Clinical Case Scenarios

NICE (National Institute for Health and Clinical Excellence) has developed a number of new clinical case scenarios to help improve and assess users' knowledge of our guidance.  The case scenarios are an educational resource that can be used for individual or group learning. The latest case scenarios on covering NICE guidelines are  on adult and paediatric epilepsy, self harm and colorectal cancer.    

Are medical students influenced by preceptors in making career choices

Increasingly medical students undertake clinical training in distributed learning environments. The driving factor for this is predominantly to address medical workforce shortages. In these environments students are often taught by private practitioners, residents, hospital staff and registrars, as well as faculty. Medical students are exposed to a wider range of preceptors, mentors and role models than has traditionally been the case. The aim of this systematic review was to understand if and how medical students’ career choices are influenced by their interactions with preceptors.

This systematic review has been published by the Rural and Remote Health journal.

Cancer Cluster Statement

The NHMRC has published a statement on Cancer Clusters with the aim to provide the general public with information on the assessment and management of cancer clusters. NHMRC convened a meeting of leading cancer experts, biostatisticians and health and medical researchers to review best practice in the management of cancer cluster assessment.  The Statement was produced with the assistance of relevant State and Territory experts nominated by the State and Territory Chief Health Officers.

What every man needs to know

Andrology Australia has revamped its website at http://www.andrologyaustralia.org/, so that men and health professionals can have easier access to information on male reproductive health and associated conditions.

Ambulance ramping affects paramedics and hospital staff

The underlying causes and knock-on effects of ambulance ramping at Queensland hospitals are explored and analysed in a ground-breaking report published this week by the Griffith Health Institute.

"Essentially, ambulance ramping was found to occur when no suitable emergency department bed was available, nor able to be made available, for patients presenting by ambulance and a patient remained under the care of ambulance personnel," said Dr Ramon Shaban, Senior Research Fellow at Griffith's Research Centre for Clinical and Community Practice Innovation.
You can download the report here.

Caring for people who sniff petrol

Caring for people who sniff petrol or other volatile substances: a quick reference guide for health workers is a summary of the NHMRC’s consensus-based clinical practice guideline for the management of volatile substance use in Australia.

This quick reference guide contains information about how to care for people who deliberately become intoxicated by inhaling vapours from solvents, gases or aerosols, which may include petrol, paint stripper and other products used in building and plumbing, glue, nail polish remover, fuel gas, lighter fluid, spray paint and other spray cans.

NSW Tobacco Strategy 2012-2017

The NSW Tobacco Strategy 2012-2017 provides an overarching framework for the actions that the NSW Government will lead to reduce smoking and tobacco related harm in NSW.  The Strategy includes:

• A focus on addressing tobacco smoking in populations with high smoking rates, particularly Aboriginal communities, women smoking in pregnancy, mental health consumers and people in corrections facilities;
• Enhanced programs to help smokers quit; and
• Measures to protect people from harmful second-hand smoke in outdoor areas.

Indigenous Chronic Disease Package

Closing the Gap’s Indigenous Chronic Disease Package Annual Progress Report 2010-11 is now available from the Australian Department of Health and Ageing.  It outlines progress being made to improve the   prevention, detection and management of chronic disease in indigenous populations.  Also available at this site is the first annual report, as well as the booklet with the original package, in which the Australian Government committed to significant new funding for preventative health and primary health initiatives focusing on Aboriginal and Torres Strait Islander individuals, families and communities.

Caring for frail older people – seminar papers

Caring for the growing numbers of frail older people : an international perspective was the title of a recent seminar run by the Kings Fund in the UK.  You can see video highlights at the program site, or download pdfs of the main presentations:

• ‘Integrated care models for frail older people: some international case studies’.  Professor Dennis Kodner.
• ‘Providing sustainable care for the most vulnerable’.  Dr Chai Patel 

ARCHI Information Exchange

The Australian Resource Centre for Healthcare Innovation (ARCHI) has started a new service called Information Exchange, where ARCHI users can upload links to good online sources and web pages relevant to current innovations in health.  There are some great links at this moderated site, so if you’re interested in innovation you should look here. 

Fact Sheets from Kids Health at Westmead

These fact sheets from the Children’s Hospital at Westmead are designed for parents and include topics ranging from allergies to bed-wetting, emotional problems, and healthy eating. There is a long list of procedures as well, including blood transfusion, catheterisation, circumcision, CT scans, immunisation, drips and venepuncture.

SANE book of the year 2012: Understanding Troubled Minds

Many of us take our mental health for granted. But when confronted by mental illness in family members, friends or ourselves, even the most competent can become overwhelmed. Understanding Troubled Minds by Sidney Bloch guides us calmly and authoritatively through the full range of mental illnesses and their treatment, and includes chapters dealing specifically with mental illnesses afflicting women, children and the elderly. The book is for loan at PMBH Library and will be purchased for CHHC Library.

Life Around Here - report on three Australian communities

In-depth interviews were undertaken with 59 households (involving 71 individuals) in Broadmeadows in Victoria, Mansfield Park in South Australia, and Carole Park near Goodna in Queensland.  'Life Around Here : Community, work and family life in three Australian communities' is a research study from the Australian Institute of Family Studies which provides information about the factors that influence the participation of families in paid employment and how it affects their communities more broadly.  The people in these particular communities were found to have high levels of disadvantage compared to the general Australian population.

Cognitive stimulation for dementia

Cognitive stimulation is an intervention for people with dementia which offers a range of enjoyable activities providing general stimulation for thinking, concentration and memory usually in a social setting, such as a small group. Cochrane has provided a systematic review of the available evidence regarding cognitive stimulation and its effectiveness. 

Pulmonary rehabilitation review, NIH

Medline Plus has updated its review on Pulmonary Rehabilitation, including sections on Disease Management, Clinical Trials and Nutrition.  Pulmonary rehabilitation is a broad program that helps improve the well-being of people who have chronic (ongoing) breathing problems. For example, PR may benefit people who have COPD (chronic obstructive pulmonary disease), sarcoidosis, idiopathic pulmonary fibrosis, or cystic fibrosis. PR also can benefit people who need lung surgery, both before and after the surgery. PR doesn't replace medical therapy. Instead, it's used with medical therapy and may include:

• Exercise training
• Nutritional counselling
• Education on your lung disease and how to manage it
• Energy-conserving techniques
• Breathing strategies
• Psychological counselling and/or group support

Role of aspirin in cancer treatment

Researchers have known for years that common drugs like aspirin can help cancer patients, but they were not sure why.  Now, scientists at the Peter MacCallum Cancer Institute in Melbourne have found a link between drugs like aspirin and the ability for cancer tumours to spread in the body. 

The Institute's associate professor Steven Stacker says the discovery unlocks a range of potential new pathways for treating cancer.  "Hopefully this insight is going to be very important to understanding how these drugs may work and in fact how the lymphatic vessels may really contribute to a tumour metastasis," he said.

The discovery was reported this week on various sources including an interview with Steven Stacker on ABC's AM and Scientists probe aspirin's role in cancer treatment - an ABC News story by Samantha Donovan.

The research was published this week in an article by Tara Karnezis, Steven Stacker and others, in the journal Cancer Cell:  VEGF-D Promotes Tumor Metastasis by Regulating Prostaglandins Produced by the Collecting Lymphatic Endothelium, Cancer Cell, Volume 21, Issue 2, 181-195, 14 February 2012.
Please contact your library for a copy of the article in full.

Myths about sleep

Myths about sleep is the title of a segment on ABC Radio National's Health Report last week.  Norman Swan interviewed Nick Glozier, Associate Professor of Psychological and Sleep Medicine at the University of Sydney.  Glozier was interested in media claims, and popular opinion, that Australians are sleep-deprived, and wanted to see whether this had any basis in fact.  Using ABS data from a number of surveys, he discovered that we may even be having a little bit more sleep today than we were having twenty years ago.  Australians are also fairly average sleepers compared to other nationalities.

Insulin treated diabetes - incidence statistics

Incidence of insulin-treated diabetes in Australia 2000-2009 has been released by the AIHW.  It outlines the latest data about the number of new cases of insulin-treated diabetes from the National Diabetes Register. During this period, 222,544 people began using insulin to treat their diabetes. Of these, 77% had Type 2 diabetes, 12% had gestational diabetes and 10% had Type 1 diabetes. The remaining 1% had other types of diabetes.  The incidence of Type 1 diabetes is increasing, and is more prevalent in males than females.

Comorbidity of mental and physical disorders

Comorbidity of mental disorders and physical conditions 2007, is a report from the Australian Institute of Health and Welfare which investigates the prevalence of mental illness in association with common chronic diseases. It shows that in 2007, 12% of Australians aged 16-85 had a mental disorder and a physical condition at the same time. The most common comorbidity was anxiety disorder combined with a physical condition, affecting around 1.4 million (9%) Australian adults. People living in the most disadvantaged areas of Australia were 65% more likely to have comorbidity than those living in the least disadvantaged areas.

Emergency Department overcrowding - research

The February 6 issue of MJA also has some fascinating articles on ED's - demand, overcrowding and best practice.  Included are the following:

• Emergency department overcrowding, mortality and the 4-hour rule in Western Australia concludes that the introduction of the 4-hour rule in WA led to a reversal of overcrowding in three tertiary hospitals, coinciding with a significant fall in the overall mortality rate in the tertiary hospital data combined. However, there was no reduction in adjusted mortality rates in three secondary hospitals where the improvement in overcrowding was minimal.
• Demand at the emergency department front door: 10-year trends in presentations asks, do demographic changes alone explain our busy EDs?  The study showed that the rise in presentation numbers and presentation rates was beyond that expected from demographic changes. Current models of emergency and primary care are failing to meet community needs.
• Emergency and acute medical admissions: insights from US and UK visits by a Melbourne tertiary health service looks at overseas innovations as the authors visited 13 EDs in the US and the UK.  Ideas included removing triage from reception and avoiding the ED altogether by directly admitting to the wards.

Again, use CIAP or contact your library to obtain the fulltext of these articles.

Aboriginal & Torres Strait Islander mental health

In his editorial in the latest issue of the Medical Journal of Australia, Robert Parker suggests that before European contact, Australian Aboriginal culture inherently supported strong mental health.  "Sense of self was seen as being intimately connected to all aspects of life, community, spirituality, culture and country. Material needs were provided for through sharing rules, and relationships and kinship defined social roles."

Two articles in the same issue discuss the current issues in indigenous mental health.  Mental health of Indigenous Australians: a review of findings from community surveys pulls together the results of 11 different surveys and concludes that there is an inequality in mental health between Indigenous and non-Indigenous Australians that starts from an early age.  Psychosis in Indigenous populations of Cape York and the Torres Strait analyses 171 Indigenous patients in Cape York and Torres Strait with psychosis diagnoses, intellectual disability, and/or substance use comorbidities.  The study corroborates clinical impressions of a high burden of psychosis in the this group, particularly male Aboriginal Australians.  "The findings indicate an urgent need for further research in this region, to extend this research to other Indigenous populations, to identify causal and perpetuating factors, and to develop effective social and clinical measures to alleviate this burden."

Please use CIAP or contact your library if you need the full text of the articles. MJA 6 February, 2012.

UK campaign to reduce alcohol consumption

Change4Life’s is a new nationwide campaign from the United Kingdom to warn people that drinking over the lower-risk alcohol guidelines can seriously impact their long-term health is now live. The campaign highlights that regularly drinking around two large glasses of wine or two strong pints of beer a day triple the risk of developing mouth cancer and double the risk of developing high blood pressure.

A new online calculator will be available on the Change4Life website to help people check how much they are drinking and work out whether they need to cut down.

British Journal of Surgery- trauma articles

The BJS special issue on trauma, highlights established and emerging areas in injury care ranging from epidemiology to epigenetics. It does not attempt to cover the complete trauma chain of survival; rather, the collection reflects areas of current and ongoing interest, explores translational aspects of pathophysiology in trauma care, discusses changes in concepts and paradigms, and gives 'best evidence' even where this is still guided largely by expert opinion and limited data."

The Editorial, Leading Articles and Reviews are all free to read. Read these articles and more online now.

On the Radar

On the Radar is a summary of some of the recent publications in the areas of safety and quality in health care. Recent content includes:
*Hospital Incident Reporting Systems Do Not Capture Most Patient Harm;
*Toward Improving Patient Safety Through Voluntary Peer-to-Peer Assessment;
*Effects of nurse staffing and nurse education on patient deaths in hospitals with different nurse work environments.

You may need to use your CIAP logon or contact your Library Staff to access the fulltext.

Drinking cultures and social occasions

Drinking cultures and social occasions : Alcohol harms in the context of major public holidays and cultural events is a study conducted by Turning Point Drug and Alcohol Centre and Eastern Health in Victoria.  It provides evidence that acute intoxication increased numbers of injuries due to assaults and traffic accidents on public holidays and other major celebratory events, as well as rises in incidents on the day before.

The authors conclude that a focus on specific events or occasions for public education may present good opportunities to target prevention and intervention, but there are limited resources, particularly during periods of high demand.  Key experts identified the importance of communication and collaboration across services for planning, intervention and harm reduction.

Diabetes indicators in Australia

Diabetes has increased significantly among the Australian population over the past 20 years, however the rate of diabetes-related deaths is falling, according to a report by the Australian Institute of Health and Welfare (AIHW), Diabetes Indicators in Australia. The report shows the prevalence of diabetes in the Australian population increased from 1.5% to 4.1% over the 20 years to 2007-08.  However, diabetes-related deaths dropped by 18% between 1997 and 2007 and hospitalisations for lower limb amputations among people with diabetes have also been falling.

The report further shows that the rate of diabetes among Indigenous Australians was more than 3 times that of non-Indigenous Australians, and Indigenous Australians had higher rates of diabetes-related deaths than the general population. The prevalence of diabetes was also slightly higher among those born overseas and people living in regional and remote areas.

The AIHW has also released a new diabetes dashboard, providing easily accessible and navigable facts and figures on diabetes.

Child deaths - suicide intent

The reasons why children and young people take their own lives are complex. Each death is unique and is influenced by a series of physical, psychological and environmental conditions and associated risk factors.  There is evidence, however, that many young people provide an indication of their intent, prior to their suicide – usually to a significant person in their lives.

Child Deaths - Suicide intent is a paper from The Commission for Children and Young People, and it focuses on understanding suicidal intent: how it is communicated and to whom, what it can mean for young people at risk of suicide, and that any threat of suicide needs to be taken seriously.

The Commission’s review of the circumstances of deaths suggests that a number of children and young people had been communicating their suicidal intent in the weeks, months or years prior to their suicides. Some children were as young as 9 years of age when they first indicated they were suicidal.

Monitoring acute coronary syndrome - report

Monitoring acute coronary syndrome using national hospital data : an information paper on trends and issues is a new report by the AIHW, which reviews the current algorithm for monitoring the incidence of Acute coronary syndrome (ACS) in Australia.  It presents a detailed analysis of hospitalisations for acute myocardial infarction (AMI) and unstable angina.

Safety and quality in health care links

ISQua is the International Society for Quality in Health Care. The ISQua Newsletter continues to have links to presentations from the 2011 ISQua Conference and the latest is one from Rajesh Aggarwal on the topic of whether medical students should practice on patients.
There is also a link to a blog convened by Karen Luxford on Patient-Centred Care which has some thought-provoking comments.

National Medication Management Plan

The Australian Commission on Safety and Quality in Health Care have released a National Medication Management Plan for use throughout Australia. This is based on the Medication Management Plan developed by the Safe Medication management Unit of Queensland Health. It is for use in the reconciliation of patient medication to ensure the use of a standardised form.

For further information, including a training presentation, see the ACSQHC website. 

Sources of Evidence database

The Health Evidence Network (HEN) new database Sources of Evidence is now online:  The database replaces the previous Sources of Evidence section on the HEN web site, allowing the user easier access to the selected resources. It provides easy access to a systematically updated collection of resources selected for their relevance, depending on factors such as WHO priority areas, current trends and geographical/strategical debates etc. It is not a collection of all materials produced by the organizations, nor is it a library.

Indigenous nutrition and governance resource sheets

Two new resource sheets have been released by the Australian Institute of Health and Welfare this week:

Healthy lifestyle programs for physical activity and nutrition
This paper assesses the evidence regarding the effectiveness of physical activity and nutrition programs for Indigenous Australians, and identifies strategies that have been demonstrated to be effective. It also reviews strategies that have the potential to be effective, based on their short-term effect or their effectiveness in non-Indigenous populations.

Improving Indigenous community governance through strengthening Indigenous and government organisational capacity
This paper found that strategies that worked to strengthen Indigenous organisational capacity included long-term partnerships between government and Indigenous people, those that recognised local contexts and took a developmental approach, and those that had clarity of purpose.

UK heart attack deaths halved

The death rate from heart attacks in England has halved in the last decade, says an Oxford University study.  
"Determinants of the decline in mortality from acute myocardial infarction in England between 2002 and 2010 : linked national database study," published in the British Medical Journal, looked at more than 800,000 men and women who suffered heart attacks between 2002 and 2010.

The researchers found that fewer heart attacks occurred in later years and, of those that did occur, fewer were fatal, and concluded that improvements in NHS care and better prevention measures have contributed to the decline. National hospital and mortality data was used to analyse 840,175 men and women in England who had suffered a total of 861,134 heart attacks over eight years. Comparing 2002 with 2010, they found death rates falling by 50% in men (78.7 per 100,000 population to 39.2) and by 53% in women (37.3 per 100,000 to 17.7). A declining mortality rate was also seen in all age groups and for both sexes.

BMJ 2012;344:d8059

'State of the Art' in Airway Management

This special issue of Anaesthesia, guest edited by J. J. Pandit and T. M Cook, includes a range of articles that demonstrate advances in the art and science of airways management. Both basic science and clinical techniques are discussed, guidelines are analysed and training and education are considered.

The option to read these articles for free ends March 25, 2012.
Anaesthesia volume 66, Issue Supplement S2. Pages 1-118, December 2011.