Bipolar disorder, psychosis and schizophrenia in children and young people

This quality standard from the National Institute for Health and Care Excellence (UK) covers the recognition, early intervention and management of bipolar disorder, psychosis and schizophrenia (including related psychotic disorders such as schizoaffective disorder, schizophreniform disorder and delusional disorder) in children and young people under 18. 

NICE Quality Standard QS102  Bipolar disorder, psychosis and schizophrenia in children and young people. October 2015.

Breast Cancer in Young Women

The Australian Institute of Health and Welfare has released a new report about breast cancer in women in their 20s and 30s. Breast Cancer in Young Women is the first national report presenting key data specific to breast cancer in women in this age group. This report provides an overview of breast cancer, risk factors for young women, breast cancer detection and diagnosis methods, and key summary measures including incidence, hospitalisations, survival and mortality.

Breast cancer in young women: key facts about breast cancer in women in their 20s and 30s. October 2015; AIHW catalogue number CAN 94

Critical Care Compendium

Life in the Fast Lane (LITFL) is a medical blog and website dedicated to providing free online emergency medicine and critical care insights and education for everyone, everywhere. It is an amazing resource and the Critical Care Compendium, part of LITFL, is a comprehensive collection of pages on core topics and controversies relating to critical care. With over 1650 entries, the Compendium entries are constantly revised and improved with links to new references and online resources added daily.

The team for LITFL is headed by Mike Cadogan and Chris Nickson, and consists (mostly) of emergency physicians and intensivists based in Australia and New Zealand. Chris Nickson is the creator of the Critical Care Compendium.

New research resource for domestic violence

"The National Information Center on Health Services Research and Health Care Technology (NICHSR) of the National Library of Medicine (US) has released a new health services research resource on domestic violence. The new resource can be found on the Web portal, Health Services Research Information Central (HSR Info Central). It is intended to support health services researchers, policymakers, administrators, and practitioners involved in detection, prevention and treatment services for this under served and often unnoticed community. The scope of this “topic page” includes Intimate Partner Violence, Reproductive and Sexual Coercion, Child Abuse and Maltreatment, and Elder Abuse."
The site includes statistics, guidelines, search strategies, education and related publications.

Domestic Violence Research Resource

Patient Perspectives: Hospital care for people with cancer

The Bureau of Health Information has released a report, Patient Perspectives: Hospital care for people with cancer. This report draws on Adult Admitted Patient Survey results from almost 6,500 patients with cancer who were admitted to a NSW public hospital during the period July 2013 to July 2014. 
This is the first time a focus has been placed on the survey results of patients with cancer in NSW.

Compared with general patients, people with cancer were more positive about many aspects of care. Although patients would like more information about potential side effects of medication.

Patient Perspectives: Hospital care for people with cancer.

Dementia, Disability and Frailty in Later Life

Leading a healthier lifestyle can delay dementia, disability and frailty in later life. A recent guideline from NICE in the UK recommends National organisations and local government departments that influence public health should continue to develop and support population-level initiatives to reduce the risk of dementia, disability and frailty by making it easier for people to:

• stop smoking
• be more physically active
• reduce their alcohol consumption
• adopt a healthy diet
• achieve and/or maintain a healthy weight

NICE also recommends that organisations make physical activity, adopting a healthy diet and achieving and maintaining a healthy weight as accessible, affordable and acceptable as possible.

Dementia, disability and frailty in later life – mid-life approaches to delay or prevent onset. NICE Guidelines [NG16] October 2015  

New breast screening guidelines in the USA

The American Cancer Society has issued new guidelines which recommend women start having mammograms at 45 instead of 40, and that they don't need to have routine manual breast checks by their general practitioners.

There seems to be a few different approaches in America with the American College of Obstetricians and Gynegologists recommending regular mammograms from 40, the US Preventive Services Task Force recommends age 50, and now the American Caner Society recommends age 45.  BreastScreen Australia targets women from 50-74, but women from 40 are eligible for free screening. 

Breast Cancer Screening for Women at Average Risk : 2015 Guideline Update From the American Cancer Society is freely published in JAMA.

314(15):1599-1614. doi:10.1001/jama.2015.12783

Lancet 10,000th issue

The 10,000th issue of The Lancet has was published last month with some memories of medical milestones since their first issue in October 1823.  

See their infographic timeline to read the original articles of some celebrated research points over the last 192 years, such as Lister arguing for antiseptic practice in surgery in 1867, the first description of ultrasound in 1958 and the introduction of the Glasgow Coma Scale in 1974.

Snapshot Report: Outpatient Survey Results 2014

The Bureau of Health Information has released the first results of the NSW Outpatient Survey which looks at the experiences of more than 18,000 patients who received outpatient services in a NSW public hospital in February or March 2014. 

This is the first time information has been available about patients' experiences of care across nine different types of outpatient services, including oncology and chemotherapy, gynaecology and obstetrics, and orthopaedic surgery.

Snapshot Report: Outpatient Survey Results 2014

World report on ageing and health

With advances in medicine helping more people to live longer lives, the number of people over the age of 60 is expected to double by 2050 and will require radical societal change, according to a new report released by the World Health Organisation.

While some older people may indeed be experiencing both longer and healthier lives, these people are likely to have come from more advantaged segments of society. “People from disadvantaged backgrounds, those in poorer countries, those with the fewest opportunities and the fewest resources to call on in older age, are also likely to have the poorest health and the greatest need,” says Dr Beard, Director of the Department of Ageing and Life Course at WHO.

The Report highlights 3 key areas for action which will require a fundamental shift in the way society thinks about ageing and older people. These actions can give the older people of today and tomorrow the ability to invent new ways of living.

World report on ageing and health. WHO 2015

Type 1 Diabetes in Children

The Australian Institute of Health and Welfare has published a new report on the prevalence of type 1 diabetes among children aged 0-14 in Australia 2013. The report, based on data from the National (insulin-treated) Diabetes Register, highlights that in 2013, 6,091 children aged 0-14 had type 1 diabetes in Australia. This represented 139 cases per 100,000 population, or about 1 in 720 Australians aged 0-14. About 2 in 5 children with type 1 diabetes used an insulin pump to administer insulin. The prevalence of type 1 diabetes among children differed by age, state/territory, and residential remoteness areas.

Prevalence of type 1 diabetes among children aged 0-14 in Australia 2013 AIHW catalogue number CVD 70.

View and download the full report for free online.

e-Mental Health: A Guide for GPs

The term e-mental health refers to the use of the internet and related technologies to deliver mental health information, services and care. e-Mental health interventions are effective for use in the management of mild to moderate depression and anxiety, and can be disseminated in the primary care setting. The RACGP has developed e-Mental health: A guide for GPs to assist you in using e-mental health interventions with patients when it is safe to do so.

The Guide is designed to provide an introduction to the field of e-mental health, direct you to key online resources for you and your patients, and help you to decide how to use e-mental health in your practice.

Health of grey nomads

Health of grey nomads: On the move and under the health sector radar has been published in the Australian Journal of Rural Health recently. The term 'grey nomads' refers to older people travelling long distances around Australia and staying in caravans, tents or motor homes.  Anecdotal evidence suggests they impose a burden on rural and remote health services, but there has been very little research to support this.

Author Melissa Raven surveyed the literature and found that many grey nomads have chronic diseases and some are inadequately prepared for travelling.  She concludes that there is a need for further research to analyse the uptake of health services from this group in order to properly resource health services and optimise their well-being.  

Outcomes of Australian rural clinical schools

Outcomes of Australian rural clinical schools: a decade of success building the rural medical workforce through the education and training continuum has been published on open access in the journal, Rural and Remote Health, by Jennene Greenhill, Judi Walker and Denese Playford.

The Australian government has funded the Rural Clinical Training and Support (RCTS) program for the past decade and this article looks in detail at the successes and challenges faced by the 17 medical schools set up under this program. Through semi-structured interviews with the program directors and others with a key involvement, as well as an analysis of enrolments of students and the consequent employment characteristics of graduates, the authors conclude that the program has been an "outstanding success" with graduates finding a passion for rural health practice.

Perceptions about antibiotic resistance

Rob Brewer, flickr,com

Antibiotic resistance? Sorry, not my problem is a piece recently published in The Conversation by Amanda McCullough, Chris Del Mar and Tammy Hoffman from Bond University.  The authors discuss doctors' and patients' perceptions and understanding of antibiotic resistance and how, although it is widely recognised as a problem, very few people take individual responsibility for prescribing or consuming antibiotics.

This article refers to a paper published earlier this week in the Journal of Antimicrobial Chemotherapy by the same authors. In that article, A systematic review of the public's knowledge and beliefs about antibiotic resistance, they conclude that the public has an "incomplete understanding of antibiotic resistance and misperceptions about it and its causes and do not believe they contribute to its development".

J. Antimicrob. Chemother. (2015)doi: 10.1093/jac/dkv310First published online: October 12, 2015.  Contact your health library for the full text of this article.

State of the world's antibiotics, 2015

This report from the Center for Disease Dynamics, Economics and Policy in the US looks at the current state of antibiotic use and resistance in humans and animals globally. It examines the differences in low and middle income countries and some national strategies to combat antibiotic resistance. 

The State of the World's Antibiotics 2015 is accompanied by interactive maps that show resistance trends in 39 countries and antibiotic use in 69 countries. The maps track infections caused by 12 common and sometimes lethal bacteria, including Escherichia coli, Salmonella, and methicillin-resistant Staphylococcus aureus (MRSA).

Guide to apps promoting healthy living

VicHealth reviewed over 200 health and wellbeing apps available on Apple® and Android™ devices between May and August 2015. The selected apps were reviewed to see if they were likely to help users change their behaviour and achieve a healthier lifestyle. Each app has been given a star rating and VicHealth aims to update those ratings annually.  You can see all the reviews along with tips for choosing apps on their Healthy Living Apps website. 

Elective surgery waiting times 2014-15

The Australian Institute of Health and Welfare has released a new report on elective surgery waiting times. In 2014-15: about 700,000 patients were admitted to Australian public hospitals from elective surgery waiting lists; 50% of patients were admitted for their surgery within 35 days; fewer than 2% of patients waited more than a year for their surgery.

 Elective surgery waiting times 2014-15: Australian hospital statistics   

AIHW catalogue number HSE 166

Download the full reportfor free online. 

What really matters at the end of life - B.J. Miller

BJ Miller is a palliative care physician at Zen Hospice Project in San Francisco, and he presented this very moving TED talk earlier this year. Miller tries to create a dignified, graceful end of life for his patients, asking what do they really want?  Miller, who suffered a horrific accident as a young man and was close to death himself, says, "Let's begin at the end.  For most people it's not death that they fear - it's dying".   

Watch the TED talk, and/or read the transcript of What really matters at the end of life.  

Improving length of stay - what can hospitals do?

The Nuffield Trust in the UK has published a report, Improving length of stay: what can hospitals do?.  The authors point out that improvements in internal processes could reduce the variations in stay for patients with similar conditions.  Some of the principles of good practice that emerged from their study of the literature and insights from clinicians include:  a focus on flow, getting the basics right and ensuring active support for discharge seven days a week.

Codeine-related deaths

Almost half of codeine-related deaths in Australia from 2000 to 2013 are attributable to accidental overdose, say researchers. Deaths related to codeine, which soon could be available only on prescription, more than doubled in Australia between 2000 and 2009.

There was a jump from 3.5 to 8.7 per million population, with a 9.3 per cent rise each year, say researchers who found the increase mainly driven by accidental deaths. Almost half were attributed to accidental overdose and a third to intentional self-harm, with education about the dangers of taking too much codeine needed. The study was published in the Medical Journal of Australia in early October.

Trends and characteristics of accidental and intentional codeine overdose deaths in Australia; Amanda Roxburgh, Wayne D Hall, Lucinda Burns, Jennifer Pilgrim, Eva Saar, Suzanne Nielsen and Louisa Degenhardt. Med J Aust 2015; 203 (7): 299

Cancers in Australia in 2010. Attributable to modifiable factors

Many cancers are caused by exposure to environmental and lifestyle factors, offering opportunities to diminish the burden of cancer if these exposures can be minimised.  Cancer is now the leading cause of death in Australia. In 2014, it is estimated that more than 45,500 people died from cancer in Australia and more than 123,500 new cancers were diagnosed, with the number of new cases expected to rise to 150,000 by 2020. In addition, about 374,000 Australians each year are estimated to develop BCC or SCC of the skin, and the costs of treating these cancers are higher than for any other cancer in Australia.
This series of reports was commissioned by Cancer Council Australia with the aim of estimating the burden of cancer arising in Australia that may be preventable.  Numbers and population attributable fractions of cancer are presented in accompanying papers, published as open access in the Australian and New Zealand Journal of Public Health.

Australian and New Zealand Journal of Public Health. Volume 39, Issue 5,  October 2015

Leading cause of premature mortality in Australia fact sheets

This product (a combination of a web report and fact sheets) from AIHW focuses on the major causes of premature deaths—both overall, and among certain age groups. The leading cause of premature death in 2010–12 was coronary heart disease, accounting for 10% of all deaths in people aged under 75. Lung cancer accounted for almost 9% of premature deaths, and was the second leading cause. More than half of all deaths due to lung cancer were among people younger than 75.
Suicide was the third leading cause of premature mortality in 2010–2012, accounting for 4.5% of premature deaths, with 92% of suicide deaths occurring among people younger than 75.
The web pages are accompanied by 15 fact sheets and 15 General Record of Incidence of Mortality (GRIM) books, looking in greater depth at a range of causes of premature mortality, including diabetes, cardiovascular disease, breast cancer, colorectal cancer, accidental poisoning, assault and chronic obstructive pulmonary disease.

AIHW 2015. Leading cause of premature mortality in Australia fact sheets. Cat. no. PHE 191-205. Canberra: AIHW.

Models of health service delivery for people with intellectual disability

The Social Policy Research Centre at the University of NSW has recently published Current models of health service delivery for people with intellectual disability: Literature review, by Gianfranco Giuntoli, B. J. Newton and Karen R. Fisher. 

The review focused on publications from January 2011 to January 2015 and identified nine models of health service delivery for people with intellectual disability, seven from the UK and two from Australia. All the models identified stressed the need for interagency collaboration as a way of delivering services based on co-operation and integration between generic and specialist teams. 

 

eBooks not yet taking over from print

Photo by Abhi Sharma 

The Plot Twist: E-Book Sales Slip, and Print Is Far From Dead is an article recently published in the New York Times by Alexander Alter.  E-book sales increased by 1,260% between 2008 and 2010 according to Alter and "the book world was seized by collective panic over the uncertain future of print."  Analysts predicted that e-books would overtake print sales by 2015. 

Now, there are signs that many people are becoming hybrid readers, using both e-reading devices and paper. E-book sales fell by 10 % in the first five months of this year, according to the Association of American Publishers, and digital books accounted last year for around 20 percent of the market, which has been steady for a few years.

Reduction in Radiation Exposure to Children and Young People from CT Scans

The Australian Commission on Safety and Quality in Health Care has published a range of resources aimed at reducing unnecessary radiation exposure to children and young people from CT scans. They estimate that over 80,000 CT scans are performed on children and young people in Australia each year, and although they are a valuable diagnostic tool, they use a higher level of ionising radiation than other types of imaging. 

The resources include brochures for parents and carers outlining the benefits and risks of CT scans - available at http://www.safetyandquality.gov.au/ctscansforkids, a fact sheet for referring doctors to provide information on the typical radiation doses and the key questions to consider when deciding whether to refer a child for a CT scan, and an online training module from the Australian Institute of Radiography to support radiographers who undertake CT scans for children and young people. 

More information can be found on the dedicated ACSQHC pages, as well as at Healthdirect, which has partnered with the Commission to develop these resources and others. See http://www.healthdirect.gov.au/ctscansforkids

Acute kidney injury in Australia

Acute kidney injury (AKI) is increasing in incidence globally. This report, Acute Kidney Injury in Australia: a first national snapshot, is a first look at the statistical impact of AKI in Australia, using hospital and mortality data.

In 2012-13, there were around 131,780 hospitalisations for AKI (as the principal and/or an additional diagnosis). The average length of stay for AKI hospitalisations was 11.4 days, which was twice as long as the average length of stay for hospitalisations overall (5.6 days).  In addition, in 2012 there were around 5,160 deaths where AKI was recorded as the underlying or an associated cause of death.

AKI hospitalisations (as a principal diagnosis) more than doubled between 2000-01 and 2012-13. Hospitalisation and death rates for AKI increase rapidly with age, with the majority occurring in those aged 65 and over. Males had at least 40% higher rate of AKI hospitalisations than females when it presents as an additional diagnosis.  People living in remote areas, socioeconomically disadvantaged areas and those with Aboriginal and Torres Strait Islander status also had higher hospitalisation and death rates.

NICE Guidelines on diabetes

The UK’s National Institute for Health and Care Excellence (NICE) has published some new (or updated) guidelines around diabetes:

NICE Guideline NG17 Type 1 diabetes in adults: diagnosis and management

NICE Guideline NG18 Diabetes (type 1 and type 2) in children and young people: diagnosis and management

NICE Guideline NG19 Diabetic foot problems: prevention and management

In addition, there's a new guideline about Coeliac disease: NICE Guideline NG20 Coeliac disease: recognition, assessment and management

Antimicrobial use in Australian hospitals

This report, covering antimicrobial use during 2014, was released last month by the Australian Commission on Safety and Quality in Health Care.  The results from 129 adult acute hospitals showed that Australian usage rates continue to be greater than in the Netherlands and Sweden, and on par with Denmark. There is a wide variance in average antimicrobial usage rates between hospitals, but a slight decline generally in usage rates since they peaked in 2010.  

Six antibacterials represented more than 50% of all those used, and these were:  Amoxicillin with clavulanic acid, Flucloxacillin, Cephazolin, Amoxicillin, Doxycycline and Cephalexin.  This NAUSP Report includes historical comparisons over five and ten-year periods for selected antimicrobials, giving valuable information about trends and patterns of use.

Antimicrobial use in Australian hospitals: 2014 report of the National Antimicrobial Utilisation Surveillance Program