Acute Stroke Clinical Care Standard

Strokes affect thousands of Australians each year and are a major cause of death and disability. About 37000 Australians were admitted to hospital with a stroke in 2012, equating to one stroke every 15 minutes.
The Australian Commission on Safety and Quality in Health Care has developed AcuteStroke - the Case for Improvement to support the implementation of the Acute Stroke ClinicalCare Standard. Designed for a wide audience, including clinicians and health services, the resource highlights what is known about the evidence, best practice and current practice, and the opportunities to bring these closer together.

Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection.

The objectives of the new WHO Guideline on Chronic Hepatitis B aims to:

• To provide guidelines on the on the prevention, care and treatment of persons with chronic hepatitis B virus (HBV) infection – defined as persistence of hepatitis B surface antigen (HBsAg) for six months or more
• To provide a framework for the development or strengthening of hepatitis B treatment programmes in low- and middle-income countries (LMICs) that is also of relevance to some high-income countries
• To complement existing World Health Organization (WHO) guidance on the primary prevention of hepatitis B through both hepatitis B vaccination and by improving blood and injection safety, as well as guidance among persons who inject drugs (PWID) and other vulnerable groups, including those living with human immunodeficiency virus (HIV) infection 

World Health Organization (WHO). Guidelines for the prevention, care and treatment of persons with chronic hepatitis B infection. Geneva (Switzerland): World Health Organization (WHO).

Folic Acid in Bread

Mandatory fortification of bread with folic acid (in Australia) and iodine (in Australia and New Zealand) was introduced in 2009 to address two important public health issues: to reduce the prevalence of neural tube defects  (serious birth defects such as spina bifida) in Australia and to deal with the re-emergence of iodine deficiency in both Australia and New Zealand.

The introduction of the mandatory fortification has resulted in improved health outcomes, particularly for teenagers and Aboriginal and Torres Strait Islander women, according to a new report from the Australian Institute of Health and Welfare (AIHW).

Monitoring the health impacts of mandatory folic acid and iodine fortification 2016. AIHW

Private Hospitals

This publication from the Australian Bureau of Statistics presents statistics about the characteristics and activities of the private hospital component of the Australian hospital sector, collected through the ABS' annual Private Health Establishments Collection (PHEC). This sector consists of private acute and psychiatric hospitals, and free-standing day hospital facilities.

4390.0 - Private Hospitals, Australia, 2014-15 

Medication use by Australia's prisoners

Medication use by Australia's prisoners 2015: how is it different from the general community? is a report from the Australian Institute of Health and Welfare which looked at the 2015 rate and types of medications taken by prisoners, who have poorer health overall than the general population. 

The types of medications where the difference between prisoners and the general community was the greatest were for those medications usually taken for mental health problems, addictions and chronic conditions. Compared with the general community, prisoners were 9 times as likely to be taking antipsychotics, more than twice as likely to be taking antidepressants or mood stabilisers, and 4 times as likely to be taking medications used in addictive disorders. Medications for high blood pressure, high cholesterol, asthma and diabetes were also taken by a higher proportion of prisoners than the general community.

The differences in prison prescribing practices was also examined. Prisoners have limited access to over-the-counter medications, and are usually not allowed to keep medications in their possession, so some medications that may be purchased without prescription in the community are likely to be prescribed in prison. The choice of prescribed medications may also be influenced by security considerations.

Dementia in My Family - website

Alzheimer's Australia has launched a new website specifically for young people dealing with Dementia in a family member.

Dementia in My Family provides age-specific information for children in several age-groups from pre-schoolers (with an animated story) to late teens (who are provided with more complex information and links to counselling services).  It also has a page for adults on how to talk to children about Dementia.  There are also some very useful links to websites, online books, fact sheets and contacts.

Making sense of the privatisation debate

Stephen Duckett from the Grattan Institute has authored an article in The Conversation which attempts to explain the current pre-election debate surrounding Medicare. Is Medicare under threat? Making sense of the privatisation debate cuts through the political rhetoric arguing that the Medicare system certainly needs to be modernised, as suggested by the Coalition, but privatising funding sources would be problematic.

mHealth Technologies for Chronic Disease Prevention and Management

mHealth is an abbreviation for mobile health, a term used for the practice of medicine and public health supported by mobile devices. This review examines the evidence regarding the benefits, uptake and operationalisation of mHealth technologies (including short messaging services (SMS), mobile apps and wearable devices) for chronic disease management and prevention. The review found mHealth interventions can promote significant improvements in glycaemic control (for diabetes patients), as well as in physical activity, weight loss and smoking cessation, with the strongest evidence for SMS. Benefits appeared to be mediated by the characteristics of both the intervention and the patient population. Integrating mHealth technologies into healthcare as part of a service rather than a standalone system was as an important marker of success.

mHealth Technologies for Chronic Disease Prevention and Management, 2015. L Laranjo, A Lau, B Oldenburg, E Gabarron, A O’Neill et al. Sax Institute  

Concussion in Sport

There is an elevated public awareness of sport-related concussion in the last few years and increased focus on the importance of diagnosing and managing the condition promptly, safely and appropriately. There has also been concern over the possible long-term consequences of recurrent concussion.
Sport administrators, medical practitioners, coaches, parents and athletes are seeking information regarding the timely recognition and appropriate management of sport-related concussion.
Funded by the Australian Government, this AIS/AMA Position Statement on Concussion in Sport brings together evidence-based information and presents it in a format that is appropriate for all stakeholders. The AIS and AMA seek to ensure that all members of the public have rapid access to information to increase their understanding of sport-related concussion and to assist in the delivery of best practice medical care.
AIS/AMA Position Statement on Concussion in Sport. Australian Institute of Sport/ Australian Medical Association, 2016

Bullying and Harassment in the Health Sector

Inappropriate behaviour including bullying and harassment have significant consequences—for individuals, patients and health sector agencies. This audit from the Victorian Auditor-General's Department focused on the effectiveness of the health sector in preventing and responding to inappropriate behaviour including bullying and harassment. 
The audit found that insufficient priority and accountability is given to worker safety in the health sector. Health sector agencies are struggling to effectively manage or prevent bullying and harassment with  staff consistently reporting that there is a culture of accepting OHS risk, and the controls in place are often ineffective and inconsistent. 
Bullying and Harassment in the Health Sector. Victorian Auditor-General's Report. 2016. PP No 148, Session 2014–16

How Australians die - series of articles

Last week, The Conversation published a series of articles about the leading causes of death in Australia: How Australians Die.

How Australians Die: cause #1 – heart diseases and stroke was written by Garry Jennings from the Baker IDI Heart & Diabetes Institute.  Here, the global implications of heart disease are also discussed, with most of the recent huge increase occurring in developing countries. 

How Australians Die: cause #2 – cancers by Terry Slevin, Cancer Council Australia and Andrew Redfern, UWS, looks at the seven cancer types that are in the top 20 causes of death in Australia. 

How Australians Die: cause #3 - dementia (Alzheimer's) is by Siva Purushothuman, Neuroscience Research Australia. With Australia's aging population, the number of people with dementia, and dying from it, is on the rise.

How Australians Die: cause #4 – chronic lower respiratory diseases was written by Stephen Milne from the University of Sydney.  He compares the lung to an upside-down tree where the wind pipe is the trunk and the bronchi are the branches. Chronic lower respiratory diseases affect these branches.

How Australians Die: cause #5 – diabetes was the final article, from Merlin Thomas and Paul Zimmet from Baker IDI Heart & Diabetes Institute. Not only is diabetes is a leading cause of death in Australia, but it also causes other conditions which can lead to premature death, such as heart attacks, strokes, amputations, kidney failure, depression and severe infections.

Antimicrobial Use and Resistance in Australia (AURA) 2016

The Australian Commission on Safety and Quality in Health Care (the Commission) has released a important report outlining the most comprehensive picture of antimicrobial resistance, antimicrobial use and appropriateness of prescribing in Australia to date. Antimicrobial Use and Resistance in Australia (AURA) 2016: First Australian report on antimicrobial use and resistance in human health highlights antimicrobial use and resistance as a critical and immediate challenge to health systems in Australia and around the world. 

AURA 2016 contains valuable data on antimicrobial use in the community, hospitals and residential aged care facilities; key emerging issues for antimicrobial resistance; and a comparison of Australia’s situation with other countries.

AntimicrobialUse and Resistance in Australia (AURA) 2016: First Australian report onantimicrobial use and resistance in human health.   

Speak Up: Easier to Say than Do

Have you ever made a mistake? This short article in the open access Journal of Perioperative & Critical Intensive Care Nursing states that hospitals are no strangers to mistakes either,  In fact, it is well known that errors occur regularly which can lead to patient harm and unnecessary financial costs borne by the healthcare system. By upholding the expectation that nurses speak up, organizations can improve patient safety. Factors such as leaders who are good role models and organizations that reward speaking up can be built upon to strengthen a hospital’s culture of safety.

2016. Speak Up: Easier to Say than Do, Nicole Hall.  Journal of Perioperative & Critical Intensive Care Nursing. doi:10.4172/jpcic.1000111

Helicobacter Pylori Infection

Helicobacter pylori infection is a major cause of morbidity and mortality worldwide and infection invariably causes active chronic gastritis. In many people this may be clinically silent throughout life, but in a significant minority it results in gastroduodenal diseases, especially peptic ulcer disease, non-cardia gastric cancer and gastric mucosa-associated lymphoid tissue (MALT) lymphoma.

The major determinant of successful eradication is the presence or absence of pre-treatment antimicrobial resistance. In Australia, three evidence-based options for second-line therapy have been evaluated and are presented in this article from this recent issue of the  Medical Journal of Australia.

2016. Epidemiology, clinical impacts and current clinical management of Helicobacter pylori infection, Hazel Mitchell and Peter Katelaris, Med J Aust; 204 (10): 376-380. 

Alcohol and other drug treatment services in Australia 2014-15

New data in the report Alcohol and other drugs treatment services in Australia, 2014–15, show that about 115,000 clients received more than 170,000 treatment episodes over the year from 843 agencies across Australia. While alcohol (38%) continued to be the main drug clients sought treatment for, amphetamine treatment doubled from 9% to 20% between 2010–11 and 2014–15.

The majority of clients received treatment in a non-residential facility, such as a community health centre. The most common types of treatment included counselling, assessment and withdrawal management, with counselling accounting for 2 in 5 treatment episodes.

Alcohol and other drug treatment services in Australia 2014–15. AIHW. Cat. no. HSE 173; 93pp.

ANZAAG Anaphylaxis Management Guidelines

Recently the second edition of the ANZAAG/ANZCA Anaphylaxis Management Guidelines were published. The key changes to the guidelines are:

1. The development of two paediatric cards to cover the immediate and refractory management of anaphylaxis in children. This allows for age specific recommendations and simplifies information on the adult cards;
2. Introduction of cardiac arrest recommendations at the top of the immediate management cards; 
3. Increased emphasis on rapid, large volume fluid resuscitation; 
4. Changing the diagnostic card to the differential diagnosis card and making it an action checklist rather than a textbook differential diagnosis list; 
5. Emphasis on the cessation/removal of possible triggers; 
6. Changing the drug name adrenaline to adrenaline (epinephrine).

These guidelines from the Australian and New Zealand College of Anaesthetists (ANZCA) and

Australian and New Zealand Anaesthetic Allergy Group (ANZAAG) are freely available to download. Diagnosis and Management Cards are also provided.

ANZAAG Anaphylaxis Management Guidelines

Guidelines for the diagnosis and treatment of acute and chronic heart failure

The European Society of Cardiology (ESC) has recently published new guidelines on heart failure, 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure was developed with the special contribution of the Heart Failure Association (HFA) of the ESC.

Alzheimer's awareness - free research articles

To raise awareness about Alzheimer’s Disease, Wiley Online has created a free research collection focusing on four aspects of the condition: risk factors, diagnosis, therapy and treatment and caregiving. The collection comprises 15 freely available articles.

Alzheimer's: Risk | Diagnosis | Therapy & Treatment | Caregiving. 2016  

Nursing and midwifery workforce 2015

Another health workforce report from the AIHW has been published: Nursing and midwifery workforce 2015.  The total number of all nurses and midwives registered in Australia increased from 330,680 in 2011 to 360,008 in 2015 (8.9%).  

In both 2011 and 2015, there were more employed nurses and midwives in the 50-54 year age group than any other age group, and in 2015 89% of employed nurses and midwives were female. Click on the right hand menu for more detailed information. 

Medicinal cannabis in Australia: the missing links

"Cultivation of cannabis for medicinal or scientific purposes needs considered management before it is rolled out as a therapeutic good" is the considered opinion of the authors of this paper in the Medical Journal of Australia. Community attitudes around cannabis as a medicine have changed recently both locally and internationally.  For example, since this time last year, 23 US states have legalised marijuana in some form.

The use of cannabis for medicinal purposes needs to be "regulated in a way that enables suitable provision to those who may benefit"conclude the authors. One of them, Jennifer Martin, was interviewed on ABC Radio's World Today about this article and she emphasised how important it is to educate the public about what medical cannabis actually is, before it's rolled out for therapeutic use.

Listen to the radio interview or read the transcrip here.

Medicinal cannabis in Australia: the missing links by Jennifer H. Martin & Yvonne A. Bonomo, (2016). Medical Journal of Australia 204(10):371-3. DOI:10.5694/mja16.00234

Evolution of breast cancer treatment

Breast cancer treatment has changed enormously since the 1950s.  In this Conversation article by Nicholas Wilcken (University of Sydney Associate Professor and Co-ordinating Editor of the Cochrane Breast Cancer Group), we are linked to the latest studies and data showing: More effective and less invasive: how breast cancer treatment has evolved since the 1950s.

Today we realise that higher doses of chemotherapy do not necessarily improve the prognosis of those with breast cancer, and a more individual approach is taken. Drugs have improved and fewer people are dying from the disease.

Improving the physical health of people with mental health problems

Published by the UK Department of Health, this guide is aimed at mental health nurses and focuses on how to deal with some of the main risk factors for physical health problems.  It emphasises the need for people living with mental health problems to have the same access to health checks and healthcare as the rest of the population.

The guide looks specifically at how to take action in supporting patients with quitting smoking, tackling obesity, improving physical activity levels, reducing alcohol and substance use, sexual and reproductive health, medicine optimisation, dental and oral health and reducing falls.

Improving the physical health of people with mental health problems: Actions for mental health nurses. Department of Health (UK) London: Department of Health; 2016.

Eye Health Workforce in Australia

The Australian Bureau of Statistics National Health Survey in 2011-12 revealed that almost 12 million Australians (54% of the total population) reported having one or more long-term eye condition. Eye health workforce in Australia is a report from the Australian Institute of Health and Welfare, which presents the latest available data on the eye health workforce in Australia.  In 2011 there were over 800 ophthalmologists, around 4,000 optometrists and over 6,000 allied ophthalmic personnel (orthoptists, optical dispensers, optical mechanics, orientation and mobility specialists and occupational therapists specialising in eye health) in the eye health workforce.

Of the different eye health workers, ophthalmologists had the lowest proportion of females, at 17.4%. followed by optical mechanics, with one-third (32.9%) being female. Around half (47.8%) of all optometrists were female and the other occupations were mostly female. 78% of the eye health workforce worked in major cities.