MNCLHD

MNCLHD

Wednesday, September 30, 2015

Life satisfaction across life course transitions

This paper looks at how life satisfaction changes as we pass through various life transitions on the pathway from adolescence through young adulthood, middle age and into old age. It explores how leaving home, commencing a relationship, having children, separating, entering the “empty nest” phase, retirement and widowhood affect life satisfaction.

We all experience ups and downs at various points throughout life. Do these transitions effect our life satisfaction and is it greater for me or for women? Some people bounce back and some never do, and how long does it take?

This report from the Australian Institute of Family Studies is free to download.
Life Satisfaction Across Life Course Transitions  Lixia Qu, David de Vaus, Australian Family Trends No. 8, September 2015.   

Health expenditure Australia 2013-14

A new report from the Australian Institute of Health and Welfare (AIHW) shows that spending on health rose in 2013–14, after record low growth in the previous year. The report, Health expenditure Australia 201314, shows that $154.6 billion was spent on health goods and services in 2013–14. This was up by 3.1% in real terms from the previous year and despite this relatively slow growth, total expenditure was 9.8% of GDP in 2013-14, up from 9.7% in 2012-13.

Download the full report for free online.  
ISSN 1323-5850; ISBN 978-1-74249-812-6; Cat. no. HWE 63; 141pp.



Special Supplement on Health Equity

Evidence shows that those with greater (economic and social) resources are more likely to have better health outcomes than those with lesser resources. Whilst health inequalities include differences in health outcomes that include those caused by natural biological variation, health inequities are health differences that are socially produced.
In 2005, The World Health Organisation (WHO) reiterated the urgent need to address the social causes of poor health and health inequities and established the Commission on Social Determinants of Health to provide guidance on how to tackle health inequities globally. VicHealth released Fair Foundations: the VicHealth framework for health equity in 2013 and has now commissioned eight rapid evidence reviews to investigate best and promising policy and practice to reduce health inequities within healthy eating, tobacco, physical activity, alcohol, mental well-being, settings for health promotion, early childhood development and social innovation investments.

Health Promotion International: Special Supplement on Health Equity, Volume 30 suppl 2 September 2015  

Unnecessary and Harmful Tests

Internationally, there is a groundswell of activity seeking to identify and reduce the use of health care interventions that deliver marginal benefit, be it through overuse, misuse or waste. A special ABC Four Corners investigation reveals many of the treatments and tests we get are unnecessary, sometimes harmful and needlessly expensive, costing the health system billions of dollars every year.
Figures from the Australian Institute of Health and Welfare show Australia spends just under $155 billion on health each year, and it is estimated that one-third of that amount — about $46 billion — is being squandered. This is total spending by federal and state governments, private health insurance and in hard cash from patients in gap fees.

"Adam Elshaug, Associate Professor of Healthcare Policy at Sydney University, is an authority on what is called low-value care and has identified at least 150 unsafe, inappropriate or ineffective medical services that receive Medicare and health insurance rebates." You can read more on this story by  from ABC Radio.

Click here to read the full ABC story. You can also read the recent article in the Medical Journal of Australia on the same topic: 
Adam G Elshaug, Amber M Watt, Linda Mundy and Cameron D Willis. (2015), Over 150 potentially low-value health care practices: an Australian studyMed J Aust, 197(10), 556-560.

Bladder Cancer Diagnosis and Management

This guideline was developed by the National Collaborating Centre for Cancer (NCC-C) on behalf of the National Institute for Health and Care Excellence (NICE) in the UK. the aim of the guideline is to offer best practice advice on the care of adults with bladder cancer.


National Collaborating Centre for Cancer. Bladder cancer: diagnosis and management. London: National Institute for Health and Care Excellence (NICE); 2015 Feb 25. 55 p. (NICE guideline; no. 2).

Tuesday, September 22, 2015

The health and health behaviours of Australian metropolitan nurses

Nurses make up the largest component of the health workforce and provide the majority of patient care. Most health education is delivered by nurses, who also serve as healthy living and behavioural role models.The aims of this study published in BMC Nursing, were to investigate nurses’ overall health and the presence of chronic disease; to describe nurses’ health-related behaviours and to compare them to those of the general population, with both groups matched by age and gender.
The study found there  are early ‘warning signs’ concerning the health status of nurses. Despite perceiving current good health, support is required for nurses to prevent future chronic disease, particularly in the areas of nutrition and alcohol intake.
 Perry, Lin,  Gallagher, Robyn  and Christine Duffield . (2015) The health and health behaviours of Australian metropolitan nurses: an exploratory study. BMC Nursing, 14:45

Brain Basics

Changes in the brain can lead to mental disorders, such as depression. Brain Basics (From NIH’s National Institute of Mental Health) provides information on how the brain works, how mental illnesses are disorders of the brain, and ongoing research that helps us better understand and treat disorders. Brain Basics will introduce you to some of this science, such as:
  • How the brain develops
  • How genes and the environment affect the brain
  • The basic structure of the brain
  • How different parts of the brain communicate and work with each other
  • How changes in the brain can lead to mental disorders, such as depression.
Brain Basics                             

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Outcomes of unplanned transfers from subacute to acute care

The aim of this study published in Australian Health Review, was to examine the timing and outcomes of patients requiring an unplanned transfer from subacute to acute care within  four Victorian health services from 1 January to 31 December 2010. Data were collected using retrospective audit.
The study found that there is a high rate of unplanned transfers to acute care within 24 h of admission to subacute care and unplanned transfers are associated with high hospital admission and in-hospital mortality rates. Physiological assessment was infrequent and incomplete in most patients who had an unplanned transfer from subacute to acute care. The analysis of the subacute to acute care
interface has highlighted the need to improve systems for recognising and responding to deteriorating patients in subacute care settings.

Considine, Julie, Street, Maryann, Botti, Mari, O’Connell, Bev, Kent, Bridie, and Dunning AM, Trisha (2015). Multisite analysis of the timing and outcomes of unplanned transfers from subacute to acute care. Aust. Health Review 39 (4), 387–394.

Australia’s annual report card on HIV, hepatitis and sexually transmissible infections

 A new report by the Kirby Institute at UNSW Australia, was released recently at the World STI and HIV Congress in Brisbane
The report shows that deaths related to chronic hepatitis C virus infection have increased by 146% in ten years and the uptake of treatment remains extremely low. Chlamydia remains the most frequently reported notifiable sexually transmissible infection in Australia with 86,136 diagnoses in 2014. The majority (78%) of cases occurred among 15- to 29-year-olds. The number of newly diagnosed HIV infections in Australia has been stable over the past three years, with 1,081 HIV infections newly diagnosed in 2014.
You can read more and download the report here.                         

Ambitions for Palliative and End of Life Care

This UK national frameworkurges health organisations and local authorities to act together to improve end of life care for people of all ages. It sets out six principles for how people near the end of their lives should be cared for. The six ‘ambitions’ for palliative and end of life care are:
  • Each person is seen as an individual
  • Each person gets fair access to care
  • Maximising comfort and wellbeing
  • Care is coordinated
  • All staff are prepared to care               


Central Line MicroSkills (Deliberate Practice)

EM Crit is a blog put out by Dr Scott Weingart, an ED Intensivist from New York City. In this post he has created a video demonstration of the core micro-skills necessary for expert central line  placement.

Wednesday, September 16, 2015

Public perceptions of CPR survival rates based on TV shows

In a recent article in Resuscitation, it was indicated that public perceptions of CPR survival rates are influenced by what they see on popular medical television programs. It isn't like this on TV: revisiting CPR survival rates depicted on popular TV shows follows up on a study from the 1990s where it was shown that the rates of survival following CPR were far higher in popular TV shows than actual rates.  The authors of this recent paper wanted to revisit this in light of today's enhanced communication and education, and also to ascertain if current shows depicted discussions of care preferences and advance directives.  

The research looked at Grey's Anatomy and House, where CPR was depicted 46 times over 96 episodes, with a survival rate of 69.6%, which is almost twice the actual rate.  There were only two mentions of advance directives. "Inaccurate TV portrayal of CPR survival rates may misinform viewers and influence care decisions made during serious illness and at end of life."

Portanova J, Irvine K, Yi J, Enguidanos S. Resuscitation, v.96, p.148-150, 19 August 2015.
dx.doi.org/10.1016/j.resuscitation.2015.08.002. Please contact your health librarian for the full text of this article.

Bullying and harassment amongst surgeons

Reported widely in the media this week has been the release of the Draft report to the Royal Australasian College of Surgeons on discrimination, bullying and sexual harassment, which presents the findings from five major pieces of work commissioned by the Expert Advisory Group in 2015, all of which are published on the College website. The research found that across all surgical specialties senior surgeons and surgical consultants were the primary source of these problems:
  • 54% of trainees and 45% of Fellows less than 10 years post-fellowship report being subjected to bullying
  • 71% of hospitals reported discrimination, bullying or sexual harassment in their hospital in the last five years, with bullying the most frequently reported issue
  • 39% of Fellows, trainees and international medical graduates report bullying, 18% report discrimination, 19% report workplace harassment and 7% sexual harassment 
One opinion piece subsequently published in The Conversation is by Kimberley Ivory from the University of Sydney: Surgeons take a scalpel to their own toxic culture.  It provides some revealing insights and context for the discussion.

Residential aged care report 2013-14

The AIHW has released the latest data on residential and home care service providers, as well as the people in care, for the 2013-14 financial year in their web report, Residential aged care and Home Care 2013–14.

Some of the statistics presented show that two out of three people in permanent residential aged care were women.  The average age for women was 85.8 and for men, 81.6. 67% of these people required high-level care to manage behaviour, while 47% needed this care for activities of daily living and 40% for complex health care.  24% of Indigenous people in permanent aged care were under 65, compared to 3% for non-Indigenous residents. 

Chronic disease and comorbidities

Chronic diseases tend to be long lasting and have persistent effects. They affect people's quality of life and also have social and economic effects. This new web release from the Australian Institute of Health and Welfare presents comorbidity data for eight selected chronic diseases. It seems that 1 in 5 Australians have two or more of these diseases: 
  • arthritis
  • asthma
  • back problems
  • cancer
  • COPD 
  • CVD 
  • diabetes
  • mental health conditions

 

Emotional harm from disrespect

Emotional harm from disrespect: the neglected preventable harm discusses a different form of harm in health care.  The authors of this paper in BMJ Quality & Safety explain that emotional harms can be understood as harms to a patient's dignity, often caused by a lack of respect.  These type of harms erode trust and damage patient-provider relationships. They also effect patients' physical health. 

The authors conclude that there needs to be a systematic approach to recording and categorising emotional harms so that we can understand how and why they occur and how we can prevent them from happening.  "Ensuring that our profession does not cause preventable harm to our patients requires that we address emotional harms with the same rigor we have applied to physical harms".

Sokol-Hessner L, Folcarelli PH, Sands KEF.  BMJ Quality & Safety. June 17, 2015.  http://dx.doi.org/10.1136/bmjqs-2015-004034 

Thursday, September 03, 2015

Conversations about alcohol and pregnancy


In Conversations about alcohol and pregnancy, a group of Canberra women were interviewed to see how they understood the issue and how they interpret different types of information about it from the media, experts and public health guidelines. 110 media items were analysed and a dominant framework of "contested evidence and advice" was revealed, where stories highlight contradictions evidencing harm or no harm to the foetus from alcohol consumption. This was largely mirrored in the women interviewed.

Some women discussed uncertainty surrounding its potential impacts as their reasoning for abstaining from alcohol, while others thought that the occasional drink was acceptable. Some felt they should be able to decide themselves what they could drink and others felt public health messages were reasonable.    

Chronic disease indicators and targets for Australia

The Australian Health Policy Collaboration has published two papers on this topic for Australia.

Development of Australian chronic disease targets and indicators is a discussion paper by Penny Tolhurst analysing baseline information for chronic diseases as a starting point for target and indicator consideration. 

Suitability of the WHO 25 x 25 chronic disease targets and indicators for Australia is a report by Jason Leung and Penny Tolhurst, which reviews the nationally available data relevant to the World Health Organisation's 25 x 25 targets and indicator with a view to identifying any existing gaps. 

World Alzheimer Report 2015

According to this report from Alzheimer's Disease International, there are over 46 million people live with dementia worldwide, and by 2050 this is estimated to increase to 131.5 million.

The report also looks at the economic impact of dementia, estimating its worldwide cost at US $818 billion. It is also estimated that 94% of people living with dementia in low and middle income countries are cared for at home, in regions where health and care systems often provide limited or no support to people living with dementia or to their families.The report "leaves us with no doubt that dementia, including Alzheimer’s disease and other causes, is one of the biggest global public health and social care challenges facing people today and in the future."

Biomarkers and Questionnaires Predict Suicide Risk


By combining measures of genetic activity with app-based questionnaires, researchers from the National Institute of Health in the US have made progress in predicting which patients might be likely to attempt suicide. Because the team studied only male psychiatric patients, further research will be needed to understand how well this approach can predict suicidal thoughts and behaviors in other populations, such as women and those who aren’t psychiatric patients.


Click here to read more on this topic.

Breast Care Nurse Role

The aim of the study published in Nursing Open, was to explore the role of the Australian breast care nurse in the provision of information and support to women with breast cancer, with a focus on the differences experienced depending on geographic work context.This was the first Australian study to describe the role of the breast care nurse nationally and the first study to investigate breast care nurses perceived ability to meet a selection of the Australian Specialist Breast Nurse Competency Standards.
Important differences were found according to the geographical location of breast care nurses.

Aherne, T., Gardner, A. & Courtney, M. (2015). A survey of the breast care nurse role in the provision of information and supportive care to Australian women diagnosed with breast cancer. Nursing Open, 2(2), 62-71

Renal Care in Children

This virtual issue focuses on “Renal care in children” highlighting previously published papers from the Journal of Renal Care on this topic. Three of the original articles explore how young adults experienced the child-to-adulthood transition, how children cope with a chronic illness, and whether the application of a specific tool can support children with CKD in achieving autonomy in the management of their disease.                                                  

Journal of Renal Care Virtual Issue: Renal Care in Children