Palliative care issues explored on the Health Report

This week's episode of ABC Radio National's The Health Report looked at some very interesting aspects of palliative care and you can read the transcripts or listen to the audio from the links below. The topics presented were:

1. Most doctors do not choose aggressive treatment at the end of their life . An interview with VJ Periyakoil from Stanford University who authored an open access study published in PLoS last year showing that doctors continue to provide high-intensity care for terminally ill patients but personally forego such care for themselves at the end of life, most choosing do-not-resuscitate orders.

2. Early palliative care can cut hospital re-admissions for cancer patients.  Richard Riedel, an Oncologist at Duke University Hospital in North Carolina discusses the development of a collaborative model with palliative care specialists to alleviate symptoms in people with advanced cancer. The result has been a reduction in the rates at which patients were sent to intensive care or re-admitted to hospital.

3. The AMEN tool to help health professionals talk to dying patients. The Reverend Rhonda Cooper has developed this tool to help health professionals respond to the spiritual needs of dying patients and their families, even if they are not religious themselves. The tool is called AMEN (Affirm, Meet, Educate, No matter what).

4. Advance care planning and end of life care. The Australian & New Zealand Intensive Care Society (ANZICS) has recently released its Statement on Care and Decision Making at the End-of-Life for the Critically Ill as a response to the need for intensive care unit staff helping families make very difficult decisions.  More information on this can be found at the Advance Care Planning Australia website.

Two thirds of deaths in current smokers attributed to smoking

A study published this week in BMC Medicine as part of the SAX Institute's 45 and Up Study adds weight to the theory that smoking kills.  Tobacco smoking and all-cause mortality in a large Australian cohort study: findings from a mature epidemic with current low smoking prevalence looked at over 200,000 adults over 45 in New South Wales and assessed their relative risk for all-cause mortality among current, past and never smokers, adjusting for age, education, income, residence, alcohol use and body mass index.

The results indicate that in Australia, up to two-thirds of deaths in current smokers can be attributed to smoking, with current smokers estimated to die an average of 10 years earlier than non-smokers.  The indications for smoking cessation supports other studies which indicate that cessation reduces mortality the earlier in life cessation occurs. 

The article is available on freely on open access.

Banks, Emily et al. BMC Medicine (2015) 13:38  DOI 10.1186/s12916-015-0281-z 

Fetal alcohol spectrum disorders in indigenous communities

The Closing the Gap Clearinghouse has recently published a new resource sheet, Fetal alcohol spectrum disorders: a review of interventions for prevention and management in Indigenous communities.  Fetal alcohol spectrum disorders (FASD) are defined and and currently available estimates of their prevalence in the overall Australian population and in the Indigenous population are provided.  The report reviews the Australian and international literature published since 1990 on the effectiveness of programs that aim to prevent FASD or to alleviate its effects. Evidence on the effectiveness of Australian and Indigenous specific programs is also assessed, including those programs that have been developed and implemented in partnership with Indigenous Australians.

Transforming Patient Safety

This report from the World Innovation Summit for Health Patient Safety Forum 2015 is intended to challenge the issue of patient safety by “by identifying reasons for the on-going heartbreak of preventable harm in healthcare and offering solutions to bridge the gaps prevalent in today’s approach to Patient Safety.” 

The report concludes with four initial steps to position and prepare the healthcare community to move forward:

1. Develop a patient safety declaration and have nations pledge commitment and resources.

2. Convene a panel of transdisciplinary subject-matter experts to classify and quantify the appropriate definitions and metrics for preventable patient harms, to ensure consistency in tracking and reporting throughout the global healthcare system.

3. Engage the systems engineering community to help describe the various constructs for the multiple system integrators (and their associated responsibilities) that are needed in the healthcare system.

4. Identify candidate nations and local organizations, representing varying levels of industrial and socio-economic development. Work with relevant stakeholders in those systems to create concepts of operation (CONOPS) and requirements for holistic patient safety solutions that are tailored to their specific culture and available resources.”

Transforming Patient Safety: A sector-widesystems approach. 

Report of the WISH Patient Safety Forum 2015

Free course for those living and working with people on the autism spectrum

A free course that will assist parents, families and carers who live and work with individuals on the autism spectrum will be launched at Swinburne University of Technology in April 2015. Running for six weeks, the Massive Open Online Course (MOOC) will use a unique scenario-based learning approach, which draws on the stories and experiences of individuals, carers and experts in the field. For more information click here. 

Quality standard on psychosis and schizophrenia

NICE’s quality standard on psychosis and schizophrenia sets out 8 quality statements designed to improve the care of adults living with the disorders. The standard highlights the benefits of early intervention, the use of CBT for psychosis, and the importance of supporting adults with psychosis or schizophrenia to return to work.

The National Institute of Health and Care Excellence recommends that adults with psychosis or schizophrenia who wish to find or return to work are offered supported employment programs. Unemployment can have a negative effect on the mental and physical health of adults with psychosis or schizophrenia.

The quality standard also includes statements that focus on providing family intervention therapy to family members of adults with psychosis or schizophrenia and the service user where appropriate, and offering carers education and support programs.

Psychosis and Schizophrenia in Adults

Bladder Cancer Guideline

The National Institute for Health and Care Excellence (NICE) in the UK has released a new guideline. ICE’s first guideline on bladder cancer aims to improve the diagnosis and management of the seventh most common cancer in the UK, with over 10,000 cases of bladder cancer diagnosed each year.

The majority of cases occur in people aged over 60, with age being the main risk factor for bladder cancer. Smoking and exposure to some industrial chemicals - such as those used in the rubber and dye industries – can also increase the risk.

Bladder cancer: diagnosis and management of bladder cancer.

Evidence on wind farms and human health - NHMRC

This Information Paper summarises the evidence on possible health effects of wind farms in humans, based on the findings of independent reviews of the evidence.

Concern about the effects on health from living near a wind farm has been expressed by some members of the community. Therefore, NHMRC examined the evidence on health effects associated with noise, shadow flicker and electromagnetic radiation.  In the NHMRC's previous 2010 statement on this topic, they concluded that there “is currently no published scientific evidence to positively link wind turbines with adverse health effects”. The 2015 report is based on a further comprehensive review of the available scientific evidence and concludes that, "After careful consideration and deliberation of the body of evidence, NHMRC concludes that there is currently no consistent evidence that wind farms cause adverse health effects in humans. Given the poor quality of current direct evidence and the concern expressed by some members of the community, high quality research into possible health effects of wind farms, particularly within 1,500 metres is warranted."

NHMRC Statement and Information Paper: Evidence on Wind Farms and Human Health  February 2015.

Fatherhood and Mental Illness

This report by Rhys Price-Robertson from the Australian Institute of Family Studies, provides practitioers and policy makers with a broad overview of some of the key issues surrounding paternal mental illness. Fatherhood and mental illness: a review of key issues identifies several important areas in need of attention, including:

• The transition to fatherhood and the early years of childrearing are periods when men are more likely to experience psychological stress

• The children of men with a mental illness are more likely than other children to experience emotional and behavioural problems, as well as to be diagnosed with a mental illness themselves.

• Fathers with a mental illness are more likely to show low levels of parental engagement  

• Fathers with a mental illness can be subject to unique forms of stigma 

• Psychiatric and welfare service providers in Australia and internationally have often struggled to effectively engage fathers 

Male bias in medical research

An interesting piece in The Conversation recently looks at the historical bias towards including males in both preclinical studies and clinical trials.  This is significant, according to Peter Rogers, Director of Research at the Royal Women's Hospital at the University of Melbourne, because it puts women at greater risk of adverse events.  There is a wide variation in the both the susceptibility and severity of many diseases between the genders, and men and women react differently to various treatments.

Fortunately, things are changing in the light of recent thinking in medical science, with concepts such as "precision medicine" recognising variability between individuals.  "Women may have been neglected by medical research for a couple of decades but the march of technology is now bound to take them forward as individuals."

Equal but not the same: a male bias reigns in medical research by Peter Rogers. The Conversation, 9 February, 2015.

Health care quality through the patient's eyes

A study has been published in the Australian Health Review which analyses 300 patient stories with a narrative approach in an attempt to look at health care service quality from the patient's perspective. Experiencing health care service quality: through patients’ eyes by Sharon Schembri reveals that patients experience this quality in varied and complex ways.  The author argues that narrative analysis can provide a more accurate and detailed picture than standard patient satisfaction surveys, providing practitioners "with strategic insight into improving the quality of service they provide outside the realm of objective satisfaction measures."

Australian Health Review 39(1) 109-116 http://dx.doi.org/10.1071/AH14079. Full text access for NSW Health staff via CIAP, or contact your health library.

Aged Care Report Card

The Aged Care Report Card (ACRC) lists aged care facilities throughout Australia, and is the first ratings website in the industry. Both consumers and healthcare professionals can access the website and share their experiences.
The ratings are based on 7 key criteria, after research showed which were the most important areas  when making decisions about aged care facilities:

• Staff Presence
• Nursing Care
• Friendliness
• Quality of Food
• Activities
• Cleanliness and Environment
• Management 

Women Want to Know Project

The ‘Women Want to Know’ project encourages health professionals to routinely discuss alcohol and pregnancy with women and to provide advice that is consistent with the National Health and Medical Research Council's Australian Guidelines to Reduce Health Risks from Drinking Alcohol.
The ‘Women Want to Know’ project was developed by the Foundation for Alcohol Research and Education (FARE) in collaboration with leading health professional bodies across Australia and is supported by funding from the Australian Government Department of Health.
The Women Want to Know project includes leaflets for professionals on pregnancy and alcohol and alcohol consumption, and leaflets for women as well as videos.
In addition three online e-Learning courses with Continuing Professional Development accreditation are available for Health Professionals.

Women Want to Know project.                   

Pioneering treatment for stroke survivors

Researchers at Royal Melbourne Hospital announced recently on the ABC News they had proved the effectiveness of a new technique that almost doubles the chances patients will walk out of hospital after stroke.
The researchers combined two types of stroke treatment with new technology to improve the outcomes for people with the most severe form of stroke. Under the new approach, doctors used advanced brain imaging to identify which parts of the brain were irreversibly damaged and which parts were salvageable. They then used new stent technology to remove the clot.
Read the report here.

A Nurses' Guide to Quantitative Research

This article provides a breakdown of the components of quantitative research methodology. Its intention is to simplify the terminology and process of quantitative research to enable novice readers of research to better understand the concepts involved.
The article from the Australian Journal of Advanced Nursing is freely available.

Using data to improve care

The UK Royal College of Physicians has produced this toolkit as a starting point for clinicians on how to collect and interpret data to improve patient care. The aim of the toolkit is to help physicians to draw together the information that is necessary to understand the quality of care provided by their team, and to work to improve it. The toolkit includes:

• a description of the main types of data
• considerations of how they should (or should not) be interpreted
• how data can be used to help improve healthcare quality.

Acute care toolkit 11: Using data to improve care.

The Cost of Unresolved Childhood Trauma and Abuse in Adults in Australia.

ASCA (Australian Survivors of Child Abuse) have just released a report finding that the ongoing costs related to child abuse are around $9 billion a year. This includes the cost of counselling services, health services and other supports that people who have experienced child abuse need. The report highlights the need to intervene early to protect children, including a strategy for addressing the structural budget deficit by addressing the public health issue of childhood trauma and abuse at its core.

The Cost of Unresolved Childhood Trauma and Abuse in Adults in Australia.

Report on Government Services 2015 Volume E: Health

The latest Productivity Commission report on health services shows the need to improve access to and quality of primary health care, rather than heading in the opposite direction. The report also looks at mental health management and public hospitals

SCRGSP (Steering Committee for the Review of Government Service Provision) 2015, Report on Government Services 2015, vol. E, Health, Productivity Commission, Canberra.

Tinnitus Clinical practice guideline

This new guidelines provides evidence-based recommendations for clinicians managing patients with tinnitus. It also gives a framework to improve patient care and ways to determine the most appropriate interventions to improve symptoms and quality of life for tinnitus sufferers.

Clinical practice guideline: tinnitus. Otolaryngol Head Neck Surg. 2014 Oct;151(2 Suppl):S1-40.

Click here to download the guideline.

Journal of the National Cancer Institute (JNCI) virtual issue

The Journal of the National Cancer Institute (JNCI) is celebrating 75 years of publication and as a tribute to some of the most important studies published, it has created a virtual issue. This freely available issue contains a number of the original articles that highlight critical advances in our basic understanding of cancer.

Free virtual issue.

Oral contraceptive use and mortality

A cohort study by researchers in Boston followed over 120,000 nurses for 36 years, looking at their health and wellbeing.  One focus of the study was on their oral contraceptive use to determine whether it was linked to mortality by any cause.  The results of this aspect of the Nurses' Health Study were recently published in the BMJ: Oral contraceptive use and mortality after 36 years of follow-up in the Nurses’ Health Study: prospective cohort study.

The researchers found that all cause mortality did not differ significantly between women who had ever used oral contraceptives and those who had never used them. They did find that oral contraceptive use had a correlation with certain causes of death, including increased rates of violent or accidental death and deaths due to breast cancer, whereas deaths due to ovarian cancer were less common among women who used oral contraceptives.

One of the authors of the paper, Karin Michels, was interviewed by Dr Norman Swan on ABC RN's Health Report last week and she made it clear that the results pertain to earlier oral contraceptive formulations with higher hormone doses rather than the now more commonly used low-dose contraceptives.

Contact your library if you have trouble downloading the fulltext of the article. BMJ 2014;349:g6356. 

First Australian Burden of Disease Study report

Fatal Burden of Disease 2010 is the first report in the Australian Burden of Disease Study series. It shows the contribution of each disease group to fatalities by age and sex, the three leading disease groups being Cancer (35%), Cardiovascular diseases (23%) and Injuries (13%).

Burden of disease analysis compares the fatal and non-fatal impacts of different diseases and injuries using a summary measure, the DALY (disability-adjusted life year), to describe the resulting health loss. One (1) DALY represents 1 year of healthy life lost, either through premature death or from living with an illness or injury. This report provides estimates of fatal burden for Australia for 2010; that is, the component of the DALY resulting from premature death.  There were around 143,500 deaths in Australia in 2010, resulting in 2.25 million years of life lost.

Consolidated HIV guidelines from WHO

The World Health Organisation has recently published Consolidated guidelines on HIV prevention, diagnosis, treatment and care for key populations. Here the authors have brought together existing guidelines related to five key population groups: men who have sex with men, people who inject drugs, people in prisons and other closed settings, sex workers and transgender people.

Selected guidance and recommendations have been updated with thorough literature reviews in order to provide a comprehensive packaged of evidence-based HIV-related recommendations.

Perioperative Medicine: The pathway to better surgical care

The Royal College of Anaesthetists in the UK has released this document which describes their vision for models of more efficient care leading to better patient outcomes from contemplation of surgery to full recovery.

Perioperative Medicine: The pathway to better surgical care argues that a multidisciplinary approach will enable faster recovery and prevent readmissions, thus helping with the growing demand for hospital beds.  This visionary report is accompanied by a very useful animated film, showing how an integrated approach to perioperative care can improve post-surgical complications, and also a series of case studies which provide useful examples. 

Still Alice - a look at early-onset dementia

A recent piece in The Conversation by two neuroscience researchers looks at the significance of the film Still Alice, which has just opened around Australia. Still Alice: a rare look at how dementia steals memories from millions by Muireann Irish and Rebekah Ahmed points out that younger-onset dementia affects around 54 in every 100,000 people aged between 30 and 65 across the population. "There are now even calls for care facilities to adapt so they can cater for these often physically healthy people."

The film is based on the book of the same title by Lisa Genova.  It was written in 2007 and is available for loan from various libraries, including Port Macquarie Base Hospital Clinical Library.