Clinical practice guidelines and principles of care for people with dementia

The NHMRC has approved the recommendations from the Clinical Practice Guidelines and Principles of Care for People with Dementia, published by the Cognitive Decline Partnership Centre at the University of Sydney.  The guidelines contain 109 recommendation that health and aged care staff should apply in their workplaces while also responding to the needs and preferences of the person with dementia and their carer(s) and family.

Clinical practice guidelines and principles of care for people with dementia
Clinical practice guidelines and principles of care for people with dementia: Recommendations

Exploring Values in Nursing

A recent article in the Australian Journal of Advanced Nursing looked at the EoC program. The ‘Essentials of Care’ (EoC) program seeks to develop a shared vision amongst nurses within particular workplace teams. The purpose of this study was to describe the experiences of nurses during the process of exploring their values and developing these into a shared vision at both an individual level and as a team. The study supports the benefits of value-based programs and found exploring values led to new perspectives on clinical practice.

Exploring values in nursing: generating new perspectives on clinical practice. Drayton, Nicola and Weston, Kathryn,  Australian Journal of Advanced Nursing. 33(1) 2016: 14-22

Mortality Over Regions and Time (MORT) books

The Australian Institute of Health and Welfare has released a new product known as 'Mortality Over Regions and Time' (MORT) Books. These books present national mortality data at the PHN level and also by selected geographical areas, including remoteness area, socioeconomic group and Statistical Area Level 3 (SA3). The analysis includes the leading causes of death and trends over time.
You can access these reports here.

Cancer Mortality Trends

A new report from AIHW presents mortality projections for selected cancers and all cancers combined from 2014 to 2025 based on mortality trends from 1968 to 2013. Cancer death rates have generally decreased over time, with the death rate from all cancers combined decreasing from 199 deaths per 100,000 people in 1968 to 166 per 100,000 in 2013. Between 2014 and 2025 the death rate from all cancers combined is projected to continue an overall downward trend.

Cancer mortality trends and projections: 2014-2025

Patient Safety: a Compendium of Reports

The Lucian Leape Institute of the [US] National Patient Safety Foundation have compiled a compendium of the executive summaries and recommendations from five of their reports as a resource for health care leaders. The five reports are: 

• Shining a Light: Safer Health Care Through Transparency (2015)
• Safety Is Personal: Partnering with Patients and Families for the Safest Care (2014)
• Through the Eyes of the Workforce: Creating Joy, Meaning, and Safer Health Care (2013)
• Order from Chaos: Accelerating Care Integration (2012)
• Unmet Needs: Teaching Physicians to Provide Safe Patient Care (2010)

Transforming Health Care: A Compendium of Reports from the National Patient Safety Foundation’s Lucian Leape Institute. Lucian Leape Institute at the National Patient Safety Foundation, Boston, 2016. http://www.npsf.org/lli/transforming-health-care            

Tackling drug-resistant infections globally

The British Government engaged economist Jim O'Neill to analyse the global issue of antimicrobial resistance (AMR) and propose ways to cope with it internationally from both a social and economic point of view.  O'Neill's independent report, Tackling drug-resistant infections globally: final report and recommendations has recently been released. 

The report first discusses the growing problem of AMR and why action is needed.  It then proposes some ways to curtail unnecessary use and increase the supply of new antimicrobials, before looking at social measures such as public awareness campaigns, improvements in sanitation and hygiene, reducing pollution, improving global surveillance and introducing rapid diagnostics and vaccines. The economic implications of innovation funds, market entry awards and global funding are also examined, as well as ways to build political and international consensus. 

Incidence of insulin-treated diabetes in Australia

Incidence of insulin-treated diabetes in Australia 2014 from the AIHW, presents the latest available national data on new cases of insulin-treated diabetes.  In 2014, nearly 30,000 Australians began using insulin to treat their diabetes. 67% of them had type 2 diabetes, 23% had gestational diabetes and 9% had type 1 diabetes.  63% of people diagnosed with type 1 diabetes were aged under 25, whereas 93% of new cases of insulin-treated type 2 diabetes occurred in those aged over 40.

Also see the AIHW's webpage, How many Australians have diabetes? which prevents the latest diabetes statistics in graphs and an easily downloadable form.

Australian Health Survey: consumption of food groups

Most Australians do not meet the minimum recommended serves for the five major food groups, according to the Australian Health Survey: Consumption of food groups from Australian Dietary Guidelines released recently by the Australian Bureau of Statistics (ABS). The report shows that Australian diets do not conform to the 2013 Australian Dietary Guidelines and its recommendations for vegetables, fruit, dairy products, proteins and grains.  

The 2011-12 National Nutrition and Physical Activity Survey is the basis of the report, which shows that the average serve of vegetables per day is 2.7, as opposed to the 5 recommended serves. Less than 4% of the population consume the minimum recommended daily serves of vegetables and legumes. The report also found that over a third of people’s total daily energy intake comes from ‘discretionary foods’, such as sweetened beverages, alcohol, cakes and sweets.

Suicide in Australia report

Suicide in Australia background information: key facts and analysis  has been released by a collaboration of leaders in suicide and mental health, led by ConNetica and the Brain and Mind Centre at the University of Sydney.  The report provides a statistical, social and economic analysis of suicide over the past decade, including the fact that between 2004 and 2014, there was a 22% increase in the number of suicide deaths in Australia and that intentional self-harm is the leading cause of death for those aged 10-24.

The authors have also released an infographic showing suicides across 28 Federal electorates and a useful website, ​National Action Agenda for Suicide Prevention, includes further data breakdowns by electorate and a call for political parties to explain what they will do about this growing problem.

 

Annual alcohol poll 2016

The Foundation for Alcohol Research and Education has published its Annual alcohol poll 2016: attitudes and behaviours. According to their surveys, 56% of people who drink to get drunk expect to feel happy and 31% expect to feel a sense of social belonging.  The reality is quite different though, as when asked how they actually felt after the last drinking episode, only 28% felt happy and 15% achieved the sense of belonging. Conversely, 29% of drinkers reported feeling tired and 17% were sick after the last time they were drunk, despite predicting much lower responses before the event.

Since the 2015 poll, there has been an increase in the proportion of people surveyed who believe that Australia has a problem with alcohol - up from 75% to 78%.  29% of Australians reported that they have been affected by alcohol-related violence, and 23% of parents with a child under 18 reported that their child had been harmed or put at risk of harm because of someone else’s drinking.

Unfulfilled promise of antidepressant medications

An article recently published in the Medical Journal of Australia asserts that antidepressants may not be as effective as we thought, especially when used in isolation from other treatments. 

The authors of The unfulfilled promise of the antidepressant medications state, "We need more effective treatments for depression, because current treatments avert less than half of the considerable burden caused by the illness." Despite this, the use of antidepressants in Australia has doubled since the year 2000.  It is suggested that combining the use of antidepressants with psychotherapy and lifestyle modifications is the most useful way to treat moderate to severe depression. 

Christopher G. Davey, Andrew M. Chanen   Med J Aust 2016; 204 (9): 348-350.

doi: 10.5694/mja16.00194 

Breast cancer screening - US Guidelines

The National Guideline Clearinghouse in the US has published a guideline synthesis, Screening for Breast Cancer in Women at Average Risk.  In it they compare two recent guidelines - how they agree and differ, their recommendations, the strength of the evidence they use, how they went about finding that evidence and the benefits and harms both sets of guidelines found in screening for this group of women.

The guidelines examined were:

• American Cancer Society (ACS). Breast cancer screening for women at average risk: 2015 guideline update from the American Cancer Society. JAMA. 2015 Oct 20;314(15):1599-614.  
• U.S. Preventive Services Task Force (USPSTF). Screening for breast cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2016 Feb 16;164(4):279-96.   

State of Australia's Mothers 2016

Save the Children Australia has published a report, State of Australia's Mothers 2016.  Some of the key findings were:

• Mothers in urban cities have better outcomes across all measures, but there are disparities within cities.  For example, in Sydney, infants born in the southwest are twice as likely to die before their first birthday as babies born in the wealthier inner-city North Shore.  
• Mothers in regional and remote areas have poorer health outcomes than city mother, with higher hospitalisation and mortality rates 
• Aboriginal and Torres Strait Islander mothers face  higher mortality rates for themselves and their children. On average, Aboriginal and Torres Strait Islanders are behind non-Aboriginal Australians on almost all typical indicators of wellbeing. 
• Mothers on low incomes have challenges involving keeping their immediate environment healthy and secure, feeding and clothing their children, looking after their health needs and keeping their children in school. 

New guidelines for cosmetic procedures

The Medical Board of Australia has published Guidelines for registered medical practitioners who perform cosmetic medical and surgical procedures. The guidelines come into effect on 31 October 2016 and emphasise a patient-centred approach.

An opinion piece by Merrilyn Walton, Professor of Medical Education (Patient Safety) at the University of Sydney, argues that while these guidelines are welcome, they only address half the problem.  There are still question marks over the use of the title "Cosmetic Surgeon" and the facilities where the surgery is performed.

Australian Burden of Disease Study

The AIHW as published Australian burden of disease study: impact and causes of illness and death in Australia 2011 which compares the impact of nearly 200 diseases and injuries on Australians in terms of living with illness (non-fatal burden) and premature death (fatal burden). 

Most of the burden of disease in 2011 came from chronic diseases, with the five disease groups causing the most burden being cancer, cardiovascular diseases, mental and substance use disorders, musculoskeletal conditions and injuries. Since this analysis was last run in 2003, there has been a 15% reduction overall in fatal burden and a 3.8% reduction in non-fatal burden.

At least 31% of the burden of disease in 2011 was preventable, being due to risk factors such as tobacco use, high body mass, alcohol use, physical inactivity and high blood pressure. There were large inequalities found across socioeconomic groups and remote areas. 

Medical error - the third leading cause of death in the US

This is the title of an analysis article recently published in BMJ. Authors Martin Makery and Michael  Daniel calculated that in 2013, medical errors accounted for 251,454 deaths in the US. This puts this cause of death third, behind heart disease and cancer.  

Medical error is not normally included in statistics on causes of death as it is not recorded on death certificates, The authors call for better reporting and visibility around errors, which would hopefully lead to a more effective response. 

Makary MA, Daniel M. BMJ. 2016;353:i2139.
http://dx.doi.org/10.1136/bmj.i2139

Evolution of diseases

Ebola Virus structure
Maurizio De Angelis, Wellcome Images 

The Conversation has recently published three articles on this topic:

Disease evolution: how new illnesses emerge when we change how we live is by Simon Reid from the University of Queensland.  He looks at Zika virus, Ebola, SARS and other emerging diseases and what we have learned about detecting them and responding to them. 

Disease evolution: the origins of anorexia and how it’s shaped by culture and time, by Dominic Murphy from the University of Sydney, examines the history of anorexia and proposes that its symptoms vary according to historical and cultural context. 

Disease evolution: our long history of fighting viruses - here, Nobel prizewinner Peter Doherty takes a look at the history of viruses as far back as ancient Egypt.  

Climate change and ecology - Peter Doherty

In the latest edition of The Griffith Review, Peter Doherty, the winner of the Nobel prize for Physiology or Medicine in 1996, reflects on the need for ecological stability in order that life-forms continue to thrive.  Doherty's lifelong work has been in understanding the effect of influenza A viruses which cause epidemics and pandemics.  In his essay, Living With Complexity, he talks about the biological consequences of climate change, "... from the effect of ocean warming and acidification on corals and zoo-plankton, to altered bird, fish and insect migration and localisation patterns, to the direct effects of extreme heat on homeothermic animals like us."

"Just as we manage human healthcare in any civilised society, our clear and present responsibility is to manage this planet, our only home, and all its magnificent life forms. Here, of course, we grapple with further levels of extraordinary complexity, especially human behaviour and short-term needs. The challenge is enormous."

The cost of youth homelessness in Australia

The cost of youth homelessness in Australia: research briefing has been prepared by Swinburne Institute for Social Research. It examines the cost of youth homelessness in Australia and outlines the economic and social benefits that could be gained by adopting tailored early intervention strategies and policies.

Youth Homelessness remains a significant social issue in Australia, often driven by family violence. Over one third of the homelessness youth surveyed reported that violence in the home had reached the point where police had to called. Homelessness is associated with a lack of safety, exposure to drugs and alcohol, and the likelihood of greater contact with the criminal justice system. In addition, these people have more health and medical issues than other youth. Half of those surveyed reported that they had been diagnosed with at least one mental health condition.

National Emergency Access Targets - effectiveness

The Deeble Institute for Health Policy Research has published a briefing paper which examines NEAT targets and argues against the use of this financially incentivised process measure on its own. National Emergency Access Target: aiming for the target but what about the goal?, by Katherine Silk, points to a 65% rise in Emergency Department presentations between 2001 and 2011, which led inevitably to increased waiting times, overcrowding and a generally higher risk for patients. 

The paper cites evidence that although NEAT attainment has improved, "hospitals broadly have been unable to achieve the targets particularly for admitted patients, the intended beneficiaries of the policy. NEAT has resulted in increases in hospital admissions ... the NEAT policy at present cannot be considered a complete success."

Latest cancer statistics

The Australian Institute of Health and Welfare has updated its web pages with the latest data, information and trends for 13 cancers, all cancers combined and cancer in Indigenous Australians.  Over time, the number of new cancers has increased, but the chance of survival has increased from 47% in 1983-7 to 67% in 2008-12. Click on the links below to find the information you need:

Human melanoma cell dividing. CC by-nc-nd 4.0

• All Cancers
• Indigenous Australians 
• Bowel cancer
• Breast cancer
• Cervical cancer
• Gynaecological cancer
• Head and neck cancer
• Kidney cancer
• Leukaemia
• Lung cancer
• Lymphoma
• Melanoma 
• Pancreatic cancer
• Prostate cancer
• Uterine cancer

2016 Budget - Health impacts

The Federal Government has handed down its 2016 Budget this week.  How did the health industry fare?  You can see all the details on the Government's Department of Health website, Health Budget 2106-17, with links to fact sheets directed to various stakeholders, such as hospitals, public health, sport, aged care, dental and so on. 

The Australian Indigenous HealthInfoNet has published Information of relevance to Aboriginal and Torres Strait Islander health with a comprehensive set of links to parts of the budget which have implications for indigenous health.

Jennifer Doggett from Croakey has very usefully collated responses to the budget from key health groups in Health budget 2016 - the reaction.  Groups such as the AMA, World Vision, PHAA, NRHA, Alzheimer's Australia and many others all provide their summation of how this budget will affect the people they represent.

Other media coverage include The Conversation's Federal budget 2016: health experts react, compiled by various health academics and Stephen Duckett from the Grattan Institute.  The ABC has a useful interactive graphic of the changes in funding and projections for the future in their article by Sophie Scott, Budget 2016: Medicare Benefits Schedule overhauled. 

Investing in Women's Mental Health

A new paper from The Australian Health Policy Collaboration discusses the extensive evidence that women’s mental health needs are significantly different from those of men. Certain mental illnesses are more prevalent in women, they use mental health services more frequently than men, and they want a broader range of treatment options than are currently available.
The burden of poor mental health among women results in adverse social and economic consequences, including disability, reduced life expectancy, impoverishment of individual women, unemployment, reduced productivity, and increasing costs of healthcare and welfare.

Investing in Women's Mental Health: Strengthening the Foundations for Women, Families and the Australian Economy. Policy Paper No 02-2016. April 2016  

Child protection Australia 2014-15

This report from AIHW contains comprehensive information on state and territory child protection and support services in 2014-15, and on the characteristics of Australian children within the child protection system. This report shows that:

• 151,980 children, a rate of 28.6 per 1,000 children, received child protection services (investigation, care and protection order and/or were in out-of-home care);
• three-quarters (73%) of these children had previously been the subject of an investigation, care and protection order and/or were in out-of-home care;
• Aboriginal and Torres Strait Islander children were 7 times as likely as non-Indigenous children to be receiving child protection services.

AIHW 2016. Child protection Australia 2014–15. Child welfare series no. 63. Cat. no. CWS 57. Canberra: AIHW.         

Children with Cancer: A Guide for Parents

The National Institute of Health in the US has published a booklet to help if your child is diagnosed with cancer. This booklet may help when you are feeling upset and overwhelmed during a challenging time.

Children with Cancer: A Guide for Parents    

Busting the myths about grief

A recent article on the SANE blog looks at misunderstandings around grief. Grief may be a normal part of life, but how people respond to loss is surprisingly misunderstood.  Gina, a Helpline Advisor at SANE has put together a list of the most common myths about grief;
- Grief is a signs of weakness
- It's only felt if a loved one dies
- There's a right and wrong way to grief
- and more...

Busting the myths about grief. Author:  Gina Date: 19/04/2016 

Medical Error- the third leading cause of death in the US

BMJ has recently published an article on death caused medical error and how the number are underestimated. If you ask a group of health professional what are  the top five causes of death, medical error would not be on the list. And that is because in the US the death statistics compiled by the Centers for Disease Control and Prevention (CDC) are compiled using death certificates filled out by physicians, funeral directors, medical examiners and coroners.
But another major limitation of the death certificate is that it relies on assigning an International Classification of Disease (ICD) code to the cause of death. There is no code to capture diagnostic error, poor judgement, communication breakdown or inadequate skill which can directly result in patient harm and death.
"People don't just die from heart attacks and bacteria, they die from system-wide failings and poorly coordinated care," lead author Dr. Martin Makary, a professor of surgery and health policy at Johns Hopkins University School of Medicine," "It's medical care gone awry."
 NSW Health staff can read the full text of the article in BMJ via CIAP otherwise ask your library staff.

• Makary Martin A, Daniel Michael. Medical error—the third leading cause of death in the US BMJ 2016; 353 :i2139