SOP Bulletin No. 110

Decision Support Unit

Level 8, 259 Queen St, Brisbane — 1st Floor Blackburn House, 199 Grenfell St, Adelaide

Intranet site: http://intranet/service_delivery_support/compensa…

6 November 2006

THE FOLLOWING RMA SOPS ARE TO TAKE EFFECT ON 8 NOVEMBER, 2006

New SOPs	Nil
Revocations & Replacements	Cerebrovascular Accident Fracture Acute Sprain and Acute Strain (replaces Acute Sprains and Acute Strains) Gastric Ulcer and Duodenal ulcer (replaces Peptic Ulcer Disease) Meniere's disease
Amendments	Osteoporosis Vascular Dementia

IMPORTANT OPERATIONAL FEATURES

Cerebrovascular Accident

Revocation – 51 & 52 of '06 Replaces 52 and 53 of '99, as amended by 30 & 31 of '02 and 57 & 58 of '03

• There have been a number of changes to these SOPs.  The most significant changes have been listed below.
• An important change has been made to t — he definition of cerebrovascular accident which now reads “cerebral ischaemia or intracerebral haemorrhage presenting as a transient ischaemia attack or stroke.”  The requirement for a transient ischaemia attack or stroke is new.  This means that there must be one of these clin — i — cal event — s for the SOP definition to be met.  For example, cerebral ischaemia diagnosed by radiological imaging without a clinical event would no longer meet this SOP defin — i — tion.
• Another important change is the inclusion of a smoking factor for intra — cerebral haemorrha — ge in both RH and BOP.  The amount of smoking required is the equivalent of fifteen cigarettes per day for at least one year.
• There are new factors in RH and BOP for:

• exertional heat stroke (which is defined);
• being envenomated by a sn — a — ke, scorpion, box jellyfish, bee or wasp;
• being treated with serotonergic drugs (a particular class of drugs used to treat depression eg Prozac);
• having a disease of the cerebral vessels (a definition lists these diseases); and
• using a drug from the specified list (includes cocaine and heroin which were previously separate factors).

• There is a new causal factor for depressive disorder in the RH SOP only. 
• The stressor factor uses the new method of stressor classification and is now experiencing a category A stressor.  The onset can now be within one year of the stressor (previously 48 hours).
• The stressor factor and the panic disorder factor have been remove — d fro — m the BOP SOP.
• A cerebr — al infection factor replaces the previous factor for meningitis, encephalitis or cerebral abscess.  The associated definition also includes helminthic, protozoal and fungal cerebral infections.
• For cerebral ischaemia only, there are new causal factors for:

• passive s — moking, RH only;
• nonsteroidal anti-inflammatory drugs, excluding aspirin (RH only);
• selective cyclo-oxygenase 2 inhibitor drugs (BOP only, these drugs are a sub-s — et of non-steroidal anti-inflammatory drugs);
• intravenous immunoglobulin;
• hormone replacement therapy in post menopausal women
• being treated with tamoxifen; and
• having sleep apnoea.

• For cerebral ischaemia, the cholesterol factor has been replaced by a dyslipidaemia factor.
• The cerebral ischaemia smoking factor has been separated into two factors; one for when smoking has ceased before the clinical onset and the other for when smoking has not ceased.  Various dose and time requirements apply.
• The revoked SOP — s had two factors which applied for vertebrobasilar ischaemia only.  Both now apply for all cerebral ischaemia.

• The first of these is for trauma of the neck or the base of the skull. 
• The second was for impingement on the vertebral artery by osteophytes.  This factor now cover — s obstruction of a vertebral artery, common carotid artery, internal carotid artery or a cerebral artery, due to pressure from an extra-arterial source.  As well as osteophytes, t — his would include, for example, tumours or foreign bodies.

• For intracerebral haemorrhage only, there are also new factors for:

• having an acute hypertensive crisis, which is defined; and
• ingesting tyramine in food or drugs/agents while being treated or with — in six weeks of cessation of monoamine oxidase inhibitors.

The next four SOPs have been put into the new format.  There has also be — en some reorganisation and rewo — rding without change in meaning.  Other changes are listed below.

Fracture

Revocation – 53 & 54 of '06 Replaces 11 and 12 of '94, as amended by 219 & 220 of '95

• The definition now specifically excludes spondylo — ly — sis.
• There are new causal and worsening factors for osteonecrosis in both RH and BOP.
• The factor for stress fractures now requires repetitive loading stress to the affected region and applies for worsening as well.  Repetitive loading stress is defined as ongoing physical activity which involves at least a moderate level of weight bearing exercise, and examples are given.
• The worsening factors for Paget's, osteoporosis or osteomalacia, maligna — nt neoplasm and benign neoplasm have been removed.

Acute Sprain and Acute Strain

Revocation – 55 & 56 of '06 Replaces 50 and 51 of '94

• The definitions of disease now specifically exclude complete rupture of a tendon, chronic sprain and chronic strain and d — egenerative disease of joints, ligaments or muscles.
• The definition of acute sprain and the factors now use the term “joint ligament” (previously joint).  The definition of acute strain and the factors now uses the term  “muscle or tendon” (previously muscle or joint). 
• There is a new causal factor for acute strain in RH and BOP for having joint instability due to ligamentous laxity or decreased proprioception (perception of movement and position).

Gastric Ulcer and Duodenal Ulcer

Revocation – 57 & 58 of '06 Replaces 21 and 22 of '99

• The SOP for Peptic ulcer disease has been replaced by this SOP for Gastric ulcer and duodenal ulcer
• The word “chronic” has been removed from the definitions of gastric and duodenal ulcer.  This means that any acute or chronic ulcer which meets the rest of the definit — ion, including a diameter of 3 millimetres or greater and extend — ing through the musculari — s mucosa into the submucosa, is covered by this SOP.
• The Helicobacter pylori infection now must be of the stomach or duodenum, and the factor is now a worsening factor as well as causal.
• The non-steroidal anti-inflammatory drug factor has been combined into one factor for gastric ulcer and duodenal ulcer; it now applies for non-topical use only and includes aspirin.
• The amount required for the smoking factor is now half a pack year RH, one pack year BOP, with time requirements.
• There are new causal and worsening factors in RH and BOP for:

• a gastrin secreting tumour;
• having a critical illness or injury (which is defined); and
• being treated with a drug from a specified list.
  The specified list of drugs is different for onset and worsening.  For worsening, but not for onset, the list includes an anticoagulant.

• There is a new causal and worsening factor in RH only for being treated with non-topical, non-inhaled corticosteroids at a dose equivalent to 10 milligram of prednisone per day, with time requirements.
• There are new causal factors in RH only for:

• receiving immunosuppressive therapy for organ transplantation; and
• having contact with a nasogastric tube or other foreign body at the site of the ulcer.

Meniere's Disease

Revocation – 59 & 60 of '06 Replaces 77 and 78 of '01

• The wording of the definition has been changed without change in meaning.
• There are new causal factors in RH and BOP for having a head injury (which is defined) and having otosyphilis.
• Ther — e is a new causal factor in RH only for having otitis media of the affected ear.

Osteoporosis

Amendment – 61 & 62 of '06 Amends 29 and 30 of '06

• The amendment is to rectify an error.   The wording of the Vitamin A factor is changed from “more than 7.5 grams per day” to “at least 7.5 milligrams per day”.

Vascular Dementia

Amendment – 63 & 64 of '06 Amends 21 and 22 of '06

• The defin — i — tion of “cerebrov — ascular disease” in this SOP has been changed to: “cerebrovascular disease” means any abnormality of the brain resulting from a pathologic process of the cerebral blood vessels or decreased blood flow to the brain, including cerebral ischaemia, intracerebral haemorrhage or cerebral infarction.
• The words “or decreased blood flow to the brain” have been added.  This means that something that causes a decreased blood flow to the brain and results in an abnormality of the brain is covered, even if the abnormality is not of the cerebral vessels.  An example would be chronic hypoxia from chronic hypoperfusion associated with congestive cardiac failure.

Remember! If you are having any problems with SOPs, or SOPs in CCPS, talk to us!