highlight a need for more research.

This cross-sectional study assessed the clinical and economic costs (Inpatient Activity Database) associated with hospitalisations due to bronchiectasis exacerbations among adult indigenous patients in the Top End, Northern Territory. Twenty case episodes from 15 indigenous patients with a mean age of 51.8 ± 12.7 years were recorded in a 3-month study window. The estimated cost was AUD 400 579.9, with cost per patient AUD 26 705 over 3 months and average cost per admission AUD 20 029. Extrapolating cost data across a 10-year period gave a conservative estimate of AUD 28 million.

Widespread adoption of lung cancer screening programmes increases the detection of pulmonary nodules, both benign and malignant. Although guidelines exist to direct the management of nodules, they do not address the management of nodules that display atypical behaviour. Although rare, certain histotypes of cancer demonstrate spontaneous resolution without treatment. In some cases, this heralds a long-lasting remission, whereas in others the cancer may progress after initial regression. We describe partial spontaneous regression of a pulmonary nodule that subsequently progressed and was diagnosed as adenocarcinoma.

AbstractIntroductionThere are limited data on chest computed tomography (CT) findings in the assessment of lung nodules among adult Aboriginal Australians. In this retrospective study, we assessed lung nodules among a group of adult Aboriginal Australians in the Northern Territory of Australia.MethodsPatients who underwent at least two chest CT scans between 2012 and 2020 among those referred to undergo lung function testing (spirometry) were included. Chest CT scans were assessed for the number, location, size and morphological characteristics of lung nodules.ResultsOf the 402 chest CTs assessed, 75 patients (18.7%) had lung nodules, and 57 patients were included in the final analysis with at least two CT scans available for assessment over a median follow‐up of 87 weeks. Most patients (68%) were women, with a median age of 58 years and smoking history in 83%. The majority recorded only a single nodule 43 (74%). Six patients (10%) were diagnosed with malignancy, five with primary lung cancer and one with metastatic thyroid cancer. Of the 51 (90%) patients assessed to be benign, 64 nodules were identified, of which 25 (39%) resolved, 38 (59%) remained stable and one (1.8%) enlarged on follow‐up. Nodules among patients with malignancy were typically initially larger and enlarged over time, had spiculated margins and were solid, showing no specific lobar predilection.ConclusionsMost lung nodules in Aboriginal Australians are likely to be benign. However, a proportion could be malignant. Further prospective studies are required for prognostication and monitoring of lung nodules in this population.

BackgroundAboriginal Australians are reported to have higher presence of chronic respiratory diseases. However, comprehensive evidence surrounding this is sparse. Hence, a systematic review was undertaken to appraise the current state of knowledge on respiratory health in the adult Aboriginal Australians, in particular among the three most common respiratory disorders: asthma, bronchiectasis and chronic obstructive pulmonary disease (COPD). MethodsA systematic review of primary literature published between January 2012 and October 2022, using the databases PubMed and Scopus, was conducted. Studies were included if they reported adult Aboriginal Australian prevalence's or outcomes related to asthma, bronchiectasis or COPD, and excluded if adult data were not reported separately, if Aboriginal Australian data were not reported separately or if respiratory disorders were combined into a single group. Risk of bias was assessed by both Joanne Briggs Institute checklists and Hoys' bias assessment. Summary data pertaining to prevalence, lung function, symptoms, sputum cultures and mortality for each of asthma, bronchiectasis and COPD were extracted from the included studies. ResultsThirty-seven studies were included, involving approximately 33 364 participants (71% female). Eighteen studies reported on asthma, 21 on bronchiectasis and 30 on COPD. The majority of studies (94%) involved patients from hospitals or respiratory clinics and were retrospective in nature. Across studies, the estimated prevalence of asthma was 15.4%, bronchiectasis was 9.4% and COPD was 13.7%, although there was significant geographical variation. Only a minority of studies reported on clinical manifestations (n=7) or symptoms (n=4), and studies reporting on lung function parameters (n=17) showed significant impairment, in particular among those with concurrent bronchiectasis and COPD. Airway exacerbation frequency and hospital admission rates including mortality are high. DiscussionAlthough risk of bias globally was assessed as low, and study quality as high, there was limited diversity of studies with most reporting on referred populations, and the majority originating from two centres in the Northern Territory. The states with the greatest Aboriginal Australian population (Victoria and New South Wales) reported the lowest number of studies and patients. This limits the generalisability of results to the wider Aboriginal Australian population due to significant environmental, cultural and socioeconomic variation across the population. Regardless, Aboriginal Australians appear to display a high prevalence, alongside quite advanced and complex chronic respiratory diseases. There is however significant heterogeneity of prevalence, risk factors and outcomes geographically and by patient population. Further collaborative efforts are required to address specific diagnostic and management pathways in order to close the health gap secondary to respiratory disorders in this population.

Abstract Eosinophilic granulomatosis with polyangiitis (EGPA) is part of the ANCA‐associated vasculitides, although ANCA‐negative presentations are not infrequent. Asthma, allergic rhinitis and peripheral eosinophilia are classic associations although pleural effusions are an uncommon manifestation of EGPA. We describe a 35‐year old Caucasian adult with asthma who presented with progressive dyspnoea, cough, peripheral eosinophilia and imaging that showed pulmonary nodules with pleural effusions. Biopsy with histopathological review confirmed the diagnosis of EGPA with steroid therapy resulting in significant resolution of symptoms and imaging findings.

Background Lung cancer is a major health problem. CT lung screening can reduce lung cancer mortality through early diagnosis by at least 20%. Screening high-risk individuals is most effective. Retrospective analyses suggest that identifying individuals for screening by accurate prediction models is more efficient than using categorical age-smoking criteria, such as the US Preventive Services Task Force (USPSTF) criteria. This study prospectively compared the effectiveness of the USPSTF2013 and PLCOm2012 model eligibility criteria. Methods In this prospective cohort study, participants from the International Lung Screening Trial (ILST), aged 55-80 years, who were current or former smokers (ie, had >= 30 pack-years smoking history or <= 15 quit-years since last permanently quitting), and who met USPSTF-2013 criteria or a PLCOm2012 risk threshold of at least 1.51% within 6 years of screening, were recruited from nine screening sites in Canada, Australia, Hong Kong, and the UK. After enrolment, patients were assessed with the USPSTF2013 criteria and the PLCOm-2012 risk model with a threshold of at least 1.70% at 6 years. Data were collected locally and centralised. Main outcomes were the comparison of lung cancer detection rates and cumulative life expectancies in patients with lung cancer between USPSTF2013 criteria and the PLCOm2012 model. In this Article, we present data from an interim analysis. To estimate the incidence of lung cancers in individuals who were USPSTF2013-negative and had PLCOm2012 of less than 1.51% at 6 years, ever-smokers in the Prostate Lung Colorectal and Ovarian Cancer Screening Trial (PLCO) who met these criteria and their lung cancer incidence were applied to the ILST sample size for the mean follow-up occurring in the ILST. This trial is registered at ClinicalTrials.gov, NCT02871856. Study enrolment is almost complete. Findings Between June 17, 2015, and Dec 29, 2020, 5819 participants from the International Lung Screening Trial (ILST) were enrolled on the basis of meeting USPSTF2013 criteria or the PLCOm2012 risk threshold of at least 1.51% at 6 years. The same number of individuals was selected for the PLCOm2012 model as for the USPSTF2013 criteria (4540 [78%] of 5819). After a mean follow-up of 2.3 years (SD 1.0), 135 lung cancers occurred in 4540 USPSTF2013positive participants and 162 in 4540 participants included in the PLCOm2012 of at least 1.70% at 6 years group (cancer sensitivity difference 15.8%, 95% CI 10.7-22.1%; absolute odds ratio 4.00, 95% CI 1.89-9.44; p<0.0001). Compared to USPSTF2013-positive individuals, PLCOm2012-selected participants were older (mean age 65.7 years [SD 5.9] vs 63.3 years [5.7]; p<0.0001), had more comorbidities (median 2 [IQR 1-3] vs 1 [1-2]; p<0.0001), and shorter life expectancy (13.9 years [95% CI 12.8-14.9] vs 14.8 [13.6-16.0] years). Model-based difference in cumulative life expectancies for those diagnosed with lung cancer were higher in those who had PLCOm2012 risk of at least 1.70% at 6 years than individuals who were USPSTF2013-positive (2248.6 years [95% CI 2089.6-2425.9] vs 2000.7 years [1841.2-2160.3]; difference 247.9 years, p=0.015). Interpretation PLCOm2012 appears to be more efficient than the USPSTF2013 criteria for selecting individuals to enrol into lung cancer screening programmes and should be used for identifying high-risk individuals who benefit from the inclusion in these programmes. Copyright (C) 2021 The Author(s). Published by Elsevier Ltd.

BACKGROUND:There is sparse evidence in the literature in relation to indications and outcomes among adult indigenous patients requiring a flexible bronchoscopy (FB). In this study, FB indications and outcomes between indigenous and non-indigenous patients were assessed.AIM:To assess the similarities and differences of FB indications and outcomes between indigenous and non-indigenous patients.METHODS:Self-reported indigenous status, resident locality and the primary indication for FB were assessed. The FB procedures details, results of microbiology, cytology and histopathology were compared between indigenous and non-indigenous patients. Chest computed tomography (CT) was also analysed for its relationship to FB outcomes.RESULTS:Of the 403 patients, 111 (28%) were indigenous, and indigenous patients were younger (mean difference 11 years) and had a higher proportion of remote residence (70% vs 13%). Malignancy (40%) and infection (31%) were the most common indications for FB, although indigenous patients reported significantly more haemoptysis (15% vs 9%). No differences were noted in findings of the preceding chest CT scans. For positive microbiology, indigenous patients had a higher presence of Streptococcus pneumoniae (30% vs 9%), while non-indigenous patients had a higher presence of Pseudomonas aeruginosa (43% vs 11%) and mycobacteria (15% vs 4%). There was no significant difference between indigenous and non-indigenous patients for a positive histopathology, particularly for a diagnosis of lung malignancy (58% vs 54%).CONCLUSIONS:This study has demonstrated that adult indigenous patients requiring a FB are significantly younger, tend to reside in remote communities and demonstrate differing microbiology with no significant difference in the diagnostic outcomes for lung malignancy. Ethnic status or remoteness should not preclude indigenous patients to undergo a FB if clinically indicated.

Background: There is sparse literature evidence in the spirometric patterns of adult Indigenous Australians with and without chest computed tomography (CT)-proven chronic airway diseases (CADs).Methods: Participants spirometry testing graded as acceptable for quality and had a chest CT scan showing radiographic evidence of CADs were included for analysis.Results: Of the 1350 spirometric tests performed between 2012 and 2020, a total of 212 patients with a mean age of 53 years and 54% females were eligible to be included. One-third (30%) had normal chest CT (without CADs), 35% had predominant COPD, 19% bronchiectasis and 16% combined COPD and bronchiectasis. Percentage predicted values for forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) both pre- and post- bronchodilator were significantly reduced for all participants - FVC: CT-normal 64%, 65%; COPD 58%, 62%; bronchiectasis 54%, 54%; combined COPD and bronchiectasis 50%, 53%. FEV1: CT-normal 62%, 65%; COPD 46%, 49%; bronchiectasis 48%,51%; combined COPD and bronchiectasis 36%,40%. FEV1/FVC was only reduced for CT abnormality patients - CT-normal 96%,98%; COPD 77%,77%; bronchiectasis 87%,89%; combined COPD and bronchiectasis 71%,72%.Conclusions: Restrictive spirometric pattern is common and an obstructive pattern with COPD, in isolation or when COPD coexists with bronchiectasis.

Abstract Polycystic ovary syndrome (PCOS) is associated with a higher prevalence of sleep disturbances and obesity. Treatment of PCOS includes modifying lifestyle behaviours associated with weight management. However, poor sleep in the non-PCOS population has been associated with poorer lifestyle behaviours. The aim was to investigate whether sleep disturbance confounds or modifies the association between lifestyle factors and PCOS. This was a cross-sectional analysis from the Australian Longitudinal Study on Women’s Health cohort aged 31–36 years in 2009 were analysed (n 6067, 464 PCOS, 5603 non-PCOS). Self-reported data were collected on PCOS, anthropometry, validated modified version of the Active Australia Physical Activity survey, validated FFQ and sleep disturbances through latent class analysis. Women with PCOS had greater adverse sleep symptoms including severe tiredness (P = 0·001), difficulty sleeping (P < 0·001) and restless sleep (P < 0·001), compared with women without PCOS. Women with PCOS also had higher energy consumption (6911 (sd 2453) v. 6654 (sd 2215) kJ, P = 0·017), fibre intake (19·8 (sd 7·8) v. 18·9 (sd 6·9) g, P = 0·012) and diet quality (dietary guidelines index (DGI)) (88·1 (sd 11·6) v. 86·7 (sd 11·1), P = 0·008), lower glycaemic index (50·2 (sd 4·0) v. 50·7 (sd 3·9), P = 0·021) and increased sedentary behaviour (6·3 (sd 2·8) v. 5·9 (sd 2·8) h, P = 0·009). There was a significant interaction between PCOS and sleep disturbances for DGI (P = 0·035), therefore only for women who had adequate sleep was PCOS associated with a higher DGI. For women with poorer sleep, there was no association between PCOS and DGI. The association between PCOS and improved diet quality may only be maintained if women can obtain enough good quality sleep.

Internal Medicine JournalVolume 50, Issue 12 p. 1592-1594 Letter to the Editor Malignant mesothelioma presenting as a solitary perifissural nodule Lin Mo, Lin Mo orcid.org/0000-0003-3674-5058 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorBrendan Adler, Brendan Adler Envision Medical Imaging, Perth, Western Australia, AustraliaSearch for more papers by this authorCelia Green, Celia Green PathWest Laboratory Medicine, Perth, Western Australia, AustraliaSearch for more papers by this authorFraser J. H. Brims, Fraser J. H. Brims fraser.brims@curtin.edu.au orcid.org/0000-0002-6725-7535 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Curtin Medical School, Curtin University, Perth, Western Australia, AustraliaSearch for more papers by this author Lin Mo, Lin Mo orcid.org/0000-0003-3674-5058 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Department of Respiratory Medicine, Fiona Stanley Hospital, Perth, Western Australia, AustraliaSearch for more papers by this authorBrendan Adler, Brendan Adler Envision Medical Imaging, Perth, Western Australia, AustraliaSearch for more papers by this authorCelia Green, Celia Green PathWest Laboratory Medicine, Perth, Western Australia, AustraliaSearch for more papers by this authorFraser J. H. Brims, Fraser J. H. Brims fraser.brims@curtin.edu.au orcid.org/0000-0002-6725-7535 Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia Curtin Medical School, Curtin University, Perth, Western Australia, AustraliaSearch for more papers by this author First published: 22 December 2020 https://doi.org/10.1111/imj.15120Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume50, Issue12December 2020Pages 1592-1594 RelatedInformation

Abstract Sleep disturbances in women with and without polycystic ovary syndrome (PCOS) and their association with lifestyle factors (diet, physical activity and sitting time) Bennett C1, Mansfield DR2, Mo L2, Hodge A3, Joham A4, 5, Cain SW6, Blumfield M1, Teede H4, 5, Moran LJ4 1. Be Active Sleep and Eat (BASE) Facility, Department of Nutrition and Dietetics, School of Clinical Sciences, Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria 2. Monash Lung and Sleep, Monash Health, Clayton, Victoria 3. Cancer Epidemiology Division, Cancer Council Victoria, Melbourne, Victoria 4. Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria 5. Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria 6. Monash Institute of Cognitive and Clinical Neurosciences, School of Psychological Sciences, Monash University, Clayton, Victoria Sleep disturbances are a risk factor for poorer lifestyle behaviours. While PCOS is associated with a higher prevalence of sleep disturbances, the relationship between sleep and lifestyle behaviours is unknown in PCOS. Self-reported data from the Australian Longitudinal Study on Women’s Health young cohort (31–36 years, n=6067, n=464 PCOS, n=5603 non-PCOS) were collected on PCOS, anthropometry, physical activity, sedentary behaviour, diet (74-item validated food frequency questionnaire) and sleeping behaviour (sleep quantity and adverse sleep symptoms). Multivariate regression models controlled for sleeping behaviour, BMI, age, marital status, education, income and area of residence. Women with PCOS reported greater adverse sleep symptoms, higher energy intake, diet quality (dietary guidelines index (DGI)), fibre intake and sedentary time and lower glycaemic index, compared to women without PCOS. This was not maintained for energy intake and sedentary behaviour on adjustment for confounders. For diet quality, there was an interaction between PCOS and sleep disturbances. Only for women with fewer sleep disturbances (~8 hours sleep/no adverse sleep symptoms) was PCOS associated with better diet quality (DGI higher by 3.14±0.86, p&lt;0.001), with no differences in diet quality for women with poorer sleep. Lifestyle behaviours in women with PCOS appear to be influenced by sleep quality and quantity. Nothing to disclose: CB, DM, LM, AH, AJ, SC, MB, HT, LM

Summary Background Polycystic ovary syndrome (PCOS) is a common condition in reproductive‐aged women. Sleep disturbances may be more prevalent in PCOS. It is not known if this relationship is independent of other factors. Aim To examine the prevalence of sleep disturbances in a large community‐based cohort study in women with and without PCOS and its relationship to clinical, demographic and comorbid factors. Methods We examined data from survey 5 (2009) of the Australian Longitudinal Study on Women's Health (n = 6578, n = 484 PCOS and n = 6094 non‐PCOS). Sleep duration and disturbances were self‐reported. Three classes of sleep pattern were derived during latent class analysis (normal sleep duration with average sleep, normal sleep duration with sleep symptoms and short sleep duration with sleep symptoms) and compared between women with and without PCOS using multivariate regression, adjusting for body mass index (BMI), depressive symptoms, demographic and comorbid factors. Results Women with PCOS had similar sleep duration but were more likely to experience difficulty sleeping often (RRR 1.67, 1.20‐2.33, P = 0.003) and sometimes (RRR 1.39, 1.07‐1.80, P = 0.015), with restless sleep reported occasionally (RRR, 1.35 1.00‐1.83, P = 0.049). They reported severe tiredness often (RRR 1.48, 95% CI 1.08‐2.04, P = 0.016) and described more sleep difficulties within the last 12 months (OR 1.29, 1.04‐1.60, P = 0.018) on adjusted analyses. Compared to the class of average sleep duration with no sleep disturbances, PCOS was associated with increased relative risk of having average sleep duration with sleep symptoms (RRR 1.40, 95%CI 1.11‐1.77, P = 0.004) and short sleep duration with sleep symptoms (RRR 1.46, 95%CI 1.07‐1.99, P = 0.016) on adjusted analyses. Conclusion Sleep disturbances are more prevalent amongst women with PCOS after adjusting for BMI, depressive symptoms, demographic and comorbid factors. Targeted screening and management of sleep disturbances is warranted in PCOS.

Obstructive Sleep Apnea (OSA) is strongly associated with adverse cardiovascular events. In these patients, increased oxidative stress has been associated with accelerated coronary atherosclerosis. However, it is unclear if OSA is associated with significant coronary artery plaque burden. Our aim is to determine whether OSA and/or markers of hypoxemia are associated with coronary plaque burden (CPB). Patients who had coronary computed tomography angiography (CCTA) and a polysomnogram within 1 year of each other between 2011 and 2016 were analyzed. Apnea–Hypopnea Index (AHI) and hypoxemic burden (ODI3%, ODI4%, nadir SpO2, average spO 2 and time of spO 2 < 88%) were obtained from the polysomnogram. Total CPB was assessed using the prognostically validated CT-Leaman score (CT-LeSc). Significant CPB was defined as CT-LeSc ≥ 8.3. There were 119 patients with mean (± SD) age of 59 ± 12 years. Using logistical regression analysis; AHI, ODI4% and ODI3% were the only parameters associated with significant CPB. Severe OSA (AHI ≥ 30 events/h) was associated with significant CPB with adjusted OR of 3.21 (p = 0.010) independent of traditional cardiovascular risk factors. Mechanisms associated with apnea and hypopnea events (as measured by AHI, ODI3% and ODI4%), but not the severity of arterial desaturation (nadir SpO 2 , burden of SpO 2 < 88%) were associated with significant CPB.

Methods: We did a cohort retrospective observational analytical in Persahabatan hospital, Jakarta Indonesia.Eligible patients were randomised to receive gefitinib or erlotinib until disease progression or unacceptable toxicity from January 2015 until December 2017 with the diagnosis of lung Adenocarcinoma with EGFR mutation advanced stage.Results: A total of 100 patients who included in the study to receive gefitinib (n=50) and erlotinib (n=50).Median progression free survival (PFS) was not better with gefitinib than erlotinib (9,5 vs 6,3 months, 95% confidence interval (CI) 0.92-2.09,P=0.120).The median overall survival (OS) and 1-year survival were 43,6 vs 35,3 months (95%CI 0.64-3,73, P=0.339) and 96% vs 95% (P=0.339),respectively.Toxicity including diarrhoea, paronychia, rash and stomatitis was observed but no significant differences in grade 3 or 4 toxicities between the two arms (P=0.349).Conclusions: Although primary end point was not met, both first generation EGFR TKI was comparable in both PFS and OS, although gefitinib was seen higher PFS and OS, but significantly not statistically significant and the two treatments had comparable and tolerable adverse effects.

Internal Medicine JournalVolume 46, Issue 6 p. 747-749 Letter to the Editor A case of delayed onset pyroglutamic acidosis in the sub-acute setting Correction(s) for this article Corrigendum Volume 46Issue 8Internal Medicine Journal pages: 995-995 First Published online: August 23, 2016 L. Mo, L. Mo Department of General Medicine, Alfred Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorD. L. Liang, D. L. Liang Department of Medicine, Melbourne Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorA. Madden, A. Madden Department of General Medicine, Alfred Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorA. K. Aung, A. K. Aung Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, AustraliaSearch for more papers by this author L. Mo, L. Mo Department of General Medicine, Alfred Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorD. L. Liang, D. L. Liang Department of Medicine, Melbourne Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorA. Madden, A. Madden Department of General Medicine, Alfred Health, Melbourne, Victoria, AustraliaSearch for more papers by this authorA. K. Aung, A. K. Aung Department of General Medicine, Alfred Health, Melbourne, Victoria, Australia Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Victoria, AustraliaSearch for more papers by this author First published: 03 June 2016 https://doi.org/10.1111/imj.13104Citations: 3Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume46, Issue6June 2016Pages 747-749 RelatedInformation