AFRM eBulletin – 27 July 2018

Osteoporosis: current prevention and management principles

Osteoporosis is characterised by reduction in bone mass and disruption of bone microarchitecture, leading to increased susceptibility to fragility fractures. Fractures have significant functional impact, including local disability and potential loss of independence. Furthermore, each fragility fracture increases the risk of both subsequent fractures and mortality by two to three fold. These increased risks persist five to 10 years from the incident fracture. Osteoporosis should be viewed as 'bone failure', and whilst other major organ failure is usually aggressively managed with mortality-reducing treatments, osteoporosis is often under-diagnosed and inadequately managed.  

Osteoporosis should be considered in patients at risk of accelerated bone loss or fractures. Determining bone mineral density can identify those with radiological osteoporosis; patients who have sustained a fragility fracture may not need a DXA for diagnosis, but a baseline scan assists with initial risk assessment and ongoing treatment monitoring. Secondary causes, although relatively uncommon, should be excluded in those with severe osteoporosis.

All patients with osteoporosis should be reviewed with regard to modifiable factors and nonpharmacological therapies. If calcium intake or vitamin D levels are insufficient, supplementation is recommended after discussing the potential risks. Exercise may be helpful in improving balance and muscle tone; effects on bone density are modest in adults. Active therapy should be individualised after considering the risks and benefits. Antiresorptive therapies (bisphosphonates and denosumab) are highly effective in reducing all types of fractures. These medications have a safe adverse effect profile and the risk of rare complications should be compared with the underlying risk of fracture (fracture risk calculators can quantify these risks). Although there are concerns regarding long-term therapy, there is emerging longer-term data of safety and potential ongoing benefit in some patients, and thus assessment of treatment benefit versus risk should be regularly reviewed in all patients. Cessation of denosumab should be carefully considered with specialist input. Hormone-related therapies are a good alternative for women in the perimenopausal or early postmenopausal stages. Currently teriparatide is the only anabolic agent available in Australia and PBS-reimbursement is reserved for those with severe osteoporosis. 

Preventing future fractures is paramount to maintaining a patients’ independence and thus management should be individualised and regularly reviewed in this era of multiple highly efficacious pharmacological therapies. 

Dr Angela Sheu
RACP Fellow 

Dr Angela Sheu is a clinical Endocrinologist in private practice in Randwick, where she manages many patients with osteoporosis and other hormone disorders. She is also undertaking a PhD at the Garvan Institute of Medical Research, where she is exploring how diabetes and metabolic health interact with bone physiology and osteoporosis.
 

A message from your President

Get interested – join a Special Interest Group

Special Interest Groups (SIGs) have been an integral part of the AFRM for many years, but for a variety of reasons, some have become less active in recent times. The role of SIGs is to advise the Faculty Council on matters relevant to the Faculty in their area of interest, respond to new and emerging rehabilitation medicine issues relevant to their area of interest, and work with other College bodies and staff to contribute to policy and advocacy matters as requested. SIGs also play an important role in educational activities such as curriculum review.

Over the past two years the Faculty has been undertaking the Special Interest Group Re-invigoration Project. The SIG Chairs have been meeting on a three-monthly basis via teleconference to consider ways of re-vitalising the SIGs. With the support of AFRM Executive Officer Stacey Barabash, a number of important activities have been undertaken including developing a Statement of Purpose and Induction Packs for new members for each SIG, updating the SIG website, developing meeting documentation templates and looking at ways to raise the profile of the SIGs, including promoting them in Rhaia and the eBulletin. 

The currently active AFRM SIGs are the: 

  • Mind SIG
  • Paediatric Rehabilitation SIG
  • Rehabilitation and Older People SIG
  • Rural, Remote and Isolated SIG
  • Spinal Cord Damage SIG
  • Cancer Rehabilitation SIG. 

Membership to a SIG is free, and available to all Fellows and trainees, and the SIGs are currently seeking new members. Over the past two years the Neurorehabilitation SIG, Musculoskeletal, Pain and Occupational Rehabilitation SIG, and Prosthetics and Orthotics SIG have transferred across to governance under RMSANZ. If you are interested in these SIGs I encourage you to visit the RMSANZ website.

The SIGs are a great opportunity for Fellows and trainees to connect with other colleagues who work in the same area of interest, and a practical and important way to engage in the life of the Faculty. I encourage you to visit the updated SIG webpage for more information and contact the Executive Officer at AFRM@racp.edu.au  to obtain an EOI form to join one of the Faculty SIGs.

Professor Tim Geraghty 
President, AFRM

Site Accreditation for Training in Rehabilitation Medicine

The Australasian Faculty of Rehabilitation Medicine has a Subcommittee that regularly reviews Training Providers/settings for accreditation referred to as the Faculty Site Accreditation Subcommittee (FSASc), which is assisted by a group of assessors.  

Settings are reviewed approximately every two years, including a Site Accreditation Teleconference (SAT) approximately every six years; the intervening assessments are Paper-Based Audit (PBA).

If there are any concerns identified at the site, accreditation may be granted for a period of 12 months and conditions may be placed on the site.  

Rather than reviewing the whole process, I would like to emphasise a few points:

  • The major purpose of the accreditation is to ascertain that trainees are provided with good supervision, regular teaching and a caseload and turnover that is appropriate for training in Rehabilitation Medicine.
  • The FSASc accredits settings, and terms within those settings, as appropriate for training. We do not approve/certify training per se. We want to know the details of the setting/term even if it is not currently occupied by an accredited trainee
  • All accreditation assessments are based on the written information provided on the Accreditation Assessment Form (AAF). It is the responsibility of the setting to complete the AAF accurately and completely. Incomplete or incomprehensible forms will be returned, and may delay a scheduled SAT, or PBA. There should be one AAF per setting.
  • There should be one contact person for accreditation, at each setting. This could be the Director of Rehabilitation, Department Head, or a nominated Training Program Director (TPD). They are responsible for the completion of the AAF, and notification of the accreditation decision is sent to the nominated contact person. 
  • If there is a significant change at a setting, for example, loss of funding of a term, change of sole consultant, or change of TPD, the Subcommittee must be notified.
  • As part of a SAT, current and/or past trainees are interviewed separately from the consultants, with comments not identified in the report. We also review the Trainee Term Evaluation Forms (TTEF) which are de-identified prior to being reviewed by the assessors. We take the input of trainees very seriously and encourage honesty.
  • To ensure the duration of accreditation complements training rotations/the clinical year, we are generally accrediting settings from February to February, though occasionally till August.

SATs can be conducted by assessors who are not members of the Subcommittee; Subcommittee members would also undertake SATs. Each SAT takes about two and a half hours, and is completed by email and teleconference.

The Subcommittee has two face-to-face meetings and two teleconferences per year.  We are keen to engage more assessors, and would like to have members of the FSASc from each state and New Zealand.  

If you are interested in becoming involved with accreditation for Rehabilitation Medicine, please contact accreditation@racp.edu.au. We look forward to working with you. 

Dr Peter Gale
Chair of Accreditation Subcommittee
The Australasian Faculty of Rehabilitation Medicine

AFRM Expression of Interest – Regional Committees

Expression of Interests are being sought for several opportunities within AFRM Regional Committees.

The AFRM Regional Committee has been established to:

  • advise the Faculty Council on matters relevant to the Faculty in their region
  • promote rehabilitation medicine in their region
  • respond to new and emerging rehabilitation medicine issues relevant to the Faculty as they arise, provided the issue is approved by the Faculty President or Faculty Council prior to work commencing
  • work with other College bodies and staff in relation to training and continual professional development; and contributing to policy and advocacy matters
  • the activities of the Committee must be consistent with the College’s Strategic Directions document or any successor document.

For further information please visit: 
AFRM NSW Regional committee
AFRM SA Regional Committee FPAC Representative
AFRM QLD Regional Committee
AFRM WA Regional Committee

Exciting line-up for Northern Territory event

Join colleagues from across Australia for a critical look at healthcare and vulnerable populations at the 2018 Northern Territory Annual Scientific Meeting (ASM).

Featuring a keynote address from Young Australian of the Year in the UK, Dr Geordan Shannon, the ASM brings together experts from Australia and abroad to share ideas, acquire new knowledge and develop unique insights that will help improve your practice.

Find out more

RACP social media channels 

The RACP has recently launched their very own Instagram page. This platform will be used to feature images and stories from around the College, with the aim of sharing our unique history, values and achievements. We would like to encourage all members of the College to follow us under the handle @theracp, and welcome you to invite colleagues, family, friends, and to anyone else with an interest in the College to do the same. 

If you’re not already following us on our existing social media channels, please like/follow us via the following links:

Additionally, if you have any content you would like to put forward for consideration please email communications@racp.edu.au

Making a connection podcast out now

In this Pomegranate Health episode, US-based physician Associate Professor Danielle Ofri discusses where breakdowns in doctor-patient communication occur – often in the first 10 or 20 seconds of a consultation. Dr Ofri suggests ways for physicians to listen better, be understood and promote adherence.

Read more

NSW Lecture Series and Bi-National Training Program

We understand that timeliness isn’t always possible in the work setting and we have strived to improve the user platform (Zoom videoconferencing). We have recently reconfigured the settings to keep the sessions open after they commence. It is important however to ensure you turn your webcam off before you join the webinar. Due to the nature of the recordings, if you connect via video conference, you will appear on the screen. Should you do so, we will assume automatic consent to be part of the recording.

Please note you are also able to click on the  Zoom Software link earlier to open the session, it will have a black screen until the presenter commences.

Applications open for 2018 AFRM Module 1 Assessment from 30 July

We are pleased to advise applications will be open for the next AFRM Module 1 Assessment from 30 July 2018 for all eligible trainees (who have met the training program requirements) for the Tuesday, 9 October 2018 examinations.

Applications will be open from 30 July 2018 and will close on 13 August 2018 at 5pm (AEST) and any applications received after this closing time cannot be accepted.  For all eligible candidates, this is the last time the Module 1 Written Assessment will be held as a second sit within the AFRM training program.  Going forward the Module 1 Written assessment will be held once a year, normally within the first six months of the year.

A reminder you will need to have satisfactorily completed all requirements for the January to June 2018 training period by the relevant deadlines in order to be eligible. The Training Handbook provides more information. 

If you have any further questions please email examinations@racp.edu.au

$17,000 on offer – don’t miss these funding opportunities offered by your Faculty

Travel Grants for 2019 and the second funding round for Education Development (Study)  Grants for 2018 applications close on Monday, 6 August (11.59 pm AEST).

If you’re thinking of taking up study overseas or doing further training and getting more technical experience in Australia or New Zealand apply now for:

Now is also the time to be thinking about research presentations for the Trainee Research Awards for your chance to attend the 2019 RACP Congress in Auckland and to have your abstract published.

Visit the RACP Foundation webpage for full details of all awards and prizes offered by your Faculty and the College. For more information about the eligibility criteria or the application process, please contact  RACP Foundation or phone +61 (02) 9256 9639.

Evolve updates

Research

Are you currently planning to undertake research as part of your Advanced Training? With 20 Evolve Top 5 Lists currently available, the recommendations to drive high-value, high-quality care offer an opportunity to undertake research across specialties. Find out more about Evolve by visiting www.evolve.edu.au or contacting evolve@racp.edu.au.

Clinical Champions

Are you interested in being involved in policy & advocacy within RACP? The Evolve initiative offers an opportunity to advocate for high-value, high-quality care in your specialty. Find out how you can become an Evolve Clinical Champion by contacting evolve@racp.edu.au or visit www.evolve.edu.au for more information.  

How to have difficult conversations

Three training resources are available, which provide examples of how to include the Evolve Top 5 List recommendations in difficult conversations between:

Grants on offer

Up to $10,000 in professional development funding is being offered to RACP Fellows who live and work in rural and remote Australia. 

The grants are being offered as part of round three of the the Support for Rural Specialists in Australia Program.

ANZCA’s PM10 Statement on Medicinal Cannabis

The Faculty of Pain Medicine (FPM) of the Australian and New Zealand College of Anaesthetists (ANZCA) has recently updated its statement on medicinal cannabis named PM10 Statement on 'Medicinal Cannabis' with particular reference to its use in the management of patients with chronic non-cancer pain, following a consultative forum.

Compared with the 2015 statement, there are no changes to its position fundamentally, that is – the current evidence base is insufficient to demonstrate the efficacy of cannabinoids in pain management among patients with chronic non-cancer pain and to support their clinical use in this context. This position is also bolstered by a recent landmark systematic review, on which the development of TGA’s document on guidance for the use of medicinal cannabis in the treatment of chronic non-cancer pain in Australia is based. 

Additionally, the background notes of the FPM’s 2018 statement include a brief summary of new evidence. 

Rehabilitation medicine in the news

NDIS online blackout as autism diagnosis rejected

Review of the Nationally Consistent Approval Framework for Workplace Rehabilitation Providers 

The Head of Workers’ Compensation Authorities (HWCA) is seeking consultation feedback in relation to its review of the Nationally Consistent Approval Framework for Workplace Rehabilitation Providers (NCAF).
  
The focus of this consultation is threefold:

  • examining the demand and appetite for national consistency and mutual recognition of workplace rehabilitation providers
  • considering whether the NCAF is fit for purpose and whether there are other regulatory and non-regulatory options
  • examining the effectiveness of the NCAF in approving suitably qualified and competent providers, safeguarding standards and providing quality assurance in the provision of workplace rehabilitation.

For further information about this consultation and to provide feedback, please visit the HWCA website. The closing date for submissions is Friday, 17 August 2018.

Trainee events

The Royal Australasian College of Physicians publishes notices of events and courses as a service to members. Such publication does not constitute endorsement or mandating of any such events or courses. 

Go to the events list at any time to see what events are coming up.

AFRM training resources

Bi-National Training Program (BNTP) 

The AFRM conducts the BNTP on the last Wednesday of every month from February to November. These training sessions are broadcast across Australia and New Zealand. The BNTP sessions use Zoom conferencing to provide trainees with Rehabilitation Medicine knowledge and information. These sessions are not intended to prepare trainees for the AFRM Fellowship Examinations. 

View session dates

Important note: If you join the session late, the videoconference room will indicate that it is locked and will not allow you to connect. Please ensure that you turn your webcam off before you join the session. Due to the nature of the recordings if you connect to the videoconference with your webcam on you will appear on the screen. 

To join the videoconference on the day, follow this link to the Zoom Software.

Please note this is the URL embedded in the above link: https://racp.zoom.us/j/3899131497 

The meeting ID: 389 913 1497 

Email the RACP events team at events@racp.edu.au or call +61 2 8247 6240 to arrange equipment testing. Ensure you do this as soon as possible to avoid any last-minute disruptions.

NSW Saturday Lecture Series

Go to the events list at any time to see what events are coming up.

AFRM contact details 

Member enquiries
Phone: (AUS) 1300 69 7227
Phone: (NZ) 0508 69 7227
Email: memberservices@racp.edu.au 

AFRM Faculty enquiries (including Council and committees):
Anastasia Barabash, Executive Officer, AFRM
Phone: +61 2 8076 6315
Email: afrm@racp.edu.au

AFRM Education and Training enquiries:
Name: Lanica Roventa, Education Officer
Phone: +61 2 8076 6350
Email: rehab@racp.edu.au  

AFRM Examination enquiries:
Name: Vanessa Hall, Examination Coordinator 
Phone: +61 2 9256 5422
Email: examinations@racp.edu.au  

AFRM training site accreditation enquiries:
Name: Sonia Tao, Education Officer
Phone: +61 8247 6233
Email: accreditation@racp.edu.au 
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