BMJ Christmas issue

It's always fun at this time of year to have a look at the more lighthearted issue BMJ puts out each Christmas.  This year's offerings include:

• Open toe sandals syndrome which looks at seasonal variation in foot infections in the summer in southern England.
• Gotta catch’em all! Pokémon GO and physical activity among young adults: difference in differences study - which demonstrated that people playing Pokemon GO did show an increase in the number of steps they took in the first few weeks, but that the effect petered out. 
• Is caviar a risk factor for being a millionaire? - which is really a study on what is actually meant by "risk factor". 
• Sniffing out significant “Pee values”: genome wide association study of asparagus anosmia  - not everyone has this smell, apparently...  
• Dispelling the nice or naughty myth: retrospective observational study of Santa Claus - which has as its objective "To determine which factors influence whether Santa Claus will visit children in hospital on Christmas Day".  Sadly, it seems that socioeconomic factors play a greater role in the appearance of Santa than does the children's behaviour.

Top ten most discussed journal articles of 2016

Altmetrics tracks mentions of scientific journal articles in news stories, blog posts, tweets, Facebook and other social media sites, in order to establish the wider "impact" of scientific literature outside academia. They have published their Top 100 articles for 2016, which includes a large number of health articles (with links):

• Number one is Barak Obama's article in JAMA on US health care reform
• Number two is an article in BMJ, about medical error being the third leading cause of death in the US
• Number five is another JAMA article about the sugar industry and coronary heart disease
• Number six was from NEJM about Zika Virus and birth defects
• Number seven, again from JAMA, was related to the association between income and life expectancy in the US

Elective surgery waiting times 2015-16

In 2015–16 almost 712,000 patients were admitted to Australian public hospitals from elective surgery waiting lists, either as elective or emergency admission, according to this report from the AIHW, Elective Surgery Waiting Times 2015-16: Australian hospiital statistics

Admissions from public hospital elective surgery waiting lists has increased by 2.4% on average each year since 2011. The most common surgical specialties for admitted patients were General surgery and Orthopaedic surgery, accounting for 38%. The most common surgical procedure for admissions from public hospital elective surgery waiting lists was Cataract extraction.

Between 2011–12 and 2015–16 (excluding the Australian Capital Territory), the overall median waiting time was relatively stable and was 37 days in the most recent report.  

Boating and watercraft drowning deaths

The Royal Life Saving Society has just released the report, Boating and watercraft drowning deaths: 10 year analysis report, which shows that 473 people drown in Australian waterways between 2005 and 2015,

Males accounted for 92% of all boating and watercraft related drowning deaths, even higher than the annual percentage of all male drowning deaths (83%) for 2015/16,  Almost one fifth of boating and watercraft drowning deaths (19%) occurred in people over the age of 65 years. Drowning occurred whilst fishing (28%) and when moving (27%), and most often in small powered boats under 5 meters or paddle craft. The study found that only 8% of people were wearing a lifejacket at the time of death, 31% had consumed drugs, of which 31% were illegal drugs; 26% of people had alcohol in their system, with 59% above the legal driving limit.

Fixing rural and remote health

This National Press Club Address, Fixing Rural and Remote Health, outlined key reform priorities in rural and remote health, including the need for greater fairness for the seven million people who live in rural and remote Australia. If disparities in health outcomes between people from rural and remote areas and people from cities can be addressed, there is potential for increased productivity and economic growth.

The speakers on November 22 were Geri Malone, Chair of the National Rural Health Alliance; Janine Mohamed, CEO of the Congress of Aboriginal and Torrs Strait Islander Nurses and Midwives; and Martin Laverty, CEO of the Royal Flying Doctor Service of Australia.

Healthy Communities - Obesity and smoking rates in Australia

Two new reports from the Healthy Communities series have been released by the Australian Government.  Both are well-illustrated with infographics and easily accessible.

Healthy communities: overweight and obesity rates across Australia, 2014-15 presents local rates of overweight and obesity by Primary Health Network areas, which in 2014-15 ranged from 53% in Northern Sydney to 73% in Country South Australia. There were higher rates for people in regional areas than in cities.  

Healthy communities: Tobacco smoking rates across Australia 2014-15 shows that although national smoking rates have been steadily declining in recent years, there are some local areas where smoking rates remain relatively high. In 2014-15, daily smoking rates ranged from 5% in Northern Sydney to 23% in Western NSW and that regional PHN areas generally had higher smoking rates than metropolitan PHN areas. Across Australia in that period, 14.5% of adults smoke daily.

Management of multimorbidity and polypharmacy in Australia

Published recently in the journal Age and Ageing, this Australian qualitative research aimed to explore the overall healthcare team implementation of best practice for patients with multimorbidity and polypharmacy.  Most of the health care professionals interviewed "did not routinely use structured approaches to incorporate patients’ preferences in clinical decision-making, address conflicting prescriber advice, assess patients’ adherence to treatment plans or seek to optimise care plans".  The authors conclude that there are extensive shortcomings in team-based care for the management of these patients and suggest that delegating coordination to specific health care professionals may support their overall care.

McNamara, K.P. et al. (2016). Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia. Age and Ageing, DOI:10.1093/ageing/afw200   

Consumer companion guide to dementia care

Alzheimer's Australia launched its Consumer Companion Guide: Diagnosis, treatment and care for people with dementia last month.  It lays out the level of care that people with dementia and their carers and families should expect, and is based on the Clinical Practice Guidelines and Principles of Care for People with Dementia that were developed earlier in the year. 

Both documents were produced in a collaborative project between people living with dementia, carers, researchers and clinicians that was funded by the National Health and Medical Research Council's (NHMRC) Cognitive Decline Partnership Centre.

Suicide in the Australian Defence Force

In response to public interest and concern about the incidence of suicide in Australian Defence Force (ADF) personnel, the Australian Institute of Health and Welfare has published this fact sheet: Incidence of suicide among serving and ex-serving Australian Defence Force personnel 2001-2014.

The data shows that between 2001 and 2014, there were 292 suicide deaths of people who had served with the ADF.  Of these, 84 were serving full-time, and 272 were men.  Comparing the men with all Australian men, this was lower for men serving full-time or in the reserve, and higher than the general population for ex-serving men.

Youth survey report

Almost 22,000 peope aged between 15 and 19 completed this survey from Mission Australia. Compared to previous surveys, more young people are reporting concerns about drugs and alcohol, mental health issues and discrimination. The leading causes of discrimination concerns were gender and race/cultural background.

The Youth Survey Report 2016 was consistent with previous years in that young people nominated coping with stress, school or study problems and body image as their top three issues of personal concern.  Catherine Yeomans, the CEO of Mission Australia, commented in her introduction that "It concerns me that mental health continues to grow as an issue of concern for Australia. There are some wonderful youth mental health programs and a range of support services. We must ensure these continue to be funded, adequately supported and accessible." 

Australia's mothers and babies 2014

Australia’s mothers and babies 2014 - in brief presents key statistics and trends on pregnancy and childbirth, and the characteristics and outcomes of births and babies. This publication is designed to accompany the perinatal dynamic data display.

This AIHW report presents data showing that in 2014, 307, 844 women gave birth in Australia, an increase of 18% since 2004, with 51% being male. The average age of women who gave birth was 30.2, compared with 29.7 in 2004 and 30 in 2009.  The rate of multiple pregnancies has decreased, and the rate of around 7 stillborn babies per 1000 has not changed much since 2004.

Australia's health and medical research workforce

Australia’s health and medical research workforce: expert people providing exceptional returns is a report for the Australian Society of Medical Research (ASMR), prepared by Deloitte Access Economics. The ASMR had noted that this particular workforce had been eroding over the past few years, principally due to static funding at the NHMRC. 

This report's findings included the calculation that each $1 invested into the NHMRC-funded health and medical research workforce for the last 15 years returned $3.20 - a net benefit of $23.4 billion. Some health conditions demonstrated very high returns, such as cardiovascular disease, which returned $9.80 per dollar invested.

The report authors concluded that their data provided "evidence of the exceptional health and economic returns of investing in Australia’s productive and highly talented research workforce. ... Australia still has capacity to provide greater output and benefits as a result of investing further in the NHMRC and the workforce it supports."

Clinical Education in Midwifery

The current issue of the Journal of Midwifery & Women’sHealth includes a supplement on Clinical Education that focuses on some of the resources and methods that clinical educators can use to strengthen their existing precepting skills or guide them as they consider becoming preceptors for the first time. The role of preceptors and clinical educators in clinician education cannot be underestimated and those in any field would find these articles valuable. Preceptors have an important role in teaching the clinical and interpersonal skills that the next generation of clinicians will need to provide high-quality health care.

Journal of Midwifery & Women’s Health November/December 2016, Supplement on Clinical Education. 61(S1), p. 1–49

Guidelines and Quality Standards from NICE [UK]

The UK’s National Institute for Health and Care Excellence (NICE) has published new (or updated) guidelines and quality standards. The latest updates are:

• NICE Quality Standard QS16 Hip fracture in adults  https://www.nice.org.uk/guidance/qs16
• NICE Quality Standard QS136 Transition between inpatient hospital settings and community or care home settings for adults with social care needs  https://www.nice.org.uk/guidance/qs136
• NICE Guideline NG58 Coexisting severe mental illness and substance misuse: community health and social care services  https://www.nice.org.uk/guidance/ng58
• NICE Guideline NG59 Low back pain and sciatica in over 16s: assessment and management  https://www.nice.org.uk/guidance/ng59
• NICE Guideline NG60 HIV testing: increasing uptake among people who may have undiagnosed HIV  https://www.nice.org.uk/guidance/ng60
  NICE Clinical Guideline CG95 Chest pain of recent onset: assessment and diagnosis  https://www.nice.org.uk/guidance/cg95
• NICE Clinical Guideline CG145 Spasticity in under 19s: management  https://www.nice.org.uk/guidance/cg145

Shared from 'On The Radar' an information resource of the Australian Commission on Safety and Quality in Health Care, edited by Dr Niall Johnson. 

Sepsis and Septic Shock

With early recognition and intervention sepsis can be avoided. A popular nurse education blog "Blogging for Your Noggin" looks into the past definition of sepsis and explains the difference with the criteria to recognise sepsis within the new Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

Society of Critical Care Medicine. (2016). The third international consensus definitions for sepsis and septic shock (sepsis-3): The sepsis definitions task force. 

Bloggin For Your Noggin. Nursing Education Made Entertaining and Easy.

Clinical Teacher's Toolbox

Articles in The Clinical Teacher’s Toolbox series offer a concise, practical and evidence-guided introduction to core topics in learning, teaching and writing about education, which are designed to be accessible to all clinical teachers. Included in this special issue of The Clinical Teacher are articles on coaching, undertaking and reporting qualitative research, patients as teachers and writing for publication.

(2016) Virtual Issue The Clinical Teacher. The Clinical Teacher's Toolbox

Healthcare in rural, regional and remote NSW

The main aim of this report is to capture the challenges to rural healthcare posed by geography and isolation. It describes the diversity and responsiveness that are hallmarks of healthcare in NSW and compares performance across the rural–urban continuum, identifying areas of achievement and highlighting areas for potential improvement.

Low population density, long travelling times, difficulties recruiting a skilled workforce and an ageing population are just some of challenges assessed in rural, regional and remote NSW. 

Bureau of Health Information. The Insights Series –Healthcare in rural, regional and remote NSW. Sydney (NSW); BHI; 2016.

Sugary drinks tax - report

The Grattan Institute's report, A sugary drinks tax: recovering the community costs of obesity, strongly supports the imposition of an excise tax of 40 cents per 100 grams of sugar on all non-alcoholic, water-based drinks containing added sugar. "Such a tax would increase the price of a two-litre bottle of soft drink by about 80 cents, raise about $500 million a year, and generate a fall of about 15 per cent in the consumption of sugar-sweetened beverages."

The report provides obesity statistics and costings in Australia, and cites other countries which already have, or are planning to have, a tax on soft drinks - France, Belgium, Hungary, Finland, Chile, the UK, Ireland, South Africa, and parts of the US.

Drug-caused deaths in Australian health professionals

A study recently published in the journal Addiction, looked at the risk of substance abuse and its associated premature death in health professionals.  404 drug-caused deaths reported to a coroner between 2003 and 2013 from this cohort were examined.  The researchers found that the most common drug-caused deaths involving health professionals at this time were females in their mid-40s with a diagnosis of mental illness.

Pilgrim, J. L., Dorward, R., and Drummer, O. H. (2016) Drug-caused deaths in Australian medical practitioners and health-care professionals. Addiction, doi: 10.1111/add.13619.  (Access is available via CIAP for NSW Health staff)

HIV, viral hepatitis and STIs

HIV, viral hepatitis and sexually transmissible infections in Australia: Annual surveillance report 2016 has been published by the Kirby Institute at the University of NSW.

This analysis includes estimates of incidence and prevalence of HIV and viral hepatitis, by demographic and risk groups, patterns of treatment for HIV and viral hepatitis infection, and behavioural risk factors for HIV and Hepatitis C infection. This annual report has been published every year since 1997. Among the many findings in this year's report are:

• The number of HIV notifications newly diagnosed in Australia has remained stable for the past four years
• At 0.1%, the prevalence or overall proportion of people in Australia who are living with HIV is low compared to other high income countries, and countries in the region.
• In 2015 there were 10,790 notifications of hepatitis C, with the highest rates in the 25 – 39 year age group.
• Chlamydia was the second most frequently reported notifiable condition in Australia in 2015, with a total of 66 033 notifications.

You can also access the Kirby Institute's interactive surveillance data website, which provides the report information in graphs and other useful visuals.

Equality and Diversity in Psycho-Oncology

A Special Issue of the journal Psycho-Oncology focussing on inequalities in cancer has been published. Concerns are raised relating to what is known about the experience of cancer treatment and cancer treatment outcomes in adults with dementia.

Findings indicate that, when compared with other cancer patients, those with dementia are diagnosed at a later stage, receive less treatment, are more likely to experience complications from treatment and have poorer survival. 

Special Issue: Equality and Diversity in Psycho-Oncology, (2016). Psycho-Oncology. 25(10), 1121-1249

Safety Monitoring and Reporting in Clinical Trials

The National Health and Medical Research Council (NHMRC) has issued new Guidance on safety monitoring and reporting in clinical trials. This Guidance will replace the existing 2009 Australian Human Ethics Committee Position Statement: Safety Monitoring and Reporting in Clinical Trials Involving Therapeutic Goods.
This guidance specifically addresses the monitoring, collection and reporting of adverse events and adverse reactions that occur in clinical trials involving investigational medicinal products (IMPs) and investigational medical devices (IMDs) for trials conducted under the Clinical Trial Exemption (CTX) or Clinical Trial Notification (CTN) schemes. The Guidance is also broadly applicable to all clinical trials involving therapeutic goods.
Guidance for Safety Monitoring and Reporting in Clinical Trials; involving therapeutic goods, (2016)

Does quality improvement improve quality?

The authors of this article in Future Hospital Journal describe the issue of quality improvement; “Although quality improvement (QI) is frequently advocated as a way of addressing the problems with healthcare, evidence of its effectiveness has remained very mixed. QI work is often pursued through time-limited, small-scale projects, led by professionals who may lack the expertise, power or resources to instigate the changes required. There is insufficient attention to rigorous evaluation of improvement and to sharing the lessons of successes and failures. Too many QI interventions are seen as ‘magic bullets’ that will produce improvement in any situation, regardless of context. Too much improvement work is undertaken in isolation at a local level, failing to pool resources and develop collective solutions, and introducing new hazards in the process.”

Dixon-Woods, Mary, Martin, Graham. (2016). Does Quality Improvement Improve Quality. Future Hospital Journal, 3(3), 191-194

Shared Decision Making through Reflective Practice

This article in the journal MedSurg Nursing focuses on competencies of shared decision making with examples of the knowledge, behaviors, and attitudes needed if shared decision making is to be realized. It also demonstrates how self-reflective questioning assists the clinical nurse to integrate these competencies in practice. This is Part II in a series of articles on shared decision making. Part I of this series reviewed background literature and considered descriptions of shared decision making, including the process and outcomes.

Truglio-Londrigan, M. (2016). Shared Decision Making through Reflective Practice: Part II
Medsurg Nursing, 25(5), 341-345,350.
 

MNCLHD staff can access this article free full text via the e-journal site or ask your library staff.

Getting Australia's Health on Track

A new report "Getting Australia’s Health on Track" presents 10 priority policy actions that, together, will help get Australia on track to reach the 2025 targets and significantly reduce preventable illness and disability in the population. It has been produced by a national collaboration of Australia’s leading chronic disease experts and organisations.

Its focus is upon interventions to reduce the consumption of sugar, salt and alcohol, and to tackle junk food marketing. It also recommends actions to reduce smoking, particularly by Aboriginal and Torres Strait Islander people and by people with mental illness.

Getting Australia's health on track—a policy report for a healthier Australia. Australian Health Policy Collaboration, 2016

Busting the cranberry myth

A recent program on ABC's Health Report titled Busting the Cranberry Myth, looked at a randomised trial which showed no significant difference in women in nursing homes who took cranberry capsules for urinary tract infections, compared to a control group who took a placebo. The lead author of the paper, published in JAMA, Manisha Juthani-Mehta, was interviewed on the program and explained her findings. She did say that cranberries probably help ease the symptoms of urinary tract infections, but could not find evidence that they can treat the problem.

Manisha Juthani-Mehta et al. Effect of Cranberry Capsules on Bacteriuria Plus Pyuria Among Older Women in Nursing Homes: A Randomized Clinical Trial. JAMA. 2016;316(18):1879-1887. doi:10.1001/jama.2016.16141

Medical students and patient-centredness

A study of medical students in Victoria found that while their confidence increased over the course of two years of clinical training, their attitudes to patient centredness did not change.  They had positive attitudes throughout and "noted its importance in contributing to quality care".

The article, published in BMC Medical Education aimed to compare students' attitudes to these two important outcomes of medical education, and to see how the setting of their clinical placement influenced them.  The authors concluded that "a new generation of doctors with a strong patient-centred focus is emerging".  Patient centredness was encouraged and supported within their clinical placements and influenced by role modelling.

Ruth McNair, Leonie Griffiths, Katharine Reid, Hannah Sloan. (2016). Medical students developing confidence and patient centredness in diverse clinical settings: A longitudinal survey study.  BMC Medical Education, 16:176  

Eye Health web resource

The Australian Indigenous HealthInfo Net has set up an Eye Health Web Resource for Aboriginal and Torres Strait Islander people.

The tools and information on this page are set up to support health professionals and students of eye health in this group.  They include links to programs and projects, reviews of the literature, relevant policies, health promotion resources and information about the workforce in this field - training, conferences and job opportunities.

Emergency department care 2015-16

The Australian Institute of Health and Welfare has published a new report on emergency department care. In 2015-16, there were 7.5 million presentations to public hospital emergency departments across Australia (excluding the Australian Capital Territory), or more than 20,000 presentations each day.

• 74% of patients received treatment within an appropriate time for their urgency (triage) category;
• 73% of patients spent 4 hours or less in the emergency department;
• 2.2 million patients were admitted to hospital from the emergency department, and 49% of these were admitted within 4 hours.

Download the report for free: Emergency department care 2015-16: Australian hospital  statistics. AIHW catalogue number [HSE 182].

Sharing of Trial Results

It is interesting the number of drug trials that are not published. Clinical trials are the best way we have of testing whether a medicine is safe and effective. They can involve thousands of people, patients and healthy volunteers, and take years to complete, but trials with negative results are twice as likely to remain unreported as those with positive results. This means that patients and doctors don't have the full information about the benefits and risks of treatments. 

The link to the trials tracker, built by the Evidence-Based Medicine Data Lab at University of Oxford is here: https://trialstracker.ebmdatalab.net/#/   

Review Issue on Viruses and Disease

The reviews assembled in this free virtual issue of the Journal of Pathology focus on the interface between virology and pathology and encompass aspects of both the clinical pathology of viral disease and the underlying disease mechanisms.

(2015). Journal of Pathology. Special Issue: Viruses and Disease, 235(2)  

Occupational Therapy Practice Guidelines

The American Occupational Therapy Association has updated 2 guidelines;

• Occupational therapy practice guidelines for adults with traumatic brain injury.  In addition to the evidence-based recommendations below, the guideline includes extensive information on the evaluation process and intervention strategies for people with traumatic brain injury (TBI)  

• Occupational therapy practice guidelines for individuals with autism spectrum disorder.  In addition to the evidence-based recommendations below, the guideline includes extensive information on the evaluation process and intervention strategies for people with autism spectrum disorder (ASD).

Workplace Bullying and Psychological Safety in the Workplace

Safe Work Australia has published two new research reports that present the latest findings on the prevalence of workplace bullying and harassment; and the impact of management commitment to psychological health and safety and poor mental health in the workplace on organisational productivity.

The Psychosocial Safety Climate and Better Productivity in Australian Workplaces: Cost, Productivity, Presenteeism, Absenteesim report presents an estimate that productivity losses associated with low levels of management commitment to psychological health and safety in the workplace comes at a cost to employers of $6 billion per annum.

The Bullying & Harassment in Australian Workplaces: Results from the Australian Workplace Barometer project 2014/2015 report provides information on the prevalence of bullying and harassment in Australian workplaces. It reports an increase in the estimated prevalence of bullying in Australian workplaces, from 7% in 2009-10 to 9.7% in 2014-15.   

Child abuse and neglect statistics

The Australian Institute of Family Studies has published this report which discusses a snapshot of data describing child protection activity in Australia.  State and territory governments have the statutory responsibility for protecting children from child abuse and neglect, which can be problematic with separate jurisdictions resulting in some children 'falling through the cracks.'

The report presents figures on the numbers of notifications to child protection services in Australia, investigations, the nature of substantiated reports of harm and the characteristics of children who are harmed. There are links to various other sites and further detailed information.

Child Abuse and Neglect Statistics 

Australian atlas of healthcare variation

An online Interactive Australian Atlas of Healthcare Variation has been developed by the Australian Commission on Safety and Quality in Health Care, which covers the areas of:

• Antimicrobial dispensing 
• Diagnostic interventions 
• Surgical interventions 
• Interventions for mental health and psychotropic medicines 
• Opioid medicines 
• Interventions for chronic diseases. 

The interactive atlas provides an easy interface to all the content in the Australian Atlas of Healthcare Variation, including the availability of data in easy-to-download formats. Users are able to look at maps of Primary Health and Local  Hospital networks and compare their areas with state, national and sometimes international rates.

Practice Guidelines for Burn Care

The International Society for Burn Injuries (ISBI) has long recognized a need to provide burn care practitioners with recommendations for patient care. The purpose of setting forth practice guidelines was to define the most effective and efficient methods of evaluation and management of burn injuries. And these practice guidelines were to be suitable for both Resource Limited Settings (RLS) and Resource Abundant Settings (RAS).

2016. ISBI Practice Guidelines for Burn Care. Burns. 42(5). 953–1021 

Heart Failure journal

This new open access journal from the Heart Failure Association of the European Society of Cardiology publishes high quality open access research that improves the understanding, prevention, investigation and treatment of heart failure.
 ESC Heart Failure journal.   

Prevention of Surgical Site Infection

The World Health Organization (WHO) has released this set of guidelines to reduce the global burden of surgical site infections (SSIs) which occur when bacteria enters a patient's body through incisions made during surgery.  These new WHO guidelines are valid for any country and suitable to local adaptations, and take account of the strength of available scientific evidence, the cost and resource implications, and patient values and preferences.
The document includes 29 recommendations covering 23 topics for the prevention of SSI in the pre-, intra and postoperative periods.

Global Guidelines for the Prevention of Surgical Site Infection

World Health Organization, Geneva: 2016  

Antimicrobial Resistance

Two recent reports have been published in Australia and the UK, on Antimicrobial Resistance. The Australian Government has released the first Implementation Plan to support the National Antimicrobial Resistance Strategy 2015-2019. The Plan incorporates activities being undertaken across various sectors to encourage and enable collaboration and information sharing. These activities contribute to the establishment of an evidence base and better target our efforts to address gaps and ensure appropriate policies and programs are in place to limit the development of antimicrobial resistance.

Implementation Plan: National Antimicrobial Resistance Strategy 2015-2019

Australian Government, Department of Health, Department of Agriculture and Water Resources
Canberra: Australian Government; 2016.

The second report from the UK discusses the growing problem of resistance and why action is needed, provides an overview of the solutions that the Review team thinks should be implemented to curtail unnecessary use and increase the supply of new antimicrobials. The report also discusses public awareness campaigns, the need to improve sanitation and hygiene, reduce pollution from agriculture and the environment, improve global surveillance, introduce rapid diagnostics and vaccines, the need to increase the number of people in this area, and use of market entry rewards and an innovation fund to generate more drugs.

Tackling drug-resistant infections globally:Final report and recommendations

Review on Antimicrobial Resistance. London: 2016

Patient Experiences in Australia: Summary of Findings, 2015-16

This publication from the Australian Bureau of Statistics presents information from the 2015-16 Patient Experience Survey.  The ABS Patient Experience Survey is conducted annually and collects data on access and barriers to a range of health care services, including:

• general practitioners (GPs) 
• medical specialists 
• dental professionals 
• imaging and pathology tests 
• hospital admissions 
• emergency department visits (ED)

It includes data from people that accessed health services in the previous 12 months, as well as from those who did not, and enables analysis of health service information in relation to particular population groups. Data are also collected on aspects of communication between patients and health professionals.
4839.0 Patient Experiences in Australia: Summary of Findings, 2015-16

Education resources from Australia's Health 2016

The Australian Institute of Health and Welfare has produced some great education resources to go with the 2016 edition of Australia's Health. All the resources are free to download and print, as long as AIHW is attributed.

Here you can find a quiz, some worksheets and factsheets, links to the OzHealth app for iPhone, and a powerpoint presentation.

Intimate partner violence reports

Two new reports from Australia's National Research Organisation for Women's Safety have recently been published, showing that among women aged 18-44, family violence  is the biggest risk factor contributing to disease burden - greater than smoking, alcohol use and obesity. Intimate partner violence (IPV) affects one in three women, seriously impacting their health.  
Examination of the burden of disease of intimate partner violence against women in 2011: final report provides details of  IPV as a risk factor for an "attributable" total, non-fatal and fatal burden of disease.

A preventable burden - Measuring and addressing the prevalence and health impacts of intimate partner violence in Australian women: key findings and future directions is by one of the authors of the above paper, Kim Webster. Here she provides useful infographics and suggestions for reducing the health burden of IPV by better support and for women and children after violence, and more effective preventative measures. 

See also Kim Webster's explanatory article in The Conversation: Study confirms intimate partner violence leading health risk factor for women.

Radiotherapy in Australia

This report from the AIHW presents data from the second year of the pilot data collection on radiotherapy treatment which covers courses that started in 2014–15 and the waiting times for those treatments.

Radiotherapy in Australia: report on the second year of a pilot collection 2014–15 looked at almost 56,400 courses of radiotherapy and showed that public providers delivered 71% of courses. Breast, prostate and lung cancers were the most common reasons for radiotherapy and 69% of patients starting treatment were aged 60 and over. 58% of the radiotherapy courses were intended to cure disease, 38% of courses were delivered for palliative purposes and 2.7% were prophylactic. 

As far as waiting times, 50% of patients received treatment within 10 days of being assessed as ready for care, and 90% received treatment within 28 days.

Population ageing and Australia's future

Population ageing and Australia's future is a new publication from the Australian National University, with a detailed examination of our population statistics and implications into the future.  It builds on presentations made to the 2014 Symposium of the Academy of the Social Sciences in Australia (ASSA) and provides evidence from a range of experts in diverse fields, including anthropology, demography, economics, education, history, law, psychology, social medicine and statistics.

This feely-downloadable book is divided into four parts:
- Perspectives on Ageing
- Population Ageing: Global, regional and Australian perspectives
- Improving Health and Wellbeing
- Responses by Government and Families/Individuals.

World Alzheimer Report 2016

The World Alzheimer Report 2016, Improving healthcare for people living with dementia: Coverage, quality and costs now and in the future, has been published by Alzheimer's Disease International. The authors argue that healthcare for people with dementia should be continuous, holistic and integrated. Current services are over-specialised, and there needs to be a more prominent role for primary and community care.  

Four main themes emerged from reviews conducted: the need for a systemisation of care processes, better management of the complexity of multimorbidities, more research, and an acknowledgement of the costs offset by efficiencies. 

Best practice in breast cancer

Cancer Australia has this week released a statement: Influencing best practice in breast cancer.  It's a summary of 12 key appropriate and inappropriate breast cancer pactices and "provides health providers, patients and policymakers with the evidence supporting effective and best practice care, to deliver value to the patient and the health system."

An example of an "appropriate" practice is no.3: Appropriate to consider and discuss fertility and family planning with premenopausal wwomen before they undergo breast cancer treatment".  An innapropriate practice is no. 11: Not appropriate to perform a mastectomy without first discussing with the patient the options of immediate or delayed breast reconstruction. Each of the practices described includes a descriptive context, a statement about the value to patients and citations of supporting evidence.

This week's Health Report on ABC radio included an interview with Helen Zorbas, CEO of Cancer Australia about this statement. Here she outlines some of her concerns that not all breast cancer patients are receiving the same standard of care in Australia.

Aged care: a quick guide

Aged Care: A Quick Guide has been published by the Parliamentary Library to give an overview of the formal aged care systme in Australia, which caters for people over the age of 65 (and Indigenous Australians over the age of 50) who can no longer live without support in their own homes. It provides statistics on the types of care provided, organisations providing the care and regulatory arrangements.  

The Australian Government spent around $15.8 billion in 2014–15 on aged care services, and the Aged Care Act 1997 provides the legislative framework for the funding and regulation of aged care. 

Preventing patient falls - US hospitals guide

In response to the alarming statistic that almost a million people fall in American hospitals every year, with around 11,000 being fatal, the Health Research and Education Trust in the US has published a guide describing the risks that lead to patient falls and some solutions. Preventing patient falls: a systematic approach reports on the experiences of seven hospitals participating in the American Joint Commission Center for Transforming Healthcare Project.

The top contributing factors to patient falls were grouped into six categories:

1. Fall risk assessment issues
2. Handoff communication issues
3. Toileting issues
4. Call light issues
5. Education and organizational culture issues
6. Medication issues

The two key areas to ensuring success in fall reduction programs were found to be adequately measuring and analysing the contributing factors and addressing culture change.

Transparency in clinical trials reporting

Physician Ben Goldacre is well known for his books Bad Science and Bad Pharma.  He is also a Senior Clinical Research Fellow at the Centre for Evidence-Based Medicine at the University of Oxford.  Recently he presented a 30 minute talk at the International Journal of Epidemiology Conference which you can see here: "Transparency, beyond publication bias". 

In this "super-speedy talk", Goldacre laments the lack of transparency in clinical trials reporting. He calls for access to consent forms, to see what patients were told, the analytic code and the post-publication peer review. All this, he argues, should be available on open access and be reuseable.

Bad Pharma is available for borrowing at PMBH Clinical Library. Contact library.pmbh@ncahs.health.nsw.gov.au 

Nutrition calculator

Dairy Australia's Foods that Do Good website includes a Nutrition Calculator which uses the Australian Government's Australian Dietary Guidelines to work out how many serves of each of the five main food groups should be consumed each day, depending on a person's gender and age.

The site also includes tools and resources for general practitioners, dentists and dietitians. These include fact sheets, infographics, links to policies and guidelines, and learning modules for CPD.

Perinatal deaths in Australia

Perinatal Deaths in Australia 1993-2012 has been published by the Australian Institute of Health and Welfare. It includes a detailed analysis of stillbirth and neonatal death data for 2011-12 and examines trends back to 1993.

During 2011 and 2012, around 6000 babies died in the preinatal period; almost one in one hundred pregnancies. Approximately three-quarters of those deaths were stillbirths with the remainder being neonatal deaths. The highest perinatal mortality rate was recorded in Victoria (12.2 deaths per 1,000 births) and the lowest in New South Wales (8.3 deaths per 1,000 births). The perinatal mortality rate of babies born to mothers who identified as Aboriginal or Torres Strait Islander was almost double that of babies of non-Indigenous mothers. The perinatal mortality rate was almost 50% higher among babies whose mothers smoked compared with those who did not smoke. The stillbirth rate for babies of teenage mothers and mothers older than 45 was more than double that for mothers aged 30–34.

Every Last Girl report

A report published by Save the Children UK for the International Day of the Girl last week ranks the best and worst countries to be a girl.  Every Last Girl: free to live, free to learn, free from harm includes a 'Girls’ Opportunity Index,' which measures countries against five indicators: early marriage, adolescent pregnancy, maternal mortality, women in parliament, and secondary school completion.

Australia is ranked only 21st out of 144 nations. The two major factors contributing to Australia’s poor rating were the low proportion of women in parliament and a relatively high teen pregnancy rate. Sweden rates most highly.

The report states that over 700 million women in the world today were married before they turned 18, and one in three of those women were married before they turned 15. 30 million girls are at risk of genital mutilation and 2.6 billion girls live in countries where marital rape is not criminalised. There are many other barriers to global equality for girls, including economic exclusion, education gaps and trafficking and slavery. 

National Eye Health Survey

The National Eye Health Survey 2016 has been prepared by the Centre for Eye Research Australia and Vision 2020 Australia. It examines the prevalence and major causes of vision impairment and blindness, which appear to be on the decline in Australia.  

4,836 people across Australia were surveyed. Findings included the fact that vision impairment and blindness are three times more prevalent in indigenous Australians than non-indigenous Australians, and that while age-related macular degeneration is the leading cause of blindness among non-Indigenous Australians, cataract is the leading cause of blindness among Indigenous Australians.

Voting rights of people with mental disabilities

This article in the UNSW Law Journal compares the laws relating to voting rights of people with mental disability in various jurisdictions in Japan and Australia.  The authors argue tthis group should not be discriminated against when it comes to their rights of political franchise.

In Australia's universal franchise system there are some people excluded from voting - people under 18, convicted criminals and people with mental disabilities. Currently several nations are assessing their compliance with the UN Convention on the Rights of Persons with Disabilities in order to argue for a political franchise without discrimination against persons with mental disabilities.  After a thorough overview of the historical and contemporary political rights of these people in Australia and Japan, the authors conclude by agreeing with the recommendations of a recent Australian Law Reform Commission inquiry that the Australian Parliament should repeal the disqualification from voting and enrolment in section 93(8)(a) of the Commonwealth Electoral Act 1918 of persons of ‘unsound mind’.

Trevor Ryan, Andrew Henderson, Wendy Bonython (2016). Voting with an 'unsound mind'? A comparative study of the voting rights of persons with mental disabilities. UNSW Law Journal 39(3): 1038-1071. 

Obesity in pregnancy related to telomere length

AJC1/Flickr, CC BY

A new study in BMC Medicine has found that a woman's pre-pregnancy BMI is associated with shorter telomere lengths in newborns. This sets telomere length for later life and could mean that these babies are not as well-protected from age related diseases as babies born to mothers with a lower BMI.

If (like me) you need a simple explanation of the function of telomeres and exactly what this research is all about, it is useful to read Jocelyn Wright's article in The Conversation, Babies born to overweight mothers more likely to get age-related diseases sooner.

Dries S. Martens et al. (2016) Maternal pre-pregnancy body mass index and newborn telomere length. BMC Medicine 14:148. DOI: 10.1186/s12916-016-0689-0

Impact of cervical cancer screening on different ages

The Australian government’s renewed cervical screening program (due to begin in May 2017), recommends that women should start HPV-based screening for cervical cancer at age 25, not age 18-20 as is currently the case.  Ahead of this change, the Medical Journal of Australia has published this study which analyses the trends in incidence of cervical cancer by age. 

It was found that between 1988–1990 and 2008–2010, cervical cancer incidence fell substantially in women aged 25–49 and 70 years or over, but plateaued in women aged 25–69. The authors concluded that although women aged 20–24 years have been included in the National Cervical Screening Program since its inception, "no significant impact on cervical cancer incidence was observed in this age group". They also found that the NCSP has had a substantial impact on overall cervical cancer incidence.

Megan Smith, Karen Canfel (2016). Impact of the Australian national cervical screening program in women of different ages.  Medical Journal of Australia: 205(8): 359-64. doi:10.5694/mja16.00289
 

Mental health services in brief 2016

The Australian Institute of Health and Welfare has published an overview of the provision of health and welfare services to Australians with mental health needs. Mental Health Services in Brief 2016 examines the prevalence and impact of mental illness in Australia, overviews existing services, resources and supports and looks at key performance indicators.

It is estimated that almost half of Australians will experience a common mental disorder in their lifetime and that in 2010 64,000 people between 18 and 64 accessed treatment annually for a psychotic disorder. There were over 17 million mental health-related GP encounters in 2014-15, mainly for depression, anxiety and sleep disturbance.  There are many other statistics and facts succinctly provided in this 38 page document.

Workplace bullying and patient safety

The Academy of Medical Royal Colleges in the UK has released a report which looks at what is being done to address bullying and undermining in the medical workforce. Creating supportive environments: tackling behavious that undermine a culture of safety emphasises that this workplace culture not only damages the wellbeing of those involved, but that it directly impacts on patient safety.

A recent article in Journal of Nursing Care Quality looks at this correlation from the nursing point of view.  Patient Safety and Workplace Bullying: An Integrative Review examines the literature and finds that workplace bullying is associated with negative nursing outcomes, but that there are very few studies examining how this affects patient safety. The authors urge for more research on this association so that policies can be developed to support a more respectful culture. "Bullying may well be so ingrained int he culture of nursing that it undermines credibility, professional values, and nursing's self-identity".

Houck, N. M., & Colbert, A. M. (2016). Patient safety and workplace bullying: An integrative review. Journal of Nursing Care Quality. doi:10.1097/NCQ.0000000000000209. NSW Health staff can obtain a copy of this article via CIAP. 

Social media for tracking epidemics

Infectious disease outbreaks cause death, disability and financial hardship. It is estimated that the outbreak of SARS cost the global economy US$54 billion. Can social media tools help to track diseases, spread news and offer guidance quickly to places in need?  This article by C Raina MacIntyre from the University of New South Wales was published inThe Conversation this week: Social media for tracking disease oubreaks - fad or way or the future?.

The author argues that there are great possibilites but we need well-constructed algorithms, thoughtful human analysis and expert interpretation of the data.

Perinatal deaths in Australia 1993-2012

"While Australia is one of the safest places in the world to give birth, almost 1 in 100 pregnancies will end in a perinatal death." This report from the Australian Institute of Health and Welfare analyses the statistics for stillbirths and neonatal deaths in Australia for the calendar years 2011 and 2012, when over 6000 babies died during the perinatal period.  It also looks at trends between 1993-2012, when there was a decrease in neonatal death and an increase in the stillbirth rate. 

Monk A, Harris K, Donnolley N, Hilder L, Humphrey M, Gordon A & Chambers GM 2016. Perinatal deaths in Australia 1993-2012  Perinatal deaths series no. 1. Cat. no. PER 86. Canberra: AIHW

Cardiovascular risk and disease in Australian women

Hidden hearts: cardiovascular risk and disease in Australian women is a report from the Mary MacKillop Institute for Health Research at the Australian Catholic University. The report reveals that CVD is the major killer of Australian women, costing our health system over $3 billion per year.

The five most common forms of CVD are coronary artery disease, heart failure, atrial fibrillation , stroke and peripheral artery disease. All these forms are potentially deadly and disabling, causing more fatalities than the most common forms of cancer.  "Within an ageing population in whom levels of most risk factors are at historically high levels, the burden of CVD among Australian women is set to increase for the foreseeable future." The report calls for more awareness-raising, more research, updating of guidelines and more standardised prevention and management programs.

Medicines and dementia

NPS MedicineWise and Alzheimer's Australia have supplied some useful downloadable materials for people with dementia and their supporters.

Medicines and dementia: what you need to know includes an information booklet, Medicines and dementia: a resource for people with dementia and their carers, as well as a series of fact sheets on strategies for dementia, other conditions with dementia and tips for medicine management.  There are also links to other resources and support services, and a short video about one person's experience with her husband's dementia.

Impacts of changes to trading hours on alcohol-related harm

Setting legal limits on trading hours for licensed premises has been a key policy approach to managing alcohol-related problems in Australia. Recently, following gradual extensions to permitted hours of sale, more rigorous restrictions on have been implemented in NSW and Queensland. There is a growing body of international research examining the impacts of trading hour policies on alcohol-related harm and this systematic review of the literature examines studies over the past ten years.

Twenty-one studies were identified, including seven from Australia, which demonstrate that reducing the hours during which on-premise alcohol outlets can sell alcohol late at night can substantially reduce rates of violence. The authors conclude that "the evidence of effectiveness is strong enough to consider restrictions on late trading hours for bars and hotels as a key approach to reducing late-night violence in Australia."

Claire Wilkinson, Michael Livingston, Robin Room Impacts of changes to trading hours of liquor licences on alcohol-related harm: a systematic review 2005–2015. Public Health Research & Practice 26 (4), September 2016.  doi: http://dx.doi.org/10.17061/phrp2641644