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February/March 2017 edition

DAME Newsletter - April 2017

From Principal Medical Officer, Dr Michael Drane

Hi everyone. It never ceases to surprise me how quickly the months go by – it seems like only yesterday we sent the last DAME newsletter out!

This month we’ve focused on a handful of interesting topics and timely reminders including:

  • changes to our aviation medicine pages on the CASA website
  • working with applicants who have not yet completed their medical history in the online medical records system (MRS)
  • assessing human performance in a clinical context using tools such as the Montreal Cognitive Assessment (MOCA)
  • the results of a recent study into treatment of atrial fibrillation.

As always, we’re keen to ensure our newsletter provides you with information that is of greatest interest and relevance to you. If you have ideas or suggestions for topics you’d like to see covered in future editions, please don’t hesitate to let me know.



Cognitive assessment – use the MOCA

One of the complex areas we address is human performance, and how to assess that in a clinical context. We are now seeing more pilots enjoying flying later in life, and we need tools to help us with our assessments of these people. We are all familiar with family members and patients who are reticent to stop driving and have little insight into the decline in their performance. Aviation has parallels, and it is worrying to receive phone calls from concerned relatives asking us to ground a pilot.

Personal insight can be a key. For example, we can contrast an attitude of "no-one’s going to stop me flying" with an approach of "I only fly routes I know now, or take an instructor with me". However, while studies confirm the importance of experience in aviation safety, it is not enough on its own.

Part of the medical examination of these applicants should explore the higher functions, and tools such as the Montreal Cognitive Assessment (MOCA) are helpful screens.  The MOCA is highly sensitive, and better at assessing executive function than the Mini-Mental State Examination. Do use the MOCA and, if you are concerned that there may be an underlying problem, consider other sources of information such as flight reviews or a history of driving incidents. If you have any questions or concerns you are encouraged to call us to discuss.

Treatment of atrial fibrillation

Patients often have their anticoagulation stopped after an ablation procedure to treat atrial fibrillation. But should they?

A paper recently released in JAMA [JAMA Cardiol 2017;2(2):146-52] explores the results of patients who were followed up for more than one year post pulmonary vein isolation. Those with a CHA2DS2VASc score greater than or equal to 2 who stopped warfarin post-treatment had over five times the risk of a stroke (1.6% vs 0.3% p.a.) compared with those continuing warfarin. We know atrial fibrillation frequently recurs post ablation and this study suggests that significant risks may also persist.

It’s an interesting paper and I’d encourage you to jump online and have a read.

Changes to our aviation medicine pages

From early May, we’ll be making changes to the way we provide you with information related to aviation medicine. All existing online aviation medicine content will be transferred across to our main corporate website at 

The design and layout of the web pages will look different, however all of the information you access regularly will still be available.

As part of this process we’re reviewing all existing information to make sure it’s up to date and relevant, and to ensure that information is easy to find. Please note the change could affect your bookmarks and favourites, so we recommend you update these once the new pages are launched. 

The search functions for DAMEs and designated aviation ophthalmologists will continue to operate in the same way, and the changes will not affect MRS or current log-in procedures.

We’ve undertaken user testing to make sure the new pages meet the needs of the aviation community, and hope you will find the transition relatively smooth. Keep an eye out for the changes from early May.

Completing medical histories

Although applicants are responsible for completing their medical history in MRS and submitting it before their DAME appointment, a small number of people are unable or unwilling to do this. If you are prepared to complete the entire examination – including the applicant’s medical history – then we recommend that your practice staff book a longer appointment and advise applicants up front of any additional costs.

If you do not wish to complete the applicant component at the time of the examination, we recommend that your staff ensure patients who call to make an appointment for an aviation medical examination are aware that they must submit the medical history component before they attend their appointment.