Cost-effectiveness of National Hand Hygiene Initiative

Arlington County/flickr CC BY-SA

A recent paper in the open access journal, PLoS ONE, has evaluated the cost-effectiveness of the National Hand Hygiene Initiative implemented from 2009-2012 in Australia. The outcome used was healthcare associated Staphylococcus aureus bacteraemia,and the eight existing state and territory hand hygiene programs were compared. 

The study covered 1,294,656 admissions from the 50 largest Australian hospitals and the authors ultimately concluded that “The Australian National Hand Hygiene Initiative was cost-effective against an Australian threshold of $42,000 per life year gained.”

Graves N, Page K, Martin E, Brain D, Hall L, Campbell M, et al.  Cost-Effectiveness of a National Initiative to Improve Hand Hygiene Compliance Using the Outcome of Healthcare Associated Staphylococcus aureus Bacteraemia.  PLoS ONE. 2016;11(2):e0148190.

Pancreatic cancer - four subtypes identified

A study recently published in the journal Nature, Genomic analyses identify molecular subtypes of pancreatic cancer, indicates that there are four different subtypes of pancreatic cancer. As one of the most aggressive and complex cancers, this detailed genetic study could have major implications on the way it is treated in the future.

If you find the Nature article overly-scientific, there is a useful summary of the findings in plain English published in The Conversation: Pancreatic cancer is really four separate cancers: study.  Author Ivy Shih interviewed one of the main researchers, Sean Grimmond, who is Director of Research for the Centre for Cancer Research at the University of Melbourne.  He said that the results may open new avenues for clinical trials and drug designs to better combat the disease.

Bailey, Peter et al.  Genomic analyses identify molecular subtypes of pancreatic cancer Nature 531, 47–52 (03 March 2016) doi:10.1038/nature16965.  (Request this article from your Librarian if you do not have access to the full text.)

Joanna Briggs short courses in EBP

The Joanna Briggs Institute (JBI) is offering a range of education and training courses for clinicians, managers, educators, academics and students from the fields of nursing, allied health, medicine, information science and the health sciences. There are various start dates for 2016 and all the courses are held at the Institute in Adelaide.

The Clinical Leadership Program is a one day program, in which participants learn skills such as how to create a positive and professional culture in their workplace, manage difficult behaviour, build productive teams and implement change.

The Comprehensive Systematic Review Training Program can be undertaken for 1, 3 or 5 days and participants learn how to develop a focussed question and then find, synthesise and evaluate the literature.

The six month Evidence-Based Clinical Fellowship Program teaches participants to lead their clinical team in an evidence implementation project of their design, audit for improvement and publish their findings. The program involves two five-day intensive training workshops at the Institute and a work-place evidence-based implementation project in the intervening months.  

Evidence based standards for burns

A paper recently published in the Medical Journal of Australia outlines the treatment variations of burns in Australia and New Zealand.  The data has been gathered over the past four years from the Burns Registry of Australia and New Zealand, which has identified "considerable variation in practice" and "significant variations in outcomes that are not explained by simple difference is casemix alone".  

As a result of these fiindings, the Australian and New Zealand Burn Association has launched the Burns Quality Improvement Program (BQIP), which aims to develop evidence-based standards of care.

Cleland H, Greenwood JE, Wood FM, Read DJ, She RW, Maitz P, et al. The Burns Registry of Australia and New Zealand: progressing the evidence base for burn care.  Medical Journal of Australia. 2016;204(5):195.  http://dx.doi.org/10.5694/mja15.00989

Prostate Cancer Guideline

The Prostate Foundation of Australia has released a new guideline titled Clinical practice guidelines PSA Testing and Early Management of Test-Detected Prostate Cancer.
The Guideline is freely available to download here.

Clinical Practice Guidelines for Dementia in Australia

The new Clinical Practice Guideline for Dementia details the optimal diagnosis and management in community, residential and hospital settings. The guidelines have been approved by the National Health and Medical Research Council.
The guidelines provide 109 recommendations, categorised as evidence-based recommendations (formulated after a systematic review of the evidence), consensus-based recommendations (formed where a systematic review has failed to identify sufficient studies to inform a recommendation) and practice points (based on expert opinion).
The guidelines recommend a systematic approach to diagnosing dementia; this includes patient and informant history taking, cognitive assessment, medication review, blood tests and computed tomography or magnetic resonance imaging to exclude other cerebral pathologies.

The full guidelines can be accessed via the Australian Clinical Practice Guidelines portal .

Unnecessary Care: the Choosing Wisely Campaign

The Choosing Wisely Australia campaign has released 61 recommendations of tests, treatments and procedures that may not be necessary and could cause harm to Australian patients as the global healthcare initiative continues to expand and gain momentum in Australia.  The Choosing Wisely Campaign is an initiative of NPS Medicine Wise. 

Choosing Wisely website.

Surgery in the Elderly

The British Journal of Surgery has published a free issue titled Surgery in the Elderly, which includes topics such as:

• Surgery for an ageing population
• Systematic review and meta-analysis of risk factors for postoperative delirium among older patients undergoing gastrointestinal surgery
• Molecular and biological hallmarks of ageing
• Characteristics, incidence and temporal trends of sepsis in elderly patients undergoing surgery.

Special Issue: Surgery in the elderly. British Journal of Surgery, January 2016. 103(2),p e7–e124.

"Ice" - concerns and responses

An editorial recently published in the Medical Journal of Australia describes the patterns of increasing use of methamphetamine over the past then years but argues that we can do something about it.  “Ice” (crystal methamphetamine): concerns and responses is by Margaret Hamilton and Adrian Dunlop, who write, "Methamphetamine has been around for some time. Although it is now available in a crystal form that is more potent and more readily smoked than earlier forms, no-one should feel impotent in the face of widespread alarmist commentary about this drug."   

The authors discuss the recent National Ice Taskforce Report in an attempt to explain the evidence of more regular and greater levels of dependent use among people who use the drug. They call for governments, health services and the community in general to respond to these problems promptly.

Creating choice in end of life care

The Australian Centre for Health Research has released a report about end of life care and the pressures it is under in Australia.  Conversations: creating choice in end of life care, by Rebecca Bartel, finds that conversation can be the principle inexpensive step to reforming the systems we have in place and ensuring that people have greater choice.

Bartel argues that the community needs to talk about dying.  Many Australians are dying in ways they would not choose - we are often receiving care we don't want in places where we don't want it. The evidence shows that open conversations about death, dying and bereavement are vital to the long-term health and well being of individuals and communities and we are not currently doing it well. "It is clear that sharing our preferences for what we’d like at the end of our life is the most important – and costly – conversation that Australia is not having".

Hospitals in Australia series

Australia is in the midst of a health funding crisis, with Federal and State governments battling over who should fix the increasing problems of overcrowded emergency departments, lengthening surgical waiting lists and other issues. This week The Conversation has been running a series of articles about hospitals in Australia, aiming to explain why hospitals are struggling and what can be done about it.
 

There are several articles available.  The Infographic: a snapshot of hospitals in Australia is a great place to start, showing how we use and pay for our hospitals.  Michael Vagg, a clinician from Barwon Health, has written From triage to discharge: a user's guide to navigating hospitals, and Stephen Duckett from the Grattan Institute tells us The problems with Australia's hospitals – and how they can be fixed. Helen Dickinson from the University of Melbourne looks into Why do we wait so long in hospital emergency departments and for elective surgery? and today, Karen Willis and Sophie Lewis compare systems with What are better, public or private hospitals?  

Patient safety tools and resources

 AHRQ  in the US has created tools to help your hospitals to educe readmissions, hospital-acquired conditions—including infections—and improve health literacy, patient/family engagement, and boost quality performance. All of our tools are evidence-based and available at no charge.

Patient Safety Measure Tools & Resources

Admitted patient care 2014-15: Australian hospital statistics

The Australian Institute of Health and Welfare has just released a new report "Admitted Patient Care 2014-15: Australian hospital statistics".

 In 2014-15, there were about 10.2 million separations in Australia's public and private hospitals: about 6.0 million of these occurred in public hospitals; 94% of separations were for acute care and 4% for rehabilitation care.

 Between 2010-11 and 2014-15: the number of separations increased overall by 3.5% on average each year, by 3.2% for public hospitals and by 4.0% for private hospitals, private health insurance funded separations increased by an average of 5.9% each year and; public patient separations increased by 2.7% each year.

AIHW catalogue number HSE 172

Download report: Admitted patient care 2014-15: Australian hospital statistics

Series of National Guidelines (SoNGs)

The Australian Department of Health has developed the Series of National Guidelines (SoNGs) in consultation with the Communicable Diseases Network Australia (CDNA) in order to provide nationally consistent advice and guidance to public health units in responding to a notifiable disease event. "These guidelines capture the knowledge of experienced professionals, built on past research efforts, and provide advice on best practice based upon the best available evidence at the time of completion."

Some of the more recent SoNGs include:

• Dengue National guidelines for public health units - 31/07/2015
• Hepatitis C National guidelines for public health units - 1/09/2015
• Psittacosis (Ornithosis) National guidelines for public health units - 23/02/2016

Immunisation rates for Australian children 2014-15

Healthy communities: immunisation rates for children in 2014–15 has been published by the National Health Performance Authority. It shows the percentages of children who were fully immunised at ages 1, 2 and 5 years in Primary Health Networks as well as particular postcodes and reports on our children's immunisation status nationally.

This report provides a detailed summary related to our blog post last month linking to an interactive data site from the NHPA and shows that there are still a number of areas where immunisation rates remain "potentially too low to prevent the spread of diseases".  The North Coast of NSW has one of the lowest rates in Australia. 

Methamphetamine users in Australia 2002-2014

A recent study in the Medical Journal of Australia examined the number of regular and dependent methamphetamine users in Australia. The results of the prevalence study showed that there were an estimated 268,000 regular methamphetamine users and 160,000 dependent users in Australia in 2013-14. Over the years the age group with the highest numbers of users was 25-34.

The authors concluded that increases over the past 12 years had been marked among young adults and that "there is an increasing need for health services to engage with people who have developed problems related to their methamphetamine use."

Louisa Degenhardt, Sarah Larney, Gary Chan, Timothy Dobbins, Megan Weier, Amanda Roxburgh, Wayne Hall, Rebecca McKetin. Estimating the number of regular and dependent methamphetamine users in Australia, 2002–2014.  MJA 204 (4)  7 March 2016.

Cancer risk - interactive body map

Ian Olver from the University of South Australia explains the difference between "relative risk" and "absolute risk" when it comes to cancer in an article published today in The Conversation: It's all relative: how to understand cancer risk.  Absolute risk is the risk of developing a cancer over a certain period of time.  Relative risk is the risk one group of people has of developing a cancer compared to the risk of another group.   

Reading this is a a good precursor to looking at the Interactive body map: what really gives you cancer? also published today in The Conversation.  Here, authors Emil Jevaratnam and Sasha Petrova bring together evidence on proven cancer correlations.  What are the risks of alcohol, red meat, sun exposure, obesity and so on, when it comes to increasing your likelihood of various cancers?

Causes of Death Australia 2014

There were 153,580 deaths registered in Australia in 2014, 5,902 more than the number registered in 2013 (147,678). There were more male deaths (78,341) registered in 2014 than female deaths (75,239).
 The leading causes of death were Ischaemic heart diseases (I20-I25), Dementia, including Alzheimer's disease (F01, F03, G30), Cerebrovascular diseases (including strokes) (I60-I69), Cancer of the trachea, bronchus and lung (C33, C34), and Chronic lower respiratory diseases (J40-J47). These accounted for over one-third of all deaths.
Published by the Australian Bureau of Statistics, the report is free to download.  


3303.0 - Causes of Death, Australia, 2014

WHO Zika App

The World Health Organization has created a Zika app. The app gathers all of WHO's guidance for agencies and individuals involved in the response to Zika Virus Disease and its suspected complications such as microcephaly, and for health care workers such as doctors, nurses and community health workers.

The app is now available both in Android and iOS versions.

iOS version:
https://itunes.apple.com/en/app/who-zika-app/id1090088404?mt=8

Android version:
https://play.google.com/store/apps/details?id=com.universaldoctor.zika

Chronic failure in primary care

Ineffective management of heart disease, asthma, diabetes and other chronic diseases costs the Australian health system more than $320 million each year in avoidable hospital admissions, according to a new Grattan Institute report.

Chronic failure in primary care finds that our primary care system provides only half the recommended care for many chronic conditions. Only a quarter of the nearly one million Australians diagnosed with type 2 diabetes get the monitoring and treatment recommended for their condition.

Chronic failure in primary care. by Hal Swerissen and Stephen Duckett. February 2016.

Small area Indicators of Wellbeing for Older Australians

The National Centre for Social and Economic Modelling, at the University of Canberra, has released the index of wellbeing for older Australians. This index shows areas where older people in Australia experience low and high wellbeing across 5 domains. The analysis shows that housing is a large contributor to wellbeing, as well as education. Areas of very low and high wellbeing for older people tend to be in cities rather than regional areas.

The index is intended to be a tool for a range of stakeholders including policy-makers and planners in government, service providers and researchers. It will enable them to identify and monitor the characteristics of the older population within local geographic areas, compare the effectiveness of policies, programs and services across different areas and provide information to assist in the development and targeting of services.

Small area Indicators of Wellbeing for Older Australians (IWOA); February 2016. Authors: Robert Tanton, Yogi Vidyattama and Riyana Miranti.   

Health workforce - updated figures

The Australian Institute of Health and Welfare has updated its webpages on the Australian health workforce with data from 2014. Summaries are provided for each of the registered health workforce groups which give a good indication of the nature, size, distribution and effectiveness of the health and community services workforce.  There are downloadable summary data tables for each category.

Nurses and midwives make up more than half of the total of over 600,000 registered health professionals in 2014.  Four in ten were aged 50 or older, and 90% of them had a clinical role.  For medical practitioners, 39.4% were women and 3477 domestic students commenced medical undergraduate training in Australia in 2014.

Blood money - paying for pathology services

The Grattan Institute has published a report by Stephen Duckett, Blood Money: Paying for Pathology Services which calls for changes in the way the government pays for pathology testing. 

The report reveals that taxpayers spend over $2.5 billion per year on pathology services via Medicare.  Providers have introduced modern technologies that allow them to run additional tests at low costs but the government pays full price for each test.  Efficiencies should be passed on and patients should be protected from out-of-pocket charges, Duckett asserts.  He also suggests that tendering for services should be part of more commercial purchasing arrangements with pathology providers.  

Dancing and cardiovascular disease

Elvert Barnes CC BY-SA 2.0 

A study just published in the American Journal of Preventive Medicine by researchers from The University of Sydney and Western Sydney University concluded that moderate-intensity dancing was more strongly associated with a reduced risk for cardiovascular disease mortality than moderate-intensity walking.

The cohort study looked at population surveys of over 48,000 adults over the age of forty in the United Kingdom.  The authors surmised that "The association between dance and cardiovascular disease mortality may be explained by high-intensity bouts during dancing, lifelong adherence, or psychosocial benefits."

An interview with one of the authors, Dafna Merom from WSU, can be found on the ABC website.

Dafna Merom, Ding Ding & Emmanuel Stamataki.  Dancing Participation and Cardiovascular Disease Mortality: A Pooled Analysis of 11 Population-Based British Cohorts American Journal of Preventive Medicine [Articles in Press]. DOI: http://dx.doi.org/10.1016/j.amepre.2016.01.004

Med Pix Free Online Medical Image Database

The National Library of Medicine has announced the launch of MedPix®, a free online medical image database. 

The MedPix collection categorizes and classifies the image and patient data for each of several subsets of image database applications (e.g. radiology, pathology, ophthalmology, etc.). The content material is both high-quality and high-yield and includes both common and rare conditions. Most cases have a proven diagnosis (pathology, clinical follow-up).     The URL is https://medpix.nlm.nih.gov/.

Diagnosis of Gout

Gout is the most common form of inflammatory arthritis, and the prevalence has been increasing. In a 2013 study that analyzed data from several national surveys in the US administered from 2002 to 2008, the number of ambulatory care visits attributable to gout was estimated to be 7 million visits annually, with 2 million attributable to acute attacks. (The rate more than doubled from 2002 to 2008.) The total annual ambulatory care costs associated with gout (visits and medications) were estimated at $933 million (in 2009 dollars). Drug expenditures accounted for 61 percent of the total costs.

This recent summary is part of an American Government initiative from the Effective Health Care Program under the guidance of the guidance of the Agency for Healthcare Research and Quality.

Click here to download: Diagnosis of Gout

Cancer in Adolescents and Young Adults

Wiley Oncology has presented a collection of manuscripts describing a National Cancer Institute workshop entitled Next Steps for Adolescent and Young Adult Oncology: A Scientific Update.

The meeting was held in September 2014 and included discussions from 5 separate working groups focusing on the following topics: Epidemiology, Basic Biology, Clinical Trials, Health Services and Medical Care, and Health-related Quality of Life and Symptoms.

You can read the recommendations on future research priorities in the articles below.

• Next Steps for Adolescent and Young Adult Oncology Workshop: An update on progress and recommendations for the future
• Incidence and incidence trends of the most frequent cancers in adolescent and young adult Americans, including nonmalignant/noninvasive tumors
• Comparison of cancer survival trends in the United States of adolescents and young adults with those in children and older adults
• Biologic and clinical characteristics of adolescent and young adult cancers: Acute lymphoblastic leukemia, colorectal cancer, breast cancer, melanoma, and sarcoma
• Social well-being among adolescents and young adults with cancer: A systematic review

American Cancer Society: Adolescent and Young Adult Series