SOP Bulletin No. 62

4 — th Floor AMP Place, 10 Eagle St Brisbane  3 — rd Floor Blackburn House, 199 Grenfell St Adelaide

Intranet site:  http://intranet/nat/comp/dp/Nop/dsu/dsudefault.htm

9 August 2002

THE FOLLOWING RMA SOPS ARE TO BE GAZETTED ON 14 August, 2002

IMPORTANT OPERATIONAL FEATURES

• The previous SOPs for Colorectal Adenomatous Polyp or Familial Adenomatous Polyposis have effectively been separated into SOPs for Colorectal Adenoma and SOPs for Familial Adenomatous Polyposis.
• Colorectal Adenoma is a broader term than colorectal adenomatous polyp, including serrated adenomas as well as colorectal adenomatous polyps.
• The following comments on the factors compare the new factors to those for colorectal adenomatous polyp in the previous combined SOPs.
• The dietary fat/fibre factor has been removed.
• There are new causal factors for physical inactivity and obesity, which in the BOP SOP are for adenoma of the colon only.
• The smoking and alcohol factors have been re-worded, with changes to the doses and time requirements.

• There are new causal and aggravating factors for obesity and non-steroidal anti-inflammatory drugs.
• Hiatus hernia, intra-abdominal surgical procedure and scleroderma are now aggravating as well as causal factors.

• There are new causal and aggravating factors for chronic renal failure in both the RH and BOP SOPs.
• There is a new causal and aggravating factor for hypertension in the RH SOP only.

• The definition has been significantly shortened, without changing the meaning.
• There are three new causal and aggravating factors.  A severe psychological stressor is in RH only.  Streptococcal pharyngitis/tonsillitis and HIV are in RH and BOP. 
• Alcohol dependence or abuse and clinically significant anxiety disorder or clinically significant depressive disorder are now causal as well as aggravating factors.
• The skin trauma factor has been re-worded, has an associated definition of “skin injury”, and now applies to causation as well as aggravation.
• The drug factors have been re-organised.  There are two types of drug factors, and both are causal and aggravating factors in RH and BOP. 
• The first drug factor is “a drug from the specified list”.  The list is the same for causation and aggravation, and for RH and BOP, and includes the drugs in the previous SOPs.  The second drug factor is undergoing treatment with a drug “assessed as having caused” the clinical onset/worsening of psoriasis, and this is defined.  The aggravating factor in both RH and BOP includes the requirement that the drug cannot be ceased or substituted.

• These SOPs replace those for Malignant Neoplasm of the Colon and Malignant Neoplasm of the Rectum, and cover all conditions previously covered by those SOPs.
• All factors, except the inability to obtain appropriate clinical management factor, are causal only.
• There is a new obesity factor, which in the BOP SOP is for malignant neoplasm of the colon only.
• There are two dietary factors for both malignant neoplasm of the colon and malignant neoplasm of the rectum, but for RH only.   These factors are for unprocessed beef, veal, pork, lamb or mutton, and processed meat product respectively, and replace the previous dietary fat/fibre factors.  There are two advisories in CLIK (AN03/1999 and AN03/2001) dealing with animal fat consumption.  These documents plus the CCPS commentary associated with the animal fat factor in MN of the prostate can provide broad guidelines about how to apply these factors until the rulebase is updated.  Specific questions can be answered by the DSU.
• The asbestos factor has new wording, and applies only to the malignant neoplasm of the colon RH SOP. 
• A reworded physical inactivity factor now applies to both colon and rectum for RH, only to colon in BOP.
• The doses in some of the smoking factors have been changed, and the factor wording now allows the smoking to take place closer to the clinical onset.  For this reason the CCPS rulebase has been disabled, pending changes to the smoking module.
• The colorectal adenomatous polyp factor has been replaced by a colorectal adenoma factor, and propagates to the new SOPs by that name.   Familial adenomatous polyposis propagates to SOPs of that name.
• There are minor changes to the wording and requirements for the alcohol, ulcerative colitis, and Crohn's disease factors.

• These SOPs replace those for Colorectal Adenomatous Polyp or Familial Adenomatous Polyposis. 
• As there was for familial adenomatous polyposis in the combined SOPs, only an inability to obtain appropriate clinical management factor applies.

The amendment deletes the word “acute” from the definition of “trauma to the cervical spine” in para.8.  This has no operational effect.

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