SOP Bulletin No. 90

Decision Support Unit

8 — th Floor, 259 Queen St, Brisbane — 3 — rd Floor Blackburn House, 199 Grenfell St, Adelaide

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

7 March 2005

THE FOLLOWING RMA SOPS TAKE EFFECT ON 09 MARCH 2005

New SOPs	Nil
Revocations & Replacements	Epileptic seizure (revokes seizures) Epilepsy Inguinal hernia Solar keratosis Chronic lymphoid leukaemia
Amendments	Nil

IMPORTANT OPERATIONAL FEATURES

Epileptic seizure	Revocation – 1 & 2 of '05 Replaces 81 and 82 of '96
Epilepsy	Revocation – 3 & 4 of '05 Replaces 79 and 80 of '96

• There are a number of types of fits/convulsions that are not covered by either of these SOPs.  These are listed in the exclusions in each SOP definition (e.g. hysterical seizure, febrile seizure).  The “seizures” SOP has also been renamed “epileptic seizure”, to emphasise that non-epileptic seizures are not covered.

• The two SOPs both cover the same types of seizures.  In essence, when the seizures are one-off events they come under the epileptic seizure SOP and when there are recurrent seizures they come under the epilepsy SOP – but it's a bit more complicated than that:

• An epilepsy diagnosis requires two or more separate seizure events
  [1]

  This is a standard, international criterion, generally used in clinical practice.

  [1] (go back)
  , more than 24 hours apart and not due a short term problem at the time such as a low blood sugar level, high blood calcium level or acute brain hypoxia (decreased oxygen supply).  Note that multiple seizures within a 24 hour period are regarded as one seizure event.
• The epileptic seizure SOP applies if: (i) there has only ever been one seizure event; or, (ii) there has been an acute precipitating cause for a seizure.

• Both SOPs may apply in the one case.  The confirming diagnosis screen in CCPS research will provide further advice.

Epilepsy factors:

• The factors from the old SOPs have all been retained, with some reorganisation and some changes to some time requirements.
• There are new factors for HIV infection, Alzheimer's disease, Cruetzfeldt-Jacob disease and multiple sclerosis.

Epileptic seizure factors:

• These SOPs have:
• Essentially the same range of causal factors as the epilepsy SOPs, with some different time periods, reflecting the fact that the first ever epileptic seizure may in time prove to be epilepsy (if and when a further seizure event occurs).
• No worsening factors (except for inability to obtain appropriate clinical management), reflecting the one-off nature of the condition.
• A host of additional factors covering acute precipitating events.

• Compared to the old SOPs, there are now factors covering: an expanded range of drugs, including “recreational” drugs; alcohol withdrawal; atmospheric pressure changes (e.g. in scuba diving); organochlorine insecticide exposure; hypertensive encephalopathy; eclampsia; sleep deprivation (RH only) and scorpion stings (RH only).

Inguinal hernia

Revocation – 5 & 6 of '05 Replaces 72 and 73 of '98

• The definition associated with the increased intra-abdominal pressure factor has an expanded list of causes, now including: a direct blow to the abdomen; and (performing an) anti-G (force) straining manoeuvre.  This latter term is separately defined.
• There is a new causal factor, in RH and BOP SOPs, for undergoing a radical retropubic prostatectomy (for prostate cancer).

Solar keratosis

Revocation – 7 & 8 of '05 Replaces 47 and 48 of '01 as amended by 56 & 57 of '01

• The definition has been changed, with no operational effect.
• There is a new causal factor in both RH and BOP SOPs, for sun exposure to unprotected skin.  This is identical to the one included in the non-melanotic malignant neoplasm of the skin SOPs in December.
• There are new causal factors in the RH and BOP SOPs for undergoing PUVA therapy and, in the RH SOP only, for exposure to bipyridyl compounds associated with paraquat manufacture.

Chronic lymphoid leukaemia

Revocation – 9 & 10 of '05 Replaces 67 and 68 of '01 as amended by 59 of '03

• The definition has been altered, with the addition of some specific inclusions and exclusions.
• The exposure to extremely low frequency magnetic fields factor, that was in the RH SOP only, has been removed.

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