National Health And Medical Research Council Guidelines Research Articles

Assessing the impact of the 2018 National Health and Medical Research Council polyp surveillance guidelines on compliance with surveillance intervals at two public hospitals.

Several studies have highlighted poor compliance with surveillance colonoscopy guidelines. The National Health and Medical Research Council (NHMRC) guidelines were revised in 2018 and were more complex than the previous iteration (2011). The aim of this study was to determine the impact of 2018 NHMRC polyp surveillance guidelines on compliance with colonoscopy surveillance intervals. A multicentre retrospective clinical audit was conducted between January 2020 and February 2021. Patients awaiting a colonoscopy for polyp surveillance at two public tertiary care hospitals in South Australia were included. Compliance rates of recommended polyp surveillance colonoscopy intervals after implementation of 2018 NHMRC guidelines were compared with 2011 NHMRC guidelines. The projected impact on colonoscopy bookings of the change in guideline intervals was modelled to 5 and 10 years, factoring in differences in compliance. Of 3996 patients awaiting colonoscopy services at two public hospitals in South Australia, 1984 patients (60% male, median age 61 years) were waitlisted for polyp surveillance. Overall compliance with surveillance guidelines was >60%. Implementation of the 2018 NHMRC guidelines significantly reduced compliance from 65.8% (2011 guidelines) to 50.8% (2018) (χ2 <0.001, OR 0.5). Modelling projections to 5 and 10 years demonstrated that application of the 2018 guidelines significantly increases the projected number of colonoscopy bookings per year. The revised 2018 NHMRC guidelines have resulted in significantly poorer compliance post-implementation, possibly due to their increased complexity. This has potential to increase the surveillance colonoscopy waiting list burden.

Is a joint-specific home exercise program effective for patients with first carpometacarpal joint osteoarthritis? A critical review

Introduction First carpometacarpal joint osteoarthritis is a common degenerative condition. The thumb has been reported to account for up to 50% of hand function and is functionally and biomechanically unique in the hand. To this end, it would seem appropriate that exercise programs for first carpometacarpal joint osteoarthritis would be specifically tailored to the thumb. However, this is not widely reflected in the literature. This review aimed to critically evaluate studies presenting primary evidence to determine whether a joint-specific exercise program is effective for patients with osteoarthritis in the first carpometacarpal joint. Methods Six electronic databases were searched for papers presenting primary data relating to home exercise programs that were specific to osteoarthritis in the first carpometacarpal joint. Methodological quality of included papers was evaluated using the Structured Effectiveness for Evaluation of Studies tool and levels of evidence were established based on National Health and Medical Research Council (NHMRC) guidelines. Qualitative analysis of the combined body of literature was performed and a recommendation generated and then graded according to NHMRC guidelines. Results Searching identified three relevant papers. Overall, methodological quality was moderate, with limitations primarily related to lack of power. Findings from the body of literature demonstrated considerable variation, but evidence to support specific thumb strengthening exercises was found. This provided an NHMRC Grade D level of recommendation. Conclusions It is recommended that future studies consider optimal frequency of strengthening exercises and the potential role of adductor pollicis release and passive carpometacarpal joint mobilization in home exercise programs for first carpometacarpal osteoarthritis.

The Australian NHMRC guidelines for alcohol consumption and their portrayal in the print media: a content analysis of Australian newspapers

Objective:To measure and characterise unpaid coverage in the Australian print media of the 2001, 2007 and 2009 National Health and Medical Research Council (NHMRC) Australian Guidelines to Reduce Health Risks from Drinking Alcohol. Methods:A total of 172 articles published in Australian newspapers between 1999 and 2014 were content analysed using a coding framework aimed to define the article descriptors, article prominence, content, slant and guidelines. Results:The majority (62.2%) of articles were published between 2007 and 2009, the predominant topic being ‘the National Health and Medical Research Council guidelines” with less than two‐thirds (59.2%) of the articles mentioning the specific guidelines for reducing alcohol‐related harm. Conclusions:There was low unpaid print newspaper coverage of the guidelines, which may contribute to low community knowledge of the guidelines. Implications for public health:This study provides a foundation for developing further studies and highlights the need to improve awareness of the guidelines.

Advice about infant feeding for allergy prevention: A confusing picture for Australian consumers?

Early feeding plays an important role in programming the immune system, particularly the risk of food allergy. There are many infant feeding guides published for consumers available in Australia, with most based on the National Health and Medical Research Council (NHMRC) 2012 Infant Feeding Guidelines for Health Workers and the Australasian Society of Clinical Immunology and Allergy (ASCIA) Infant Feeding Advice for allergy prevention. We sought to compare allergy-specific content of infant feeding educational material written for parents with these two documents. Australian websites of children's hospitals, early child health organisations and consumer groups providing information about diet during pregnancy, breastfeeding and early infancy were compared with NHMRC and ASCIA guidelines. Twenty-five sets of infant feeding information were identified. Food allergy was discussed in 18 resources. Recommended length of exclusive breastfeeding and timing of commencing solid foods was consistently around 6 months, with some variation in wording. Advice regarding to include and not delay introduction of common allergens into babies' diets was generally consistent with NHMRC and ASCIA recommendations, however the audit identified some resources that still recommended delayed introduction of common allergens. As consumers have access to a plethora of health information it is imperative that information about infant feeding from health-care authorities is simple, evidence-based and consistent to avoid confusion. Use of consensus wording related to infant feeding guidelines to prevent allergies will provide clear messages related to the timing of introduction to solid foods and inclusion of allergens in the early diet.

Predictors of awareness of standard drink labelling and drinking guidelines to reduce negative health effects among Australian drinkers.

This study examined rates of awareness of standard drink labelling and drinking guidelines among Australian adult drinkers. Demographic predictors of these two outcomes were also explored. Online survey panel participants aged 18-45 years(n = 1061; mean age = 33.2 years) completed an online survey assessing demographics, alcohol consumption patterns, awareness of standard drink labels and the National Health and Medical Research Council (NHMRC) guidelines, and support for more detailed labels. The majority (80%) of participants had seen standard drink labels on alcohol products; with younger drinkers, those from a regional/rural location and high-risk drinkers significantly more likely to have seen such labelling. Most respondents estimated at or below the maximum number of drinks stipulated in the NHMRC guidelines. However, their estimates of the levels for male drinkers were significantly higher than for female drinkers. High-risk drinkers were significantly less likely to provide accurate estimates, while those who had seen the standard drink logo were significantly more likely to provide accurate estimates of drinking levels to reduce the risk of long-term harms only. Just under three-quarters of respondents supported the inclusion of more information on labels regarding guidelines to reduce negative health effects. The current standard drink labelling approach fails to address high-risk drinkers. The inclusion of information about NHMRC guidelines on alcohol labels, and placing standard drink labelling on the front of products could improve awareness of what constitutes a standard drink and safe levels of consumption among Australian drinkers.[Kerri Coomber, Sandra C. Jones, Florentine Martino, Peter G. Miller. Predictors of awareness of standard drink labelling and drinking guidelines to reduce negative health effects among Australian drinkers. Drug Alcohol Rev 2017;36:200-209].

A whole-population profile of HPV testing as a test of cure for high-grade cervical dysplasia in NSW, Australia.

Few population-based studies have been conducted on the efficacy of human papilloma virus (HPV) testing as a test of cure for high grade cervical dysplasia. A cohort of women (n = 11,521) with high grade (CIN2+) cervical dysplasia diagnosed during 2006-2010, who also had accompanying HPV testing (n = 19,434 HPV tests), was analyzed with respect to National Health and Medical Research Council (NHMRC) follow-up guidelines. Cure rates, and number of follow-up tests and times to reach a cure were estimated. In the ≥2-years following high grade dysplasia, 53% of women had a single follow-up HPV test, 33% had two, and 14% had three or more HPV follow-up tests. 75% of women with follow-up HPV and cytology testing according to NHMRC guidelines were cured (2,210 from 2,948). Cure rates were lowest in those aged <30 (71%) and highest in women aged 30-49 (80%). Of those cured, 68% attained cure by the second HPV test, 21% by the third, and 11% at the fourth or later HPV test. The median time to cure was 1,097 days. In non-cured women, 56% of test results originated from all-negative cytology with positive HPV, compared with 9% from all-negative HPV results. Cure rates in women with follow-up testing according to NHMRC guidelines are high. Further studies are needed of the high proportion of women with negative cytology classed as not cured due to HPV positivity, and of the high proportion of women with high grade dysplasia who had one follow-up HPV test only.

Health knowledge and iodine intake in pregnancy

Pregnant women have much higher iodine requirements as compared to all other population groups. The National Health and Medical Research Council (NHMRC) recommends pregnant women take a daily iodine supplement of 150μg to meet their high iodine requirements. To investigate iodine supplement use and health knowledge among pregnant women. A cross-sectional sample of 200 pregnant women aged 18years or older, in their third trimester based in Gippsland (Victoria, Australia) undertook a self-administered questionnaire from August 2011-May 2012. The women were recruited from antenatal classes and clinics from all birthing hospitals across Gippsland. Data were analysed using descriptive statistics and logistic regression. A total of 46% of participants did not follow the NHMRC recommendation of 150μg/day iodine supplement. The participants lacked knowledge about iodine and the need for supplementation. Only 18.5% of pregnant women believed they needed an iodine supplement. The majority of participants (83.5%) indicated their medical practitioners were the main source of health information, yet only 34.5% indicated being made aware of the importance of increasing iodine intake during pregnancy by their medical practitioner. The predictors of iodine supplementation are general supplementation use and knowledge of the importance of iodine. Despite NHMRC guidelines for iodine supplementation during pregnancy, many women were not taking a sufficient iodine supplement. Pregnant women may be inclined to take an iodine supplement if they had greater knowledge of their increased iodine needs during pregnancy. Medical practitioners are best placed to provide this information to pregnant women.

Reframing spaces by building relationships: Community collaborative participatory action research with Aboriginal mothers in prison

Aboriginal women are vastly over-represented in the Australian prison system. Their recidivism rates are high. Aboriginal women in contact with the criminal justice system also have higher rates of mental health disorders and are likely to have been a victim of violence. The majority of these women are mothers. Their increasing incarceration therefore has serious implications for the health and social and emotional wellbeing of their Aboriginal children, families and communities. Illustrating and exploring this situation requires an Indigenous informed conceptual framework utilising a decolonising research methodology inclusive of enduring community and stakeholder dialogue and consultation. Respectful and ethical praxis are central to this approach. We will describe how this methodology has been applied within a current National Health and Medical Research Council (NHMRC) research project in NSW, Australia. The NHMRC guidelines for research with Aboriginal and Torres Strait Islanders peoples have supported our process and will be highlighted in illustrating our research experience.

An empirical investigation into beliefs about collaborative practice among maternity care providers

To investigate agreement with the National Health and Medical Research Council (NHMRC) definition of collaboration in maternity care by care providers, and to examine their preferences for models of care in order to shed light on the lack of success in implementing collaborative practice. Maternity care providers completed a survey in Queensland. The final sample consisted of 337 participants, including 281 midwives (83.38%), 35 obstetricians (10.39%), and 21 general practitioners (6.23%). Ninety-one percent of the participants agreed with the NHMRC definition of collaboration: Midwives (M=5.97, s.d.=1.2) and doctors (obstetricians and general practitioners: M=5.7, s.d.=1.35) did not differ significantly in their level of agreement with definition (t (332)=-1.8, P=.068). However, 72% of doctors endorsed a doctor-led model of care, whereas only 6.8% of midwives indicated agreement with it. Fewer (56%) doctors agreed with the midwife-led model of care, whereas 99.3% of midwives endorsed it. The concept of collaboration does not recognise the different interpretations by midwives and doctors of its impact on their roles and behaviours. Successful collaborative practice requires the development of guidelines that recognise these differences and specify the communication behaviour that would assist midwives and doctors to practice collaboratively.

Practitioner characteristics and the treatment of children and adolescents with attention deficit hyperactivity disorder

To investigate whether recent Australian practice conforms to the draft 2009 National Health and Medical Research Council (NHMRC) guidelines on the management of attention deficit hyperactivity disorder. Data from the 2007 Special Review on Attention Deficit Hyperactivity Disorder in Children and Adolescents in New South Wales (NSW) were examined. Two hundred seven approved stimulant prescribers in NSW responded to a detailed survey on treatment practice (including 121 paediatricians and 67 psychiatrists). Overall, the practice identified in this survey of NSW approved stimulant prescribers was consistent with that recommended in the draft NHMRC guidelines. Paediatricians were more likely to inform families of developmental therapies. Most prescribers (67%) considered stimulants to be the first line of treatment for at least half of their patients. Psychiatrists were more likely to use stimulants as first-line treatments, while those recently qualified were less likely to prescribe. Half of the prescribers were willing to consider prescribing for children 4 years of age and younger. Paediatricians were more likely to consider prescribing to this age group, while those recently qualified were less likely. There were no significant differences in prescribing practice between child and adult psychiatrists. Most prescribers (67-97%) routinely monitored patients on stimulants for weight, height, blood pressure and academic progress. Psychiatrists were less likely to review these parameters than paediatricians, with this difference being largely due to adult psychiatrists. There are significant differences in prescribing practice between paediatricians and psychiatrists. These variations may reflect differing training programs and patient populations, and merit close consideration in any review arising from the publication of the recent NHMRC guideline.

Alcohol consumption in tertiary education students

BackgroundHeavy alcohol consumption among adolescents and young adults is an issue of significant public concern. With approximately 50% of young people aged 18-24 attending tertiary education, there is an opportunity within these settings to implement programs that target risky drinking. The aim of the current study was to survey students and staff within a tertiary education institution to investigate patterns of alcohol use, alcohol-related problems, knowledge of current National Health and Medical Research Council (NHMRC) guidelines for alcohol consumption and intentions to seek help for alcohol problems.MethodsStudents of an Australian metropolitan university (with staff as a comparison group) participated in a telephone interview. Questions related to knowledge of NHMRC guidelines, drinking behaviour, alcohol-related problems and help-seeking intentions for alcohol problems. Level of psychological distress was also assessed.ResultsOf the completed interviews, 774 (65%) were students and 422 (35%) were staff. While staff were more likely to drink regularly, students were more likely to drink heavily. Alcohol consumption was significantly higher in students, in males and in those with a history of earlier onset drinking. In most cases, alcohol-related problems were more likely to occur in students. The majority of students and staff had accurate knowledge of the current NHMRC guidelines, but this was not associated with lower levels of risky drinking. Psychological distress was associated with patterns of risky drinking in students.ConclusionsOur findings are consistent with previous studies of tertiary student populations, and highlight the disconnect between knowledge of relevant guidelines and actual behaviour. There is a clear need for interventions within tertiary education institutions that promote more effective means of coping with psychological distress and improve help-seeking for alcohol problems, particularly among young men.

Staff immunisation: Policy and practice in child care

The aims of this study were to determine the level of knowledge among child-care centre directors regarding the National Health and Medical Research Council (NHMRC) recommendations for the immunisation of child-care workers, the extent to which this knowledge was translated into practice and any organisational barriers to the development and implementation of staff immunisation policy. A cross-sectional survey, conducted in August 2006, in which a postal questionnaire was sent to a random sample of 784 NSW child-care centres. Centre directors were asked to complete the questionnaire on immunisation knowledge, policy and practice for the centre. A multivariate logistic-regression model was used to identify factors independently associated with centres with an immunisation policy for staff and centres that offered to pay all or part of the cost of vaccination of staff. Directors from 437 centres participated in the study for a response rate of 56%. Of these, 49% were aware of the NHMRC recommendations, and 57% had a staff immunisation policy in place. In the logistic regression model, centres with a written immunisation policy for staff were more likely to be aware of the NHMRC guidelines and offer long day care services. Centres that offered to pay all or part of the cost of immunisation for staff were more likely to be aware of the NHMRC guidelines, offer other child-care services and not operate for profit. Barriers to staff immunisation were related to the implementation of policy and included cost, time and access to information. The level of awareness of specific staff immunisation recommendations was relatively low. The transition of knowledge to policy was encouraging, although implementation of policies requires further commitment.

Large loop excision of transformation zone procedures used in the management of cytological abnormalities of the cervix

National Health and Medical Research Council (NHMRC) guidelines published in 2005 changed the management of cervical squamous intraepithelial lesions. Asymptomatic low-grade abnormalities may be treated conservatively as many regress spontaneously. Cervical changes reflect infection with the human papilloma virus (HPV). Risk factors for acquiring HPV are the same as those for other sexually transmitted infections (STIs). To perform a comparison of the Papanicolaou (PAP) smear, histology results of the cervical biopsy and large loop excision of transformation zone (LLETZ) to determine what proportion were over treated, and conversely what proportion would have been under treated in relation to the 2005 NHMRC guidelines. This group of patients was reviewed also for history of STI or concurrent infection. Retrospective chart audit of LLETZ procedures and related histology in a population of women under 25 years between 1999 and 2003 presenting to a colposcopy clinic at a regional hospital. Two hundred and fifty-one asymptomatic women underwent LLETZ procedures. Of them, 27.6% reported a history of STI and 9.2% had a positive test result or history of Chlamydia. Based on the 2005 NHMRC guidelines, which require high-grade squamous intraepithelial lesions (HSIL) on PAP or biopsy, 34% of women had no indication for LLETZ. Of these, 65% were over treated having no HSIL on LLETZ histology and 35% would have been under treated. The 2005 NHMRC guidelines should result in 33.9% fewer LLETZ procedures being performed in the younger age group. This has benefits for their future fertility needs. STI screening would be beneficial in this group when seen at colposcopy clinics, as they have significant rates of prior or current infection.

Midwives and pregnant women talk about alcohol: what advice do we give and what do they receive?

Background the Australian National Health and Medical Research Council (NHMRC) recently revised its guidelines for alcohol consumption during pregnancy and breast feeding, moving from a recommendation of minimising intake to one of abstinence. Women are potentially exposed to a variety of messages about alcohol and pregnancy, including from the media and social contacts, and are likely to see midwives as the source of expert advice in understanding these contradictory messages. Objective to explore the advice that midwives believe they give to pregnant women about alcohol consumption, and the advice that pregnant women believe they receive; the knowledge and attitudes of both groups regarding alcohol consumption and the consistency with the NHMRC guidelines; and the receptivity and comfort of both groups in discussing alcohol consumption in the context of antenatal appointments. Design individual semi-structured interviews with midwives and pregnant women. Setting face-to-face interviews with midwives and telephone interviews with pregnant women were conducted in two regional areas of New South Wales in 2008–2009. Participants 12 midwives and 12 pregnant women. Findings midwives and pregnant women consistently agreed that conversations about alcohol are generally limited to brief screening questions at the first visit, and the risks are not discussed or explained (except for high-risk women). Key conclusions both groups expressed comfort with the idea of discussing alcohol consumption, but lacked knowledge of the risk and recommendation, and it appears that this opportunity to provide women with information is under-utilised. Implications for practice there is a need to provide midwives with accurate information about the risks of alcohol consumption during pregnancy and effective communication tools to encourage them to discuss the risks and recommendations with their patients.

'I don't know why they don't come': barriers to participation in cardiac rehabilitation

To describe health professionals' perceptions of Aboriginal people's access to cardiac rehabilitation (CR) services and the role of institutional barriers in implementing the National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander peoples. Qualitative study. Metropolitan and rural tertiary and community-based public CR services and Aboriginal health services in WA. Thirty-eight health professionals working in the CR setting. Semistructured interviews were undertaken with 28 health professionals at public CR services and 10 health professionals from Aboriginal Medical Services in WA. The participants represented 17 services (10 rural, 7 metropolitan) listed in the WA Directory of CR services. Emergent themes included (1) a lack of awareness of Aboriginal CR patients' needs; (2) needs related to cultural awareness training for health professionals; and (3) Aboriginal health staff facilitate access for Aboriginal patients. Understanding the institutional barriers to Aboriginal participation in CR is necessary to recommend viable solutions. Promoting cultural awareness training, recruiting Aboriginal health workers and monitoring participation rates are important in improving health outcomes.

Are the processes recommended by the NHMRC for improving Cardiac Rehabilitation (CR) for Aboriginal and Torres Strait Islander people being implemented?: an assessment of CR Services across Western Australia

BackgroundCardiovascular disease is the major cause of premature death of Indigenous Australians, and despite evidence that cardiac rehabilitation (CR) and secondary prevention can reduce recurrent disease and deaths, CR uptake is suboptimal. The National Health and Medical Research Council (NHMRC) guidelines Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander peoples, published in 2005, provide checklists for services to assist them to reduce the service gap for Indigenous people. This study describes health professionals' awareness, implementation, and perspectives of barriers to implementation of these guidelines based on semi-structured interviews conducted between November 2007 and June 2008 with health professionals involved in CR within mainstream health services in Western Australia (WA). Twenty-four health professionals from 17 services (10 rural, 7 metropolitan) listed in the WA Directory of CR services were interviewed.ResultsThe majority of respondents reported that they were unfamiliar with the NHMRC guidelines and as a consequence implementation of the recommendations was minimal and inconsistently applied. Respondents reported that they provided few in-patient CR-related services to Indigenous patients, services upon discharge were erratic, and they had few Indigenous-specific resources for patients. Issues relating to workforce, cultural competence, and service linkages emerged as having most impact on design and delivery of CR services for Indigenous people in WA.ConclusionsThis study has demonstrated limited awareness and poor implementation in WA of the recommendations of the NHMRC Strengthening Cardiac Rehabilitation and Secondary Prevention for Aboriginal and Torres Strait Islander Peoples: A Guide for Health Professionals. The disproportionate burden of CVD morbidity and mortality among Indigenous Australians mandates urgent attention to this problem and alternative approaches to CR delivery. Dedicated resources and alternative approaches to CR delivery for Indigenous Australians are needed.

ORIGINAL RESEARCH–ERECTILE DYSFUNCTION: Alcohol Consumption and Male Erectile Dysfunction: An Unfounded Reputation for Risk?

ABSTRACT Introduction Alcohol consumption is a contentious social topic and is often assumed to have deleterious effects on sexual performance. There is a lack of consensus on whether alcohol consumption may in fact be beneficial to erectile function. Aim We examined the data from a population-based cross-sectional study of men’s health to assess the association between usual alcohol consumption and erectile dysfunction (ED). Method Reply-paid questionnaires were posted to a randomly selected age-stratified male population sample obtained from the Western Australian (WA) Electoral Roll. Main Outcome Measures The survey questionnaire included sociodemographic details, self-reported clinical information, and drinking habits. The 5-item International Index of Erectile Function (IIEF-5) was used to assess erectile function. Results Most (87%) participants were current alcohol drinkers, with binge drinking, as defined by the Australian National Health and Medical Research Council (NHMRC), reported by 20% of drinkers. Compared with never-drinkers, the age-adjusted odds of ED were lower among current, weekend, and binge drinkers and higher among ex-drinkers. Among current drinkers, the odds were lowest for consumption within the NHMRC guidelines of between 1 and 20 standard drinks a week. On further adjustment for cardiovascular disease (CVD) or for cigarette smoking, age-adjusted odds of ED were reduced by 25–30% among alcohol drinkers. Conclusions Our findings suggest a modest negative association between alcohol consumption and ED and confounding of the association by CVD and cigarette smoking. The Western Australia Men’s Health Study certainly provides no justification for advising men with ED whose drinking habits are consistent with NHMRC guidelines that they should cease or reduce their consumption of alcohol.

Diagnosis and management of childhood obesity: A survey of general practitioners in South West Sydney

To describe general practitioners' (GPs) diagnosis and management of overweight and obesity in children, their attitudes regarding obesity and their awareness of National Health and Medical Research Council (NHMRC) clinical practice guidelines. A cross-sectional written survey of members of the Liverpool Division of General Practice (located in South West Sydney, Australia). Of 137 questionnaires sent, 85 (62%) were returned. Although the majority prescribed the correct interventions, there was variability in complications screening, ranging from 75% screening for psychosocial problems to 30% for fatty liver. Less than a third (28%) of GPs used NHMRC guidelines in their practice and only 9% used body mass index charts to correctly diagnose childhood obesity. GPs felt that childhood obesity was a significant issue and identified parental denial and lack of community support as barriers to treatment. Although NHMRC guideline adherence was far from universal, the GPs in our survey are motivated and aware of the importance of managing childhood obesity. If the primary care approach is to work, then GPs need support and education in an environment where there is greater community awareness of the impact of childhood obesity.

A review of policies on alcohol use during pregnancy in Australia and other English‐speaking countries, 2006

It is well accepted that heavy alcohol consumption during pregnancy is a risk factor for fetal alcohol spectrum disorder, but research findings for exposure to low to moderate alcohol levels during pregnancy are equivocal, allowing a range of interpretations. The 2001 guideline from the National Health and Medical Research Council (NHMRC) for low-risk drinking for "women who are pregnant or might soon become pregnant" recommends fewer than seven standard drinks per week, and no more than two standard drinks on any one day. This position has polarised health professional and consumer opinion in Australia. The NHMRC guidelines on alcohol are scheduled for review in 2007. We surveyed the alcohol and pregnancy policies and clinical practice guidelines of Australia and six other English-speaking countries to identify current policy. Documents were obtained through Internet searches and direct contact with the relevant organisations. The policies and guidelines varied both across and within countries, and the NHMRC guideline, while not universally supported in Australia, is in step with the policies of the United Kingdom and Canada. Research is needed to elucidate the true association between low to moderate alcohol consumption and fetal harm, the impact of different policies on rates of maternal alcohol consumption during pregnancy, and any untoward outcomes of an abstinence message, to inform and underpin future policy development in Australia.

Acute Pain Management: Current Best Evidence Provides Guide for Improved Practice: Table 1

Effective management of acute pain is a major priority for both patients and healthcare providers. Inadequate control of acute and postoperative pain can lead to adverse outcomes that include pulmonary and thromboembolic complications and additional time in hospital or intensive care, with associated increased costs [1]. It can also have negative effects on mobility and function, emotional well-being, quality of life, and overall recovery [2]. Although significant advances have been made in the understanding, assessment, and management of acute pain, further improvements in clinical practice are required. This can be assisted by the provision of up-to-date evidence-based guidelines. The Australian and New Zealand College of Anaesthetists (ANZCA) and Faculty of Pain Medicine (FPM) have recently published the Second Edition of “Acute Pain Management: Scientific Evidence”[3]. This document is a compilation of current evidence and expert practice relevant to acute pain management across a wide range of patient populations and clinical settings, and therefore a systematic approach with multidisciplinary collaboration was required. A Working Party was convened by ANZCA to appoint contributors and edit submissions. Searches of electronic databases and recent publications were conducted (as outlined in Appendix B of the document) and were greatly aided by systematic reviews that had been published by the Cochrane Collaboration and Oxford Pain Group. Evidence was graded according to current Australian National Health and Medical Research Council (NHMRC) criteria (see Table 1) with assistance from the NHMRC Guidelines Assessment Register. Since the publication of the First Edition, “expert opinion” is no longer graded as evidence. However, as high levels of evidence are not available for all interventions, recommended best practice based on experience and expert opinion was included as “clinical practice points.” The initial draft document was reviewed by a multidisciplinary consultative committee, made up of members of …