New Guideline: Fever in Children (UK)

NICE has updated the traffic light system for predicting the risk of serious illness from fever in children under 5, and issued new advice on the use of paracetamol and ibuprofen.
A baseline assessment tool, clinical case scenarios, costing statement, a slide set, and electronic audit tools are available to help put this guideline into practice. A spotting the sick child online learning resource is also available, as well as an educational resource on the traffic light table.
Feverish illness in children: Assessment and initial management in children younger than 5 years.

One Stop Cardiac Management Website: (Heart) Online

The Heart Foundation has launched Heart Education Assessment and Rehabilitation Toolkit (HEART) Online - a one-stop website providing up-to-date best-practice information on cardiac prevention, rehabilitation and heart failure management. Full of uptodate and evidence based information, it also includes 5 calculators for you to try to test your bmi, waist size, cost of smoking, CVD risk and target heart rate.

See the toolkit at heartonline.org.au

Scientific 7 minute workout

The American College of Sport Medicine has published an interesting article in their ACSM'S Health & Fitness Journal. Titled "High-Intensity Circuit Training Using Body Weight: Maximum Results With Minimal Investment", the article aims to understand the health benefits and practical application of a high-intensity circuit training exercise protocol. Exercises are performed for 30 seconds, with 10 seconds of transition time between bouts. Overall, the objective is for incomplete recovery between exercises so the high exercise intensity can be sustained for the short duration circuit, without compromising proper exercise form and technique.

Read the full article here. 

Using technologies to promote young people's wellbeing

Emerging technologies provide a remarkable opportunity for improving the access of young people to and Using technologies safely and effectively to promote young people's wellbeing : a better practice guide for services is the result of a project between the Young and Well Cooperative Research Centre and the NSW Centre for the Advancement of Adolescent Health.  It provides an evidence base to help health professionals and youth organisations to use technologies to engage with young people in promoting their mental health and wellbeing and is an invaluable resource for health service providers to extend their work into online settings where young people feel comfortable.   
engagement with health services.

Patient neglect in healthcare institutions

Patient neglect is an issue of increasing public concern yet remains poorly understood. "Patient neglect in healthcare institutions: a systematic review and conceptual model" reports on the nature, frequency and causes of patient neglect as distinct from patient safety topics such as medical error. Two aspects were found - procedure neglect, which refers to failures of healthcare staff to achieve objective standards of care; and caring neglect, which refers to behaviours that lead patients and observers to believe that staff have uncaring attitudes. The authors found that patients and their family members are more likely to report neglect than healthcare staff, and nurses are more likely to report on the neglectful behaviours of other nurses than on their own behaviour. The authors developed a social psychology-based conceptual model to explain the occurrence and nature of patient neglect to further facilitate further research into patient neglect in healthcare institutions.

Reader TW, Gillespie A. (2013). BMC Health Services Research, 13, 156 

Snapshot of Rheumatoid Arthritis

The Australian Institute of  Health and Welfare has published the latest in its "Snapshot" series with A Snapshot of Rheumatoid Arthritis.  Rheumatoid arthritis affects around 2% of Australians, is more common in those aged 55 or over, and is 1.6 times as common in women (2.4%) as in men (1.5%).  Even though management of the condition has improved markedly in recent years, mainly due to the availability of new medicines, people with this condition are likely to report severe pain, poor health status and psychological distress.  The size of indirect costs associated with the disease (such as productivity losses and the cost for carers) are unknown.

Young people, social media and sexual health

This article in the International Journal of Communication discusses the findings from focus groups of young people in Australia about the use of social media and social network sites for sexual health communication.  One of the potential challenges for health professionals is addressing concerns about privacy and bullying, and the stigma attached to sexual health.

"Young people,social media, social network sites and sexual health communication in Australia : 'this is funny, you should watch it!'" Clifton Westly Evers, Kath Albury, Paul Byron, Kate Crawford | International Journal of Communication 7 (2013) : 263-280.

Prostate cancer screening guidelines

The American Urological Association has changed direction somewhat in its new Detection of Prostate Cancer guidelines. The previous guidelines from this group recommended PSA screening all of men over 40.  Now the AUA "does not recommend routine screening in men between ages 40 to 54 years at average risk."  They acknowledge that the optimum age for screening is 55-69, although fall short of recommending routine screening even for this group.  They do not recommend screening for men over 70.

The ABC website page on prostate cancer testing summarises the significance of  these changes and includes links to local guidelines and recommendations.

Improving patient care in hospital

Norman Swan interviewed Dr Terry Platchek, Medical Director for Performance Improvement from the Lucile Packard Children's Hospital at Stanford University in California in this week's Health Report from the ABC.  The subject was the improvement of patient care in hospital by using a method similar to a production line, driven by an examination of the whole process, not just applying a bandaid to undesirable outcomes.  Platchek gave examples an improvement in the patient flow in Theatres to the extent that less recovery beds were needed, the elimination of the down time of an MRI machine obviating the need to purchase a new one, an improvement in doctor's appointment systems so patients don't have to wait and become more anxious, and ways to increase the amount of time nurses spend on patient care compared to other tasks.

You can read more in this paper:

Platchek T, Kim C. "Lean Health Care for the Hospitalist." Hospital Medicine Clinics 2012;1(1):e148-160 

Hand hygiene for patient safety

BMJ recently published an editorial, Keeping hand hygiene high on the patient safety agenda, which was written to mark the World Health Organisation's annual global hand hygiene day on 5 May.  Despite being the first country to roll out a national Cleanyourhands campaign in 2004, the UK government closed the campaign in December 2010, stating that “Hand hygiene is now an established part of clinical care.”  The authors argue strongly that continued monitoring, audit, feedback, and improvement of hand hygiene compliance must be a priority.  BMJ 2013;346:f2699

WHO's Save Lives - Clean your hands campaign site includes links to relevant videos, podcasts, action plans and other information. You can also find links there to their documents, "WHO Guidelines on Hand Hygiene in Health Care" and "Hand hygiene in outpatient care, home-based care and long-term care facilities".

Global asthma guidelines update

300 million people worldwide are estimated to suffer from asthma. The Global Initiative for Asthma (GINA) has updated its guideline, Global strategy for asthma management and prevention.   The authors acknowledge that the cost to control asthma seems high, but the cost of not treating it correctly is even higher.

The factors influencing a person's risk of developing asthma can be divided into genetic host factors and environmental factors, and the clinical spectrum of asthma is highly variable.  Key recommendations from the guidelines include:

• The development of patient and doctor partnerships
• The identification and reduction of exposure to risk factors
• Effective assessment, treatment and monitoring of the condition according to the best evidence  

Self-harming Behaviour: Management in Adolescence

Dr Norman Swan chairs this panel discussion on Self-harming Behaviour: Management in Adolescence, available for viewing online or ordering on DVD through the Rural Health Education Foundation. The 60 minute program identifies support services and resources for health professionals, educators and carers. 

Self-harming behaviours in adolescents are not uncommon, and early diagnosis is seen as the key to management, along with the identification of underlying causes. 

Snapshot of osteoarthritis

With hospitalisations related to osteoarthritis rising by 25% between 2001 and 2011, the Australian Institute of Health and Welfare has published this Snapshot of Osteoarthritis which provides the most recent Australian statistics on the condition.

Osteoarthritis is the most common form of arthritis, affecting an estimated 1.8 million Australians (about 8% of the population).  In 2010-11 there were 115,000 surgical procedures performed on people with osteoarthritis, 30% being knee replacements and 20% hip replacements.

There are some useful references on this site and you can always obtain the full text of these articles from your friendly librarian.

Aboriginal Palliative Care

This review discusses palliative care and end-of-life models of care for Aboriginal people in New South Wales. Currently Aboriginal people tend to not access palliative care services in mainstream facilities and it is important that future palliative care models fit with Aboriginal peoples’ community values, beliefs, cultural/ spiritual rituals, heritage and place. This online article in the journal Rural and Remote Health is available free online to download.
O'Brien AP, Bloomer MJ, McGrath P, Clark K, Martin T, Lock M, Pidcock T, van der Riet P, O'Connor M. Considering Aboriginal palliative care models: the challenges for mainstream services. Rural and Remote Health 13: 2339. (Online) 2013.

Hepatology: a Clinical Textbook

Hepatology: a Clinical Textbook 2013, is the most downloaded book on the free site
www.freebooks4doctors.com

Borderline Personality Disorder

The National Institute of Mental Health has made freely available a booklet describing the signs, symptoms, treatment options, and current research on borderline personality disorder. Go the the NIMH website for other booklets, brochures and fact sheets on specific mental illnesses.

Borderline Personality Disorder booklet.

GoogleFOAM

GoogleFOAM has been created by Vancouver based Physician Todd Raine @RaineDoc, and was previously known as emgoogle.com. GoogleFOAM is a searchable index of emergency blogs, pocasts or relevant tools with FOAM standing for Free Open Access Meducation. Well worth a look.

New osteoporosis recommendations

Building healthy bones throughout life. An evidence-informed strategy to prevent osteoporosis in Australia has been published by MJA Open and authored by Osteoporosis Australia.
1.2 million Australians have osteoporosis and a further 6.3 million have osteopenia.  Fragility fractures cost our economy billions of dollars per year.  The main recommendations from this document are that:

• Daily dietary calcium intakes should be consistent with Australian & NZ guidelines
• Serum levels of vitamin D in the general population should be above 50 nmol/L in winter or early spring
• Regular weight-bearing physical activity, muscle strengthening exercises and balance activities should be undertaken. 

MJA Open 2 Suppl 1 · 4 February 2013 1

Elective hip and knee-replacement surgery in Australian public hospitals

The journal, Australian Health Review has recently published an open access article on the waiting lists for elective surgery and the problems caused for our health systems.
"The progression through elective surgery waiting lists can be likened to a game of snakes and ladders where barriers (snakes) delay access to surgery and facilitators (ladders) expedite access. The aim of the present study was to describe the barriers and facilitators to delivery of total hip- and total knee-replacement surgery in South Australian public-funded hospitals." (from article abstract)
Snakes and ladders: the barriers and facilitators of elective hip- and knee-replacement surgery in Australian public hospitals by Julie L. Walters A, Shylie F. Mackintosh A and Lorraine Sheppard. 2013.
Australian Health Review 37(2) 166-171

"Influenza vaccines: time for a rethink"

In this recent JAMA article, author Peter Doshi challenges the basic assumption that influenza is "a major public health threat for which the annual vaccine offers a safe and effective solution."  Doshi argues that there is no evidence that vaccines reduce the serious complications of influenza.  He says that the media and health promotional messages confuse the influenza virus with "flu", causing people to have unrealistic expectations about the vaccine's potential benefit.  Doshi also highlights the risks and benefits of influenza vaccines and calls for more discussion on the topic. 

JAMA Intern Med. 2013;():1-3. doi:10.1001/jamainternmed.2013.490. 

painHEALTH - new website for chronic pain

painHEALTH is a new website from WA Health, aimed at helping the estimated 700,000 Australians suffering from musculoskeletal pain such as low back pain, neck pain, osteoarthritis, osteoporosis and rheumatoid arthritis.  The aim is to provide these sufferers with evidence based information on how best to manage their conditions.  The site includes pain stories from people with chronic musculoskeltal pain, pain management training modules, links to various resources, pain self-checks and basic information about pain.

Euthanasia background paper

Euthanasia is an updated background paper by Gareth Griffith and Lenny Roth of the NSW Parliamentary Library.  In light of the recent introduction of the Rights of the Terminally Ill Bill in NSW, this paper examines recent cases in Australia, proposed reforms and recommendations in selected jurisdictions, especially South Australia, Tasmania and the United Kingdom.  Sections on Canada and New Zealand are also included, with reference to recent journal articles and media reports.

Antibiotics and chronic back pain

A Danish study in the European Spine Journal received some publicity last week when it showed that 40% of chronic back pain could be helped with antibiotics rather than surgery.

This study supported previous studies which have demonstrated that many patients undergoing surgery for a first-time disc herniation have a bacterial infection.  An item on ABC's PM program sought the reaction of Peter Wilde, President of the Spine Society of Australia.

Ask your librarian for the full text of the article, Eur Spine J (2013) 22:697–707 DOI 10.1007/s00586-013-2675-y.  "Antibiotic treatment in patients with chronic low back pain and vertebral bone edema (Modic type 1 changes): a double-blind randomized clinical controlled trial of efficacy" by Hanne B. Albert et al.

Mothers and babies bedsharing

This week's Health Report on ABC Radio National, included an interview with Catherine Fetherston from Murdoch University, whose article in Breastfeeding Review late last year provoked some controversy.  In the interview (read the transcript or listen here), Fetherston questioned the current recommendations which caution against babies sleeping with their mothers as a risk for SIDS.  She states that this is not evidence-based as other risk factors have not been accounted for, such as smoking, alcohol consumption, sleeping in a chair or on a sofa.

Analysis of the ethical issues in the breastfeeding and bedsharing debate, Fetherston, C. & Leach J.
Breastfeed Rev. 2012 Nov;20(3):7-17.

Heart disease and risk of depression

Around 40 per cent of people experience mild forms of depression after a heart attack or bypass operation and 15 per cent experience major depressive disorder. Aside from the obvious problems, depression hinders recovery from the heart operations. The Heart Foundation has highlighted this, in their statement, Heart Disease Patients face higher depression risk.  They recommend routine screening for depression in all people diagnosed with heart disease.

The Heart Foundation refers to a recent article in the Medical Journal of Australia, Screening,referral and treatment for depression in patients with coronary heart disease by David M. Colquhoun et al.  The authors update the evidence on all levels of depression in patients with coronary heart disease, and provide guidance for health professionals on the screening and treatment of this condition.  
– Med J Aust 2013; 198 (9): 1-7.

Why fund the National Disability Insurance Scheme?

Why fund NDIS? : because some day you might need it is an opinion piece by Stella Young, published on the ABC's disability discussion site, Ramp-Up.  As someone who is disabled, Stella mounts a convincing argument for everyone to contribute to the scheme.  "For people with disabilities, myself included, discussions about the money are simply beside the point. We don't think about the NDIS in terms of dollars; we think about it in terms of showers per week, mobility aids that meet our needs and general access to our communities."

Younger onset dementia report

Younger onset dementia : a new horizon? was launched this week by Alzheimer's Australia.  It documents the unique challenges faced by the 24000 people living with younger onset dementia in Australia, and suggests how the National Disability Insurance Scheme and other funding systems should respond to their needs. The report was launched by Ita Buttrose, who spoke about these sufferers, who "don't typically qualify for aged care and find it difficult to fit into disability services because they have to cope with a completely different set of professional and family-related issues.  They also experience difficulties accessing respite care, getting a diagnosis and dealing with stigma and isolation within the broader community."

Q & A - The Health Debate

ABC TV aired a special episode of Q & A in April as a lead-up to the federal election. Host Tony Jones was joined by Minister for Health Tanya Plibersek and Shadow Minister for Health, Peter Dutton.  Topics discussed included:

• Hospital funding
• Health cost blow-out
• Palliative care
• Organ donation
• Medicare locals
• Health professional training
• Rural and remote health
• e-health
• Dementia prevention
• Indigenous health gap

The Health Debate is available for viewing, or download the transcript. 

Social media and health - new articles

The use of social media by health professionals and consumers is no longer new, but it is a constantly developing phenomenon and there have recently been a few interesting studies published: 

Social media in primary health care: Opportunities to enhance education, communication and collaboration among professionals in rural and remote locations: Did you know? Practical practice pointers by Anikeeva and Bywood in the Australian Journal of Rural Health, looks at blogs, microblogs and wikis.  The authors give some useful practical advice and encourage involvement in implementation and design. AJRH, 21(2), 132-134.

Social networking in online support groups for health:How online social networking benefits patients by Chung in the Journal of Health Communication: International Perspectives, discusses online social media such as patient blogs and Internet support groups as sources of health information. The author conducted an online survey with current users of online support groups and how different people use them to receive emotional and informational support. 

DOI:10.1080/10810730.2012.757396.

 

A new dimension of health care: Systematic review of the uses, benefits, and limitations of social media for health communication by Moorhead et al has been published in The Journal of Medical Internet Research. According to the authors there is a lack of information about the uses, benefits, and limitations of social media for health communication among the general public, patients, and health professionals, and this requires investigation. Using a systematic search of the literature they identified seven main uses of social media for health communication, as well as a number of limitations and gaps. They concluded that social media is a powerful tool that does bring a new dimension to health care, offering a communication medium for the public, patients, and health professionals to discuss health issues with the possibility of potentially improving health outcomes. JMIR 15 (4), e85. 

Please contact your health library if you have trouble accessing the fulltext of these articles.