Non-beneficial treatments at the end of life

A literature review was recently published in the International Journal for Quality in Health Care, Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem. Across the 38 studies from 10 countries (including two from Australia), 33-38% of palliative patients had received non-beneficial treatment, that is a treatment that was given with little or no hope of benefit.

The most commonly reported non-beneficial treatments were admissions to ICU for patients with advanced incurable disease, CPR for terminal patients, and the initiation or continuation of chemotherapy in the last 2-4 weeks of life.  The authors concluded that this problem "has been recognized for at least two decades and it remains today despite much literature about its negative repercussions for patients, families, healthcare professionals and the health system."

M Cardona-Morrell, JCH Kim, RM Turner, M Anstey, IA Mitchell, K Hillman
International Journal for Quality in Health Care. 2016. http://dx.doi.org/10.1093/intqhc/mzw060

2015 Regional Wellbeing Survey

Wellbeing, resilience and liveability in rural and regional Australia: the 2015 Regional Wellbeing Survey has been recently published by the University of Canberra.  This survey of over 12,000 respondents living outside Australia's major cities, revelead that 70% of rural and regional Australians are satisfied with their lives and feel the things they do in life are worthwhile. On the other hand, that means that 30% do not feel satisfied with their lives. "This suggests that rural and regional communities are supporting the wellbeing of most, but not all, of their residents."

There are many details in the report about health, financial prosperity, the need to relocate, facilities and isolation issues.

Schirmer, J.; Yabsley, B.; Mylek, M. and Peel, D. 2016. Wellbeing, resilience and liveability in regional Australia: The 2015 Regional Wellbeing Survey. University of Canberra, Canberra.

The economic burden of physical inactivity

Researchers from the University of Sydney have calculated that physical inactivity cost the world 90 billion Australian dollars in 2013 and they have published their findings in The Lancet. The cost burden of several lifestyle diseases on health budgets and the cost of premature death due directly to physical inactivity were analysed for 142 countries, representing 93.2% of the world's population. The high income countries bear a larger proportion of this economic burden, and the lower income countries have a higher proportion of the disease burden.

Author Dr Melody Ding and her colleagues conclude, "In addition to morbidity and premature mortality, physical inactivity is responsible for a substantial economic burden. This paper provides further justification to prioritise promotion of regular physical activity worldwide as part of a comprehensive strategy to reduce non-communicable diseases."

The economic burden of physical inactivity: a global analysis of major non-communicable diseases The Lancet Available online 28 July 2016.  doi:10.1016/S0140-6736(16)30383-X

For an accessible summary, see today's ABC's story, Physical inactivity costs world billions of dollars, Sydney University study finds

Does nurses’ health affect their intention to remain in their current position?

An online survey of health and work-related assessments was distributed through the New South Wales Nurses and Midwives Association and professional contacts between June 2014 and February 2015. Results showed that nurses and midwives reported good-very good health overall. With 22.2% intending to leave in the next 12 months, the study findings flagged the importance of health as an influence on intention to leave. Alongside job satisfaction and shift-working, health presents opportunities for workplace initiatives to maintain nurses in the workforce.

 Perry, Lin,  Gallagher, Robyn,  Duffield, Christine, Sibbritt, David, Bichel-Findlay, Jen, Nicholls, Rachel. (2016).  Does nurses’ health affect their intention to remain in their current position? Journal of Nursing Management, DOI: 10.1111/jonm.12412 (early online view, Open Access)

Diabetes Standards and Guidelines

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 Guideline NG17 Type 1 diabetes in adults: diagnosis and management  https://www.nice.org.uk/guidance/ng17
• NICE Guideline NG28 Type 2 diabetes in adults: management  https://www.nice.org.uk/guidance/ng28
• NICE Quality Standard QS125 Diabetes in children and young people  https://www.nice.org.uk/guidance/qs125   

Self Managing Chronic Pain

The Pharmacy Guild of Australia and Painaustralia have produced a joint fact sheet to assist people suffering from chronic pain. You can download this fact sheet and numerous others on the Painaustralia website.    

Perils of Place: Identifying Hotspots of Health Inequality

Stephen Duckett has authored a new report published by the Grattan Institute. The report titled "Perils of Place: Identifying Hotspots of Health Inequality", looks a the unfair, unnecessary and avoidable inequalities throughout the population in Australia.
In the report health inequalities are defined, with the outcome measure being potentially preventable hospitalisations. An overview of the methodology for identifying and prioritising hotspots of health inequalities is provided and specific options for reducing these hospitalisations and recommendations are listed.

You can choose to download the report or listen to a podcast of Stephen Duckett talking about the report here.  

Skin cancer in Australia

Skin cancer accounts for the largest number of cancers diagnosed in Australia each year. This year it is estimated that over 13,000 new cases of melanoma will be diagnosed in Australia, and approximately 1,700 people will die from this disease. Skin Cancer in Australia has been published by the Australian Institute of Health and Welfare and provides comprehensive national information and statistics on skin cancer, with estimates to 2016 and trends over time.  

Although the incidence of melanoma has increased over the last thirty years, for people under 40 years of age, the incidence has dropped since 2002.  In 2013–14, there were 23,437 melanoma-related hospitalisations in Australia, a 63% rise from 2002–03.

Delirium Clinical Care Standard

About 10% of Australians aged over 70 years have delirium at the time of admission to hospital, and a further 8% develop delirium during a hospital admission. Despite delirium being so common, the condition is poorly recognised.  The Australian Commission on Safety and Quality in Health Care has developed the Delirium Clinical Care Standard and supplementary resources to guide and support its implementation.

The standard aims to ensure that patients presenting to hospital with delirium receive optimal treatment, and that patients at risk of delirium are identified promptly with preventative strategies put in place. Additional resources include an Indicator Specification, fact sheets for clinicians and consumers, and a list of supporting evidence sources.

US Health care reform - Barack Obama

The US President, Barack Obama, has published an article in the Journal of the American Medical Association (JAMA) to explain his health reform package. United States Health Care Reform: Progress to Date and Next Steps reviews the Affordable Care Act, looking at its effects so far and recommend further improvements.

Unsurprisingly, Obama finds much evidence to support his reform policy and urges increased federal funding in the sector as well as a reduction of prescription drug costs. "Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges."

JAMA. Published online July 11, 2016. doi:10.1001/jama.2016.9797

New hypertension guideline

The National Heart Foundation of Australia has this week released Guideline for the diagnosis and management of hypertension in adults 2016.  There are several changes since the last update in 2010, including both a primary and secondary prevention focus "in the context of an ageing population with increasing complexities", and one area of change is a new lower pressure target of 120mmHg in selected high cardiovascular risk populations.

Brett Montgomery of the University of Western Australia has written an explanatory piece in The Conversation, Blood pressure targets – what does the new guideline say and how low should you go? Here, he explains the evidence behind the new target and why it's not for everyone.

Mental health care at University

The uni virtual clinic (UVC) has been established as a comprehensive online service developed in partnership between the Centre for Mental Health Research at the Australian National University and the Young and Well Cooperative Research Centre.  It has been designed to prevent and treat mental health problems and related issues in university students as an anonymous, free service, incorporating evidence-based treatments and information. 

The uni virtual clinic: changing the way mental health care is provided to young people at university has been published after the completion of a pilot version at ANU and outlines the argument for extending the UVC program across Australian Universities.

According to the report, half of all university students will experience a mental disorder and one in ten will contemplate suicide.  Only a third of young people seek help for mental health problems and this figure is even lower among university students.  Making this program anonymous is one way of increasing help-seeking in this vulnerable group.

Complex multimorbidity in Australia

This research published in the Australian & New Zealand Journal of Public Health used a random sample of 8707 patients visiting 290 general practitioners to measure the prevalence of multimorbidity and complex multimorbidity in the Australian population and to identify the most prevalent patterns of chronic conditions and body systems affected. 

The authors of The prevalence of complex multimorbidity in Australia estimate that 47.4% of patients at GP encounters and one-third of the population had multimorbidity, with 27.4% of patients at GP encounters and 17% of the Australian population experiencing complex multimorbidity. The most prevalent combination of conditions was hypertension with hyperlipidaemia and osteoarthritis, and the most prevalent combination of body systems was circulatory, musculoskeletal and endocrine/nutritional/metabolic systems. "To meet the challenge posed by complex multimorbidity, the single disease focus of our healthcare system needs to be re-evaluated."

Harrison, C., Henderson, J., Miller, G., Britt, H. The prevalence of complex multimorbidity in Australia.Aust N Z J Public Health. 2016 Jun;40(3):239-44. doi: 10.1111/1753-6405.12509  

Know your bones - self assessment tool

'Know your bones' is a bone health self-assessment tool created by Osteoporosis Australia and the Garvan Institute of Medical Research.  Its aim is to help adults assess their likelihood of fractures, given that 7,5 million Australians have osteopenia or osteoporosis, and new figures reveal a bone break every 3.4 minutes in Australia due to poor bone health. 

The online tool includes demographic questions, medical history and lifestyle factors. A summary of risk of fracture over the next five and 10 years is provided for people over 50 years of age.

Elder abuse issues paper

Earlier this year, the Australian Law Reform Commission (ARLC) was directed by the Attorney-General to identify a legal framework to protect older people from physical and psychological abuse in Australia.  The Elder Abuse: Issues paper is the first consultation document in the Inquiry. It introduces the scope of the issues involved and requests submissions from stakeholders.   

For more information, you can listen to the Elder Abuse issues paper podcast.  Here, Sabina Wynn, (Executive Director of the ALRC), interviews Professor Rosalind Croucher, President of the ALRC, and the Commissioner who is leading the Inquiry about the growing problem of elder abuse in our communities and why this Inquiry is so necessary.

Back problems and associated comorbidities

Three million Australians suffer from back problems, and two in five of those people report that it limits their activity. The Australian Institute of Health and Welfare has released a report highlighting the various chronic diseases that people with back problems frequently experience.  Back problems, associated comorbidities and risk factors includes the conditions of cardiovascular disease, arthritis, mental health problems, asthma, diabetes, chronic obstructive pulmonary disease (COPD), and cancer.  It also looks at the risk factors of smoking, physical activity, and overweight and obesity. 

The report found that 2 out of 3 Australians with back problems reported having at least one other chronic condition, with arthritis being the most common comorbidity, followed by cardiovascular disease and mental health problems.  People with back problems were more likely to report being obese (32.6%) than people without back problems (26.6%).

Munchausen by Internet

Munchausen by internet: What drives people to fake an illness online? is a story that was reported on the ABC this week about a new form of this much-reported syndrome. The Health Report on Radio National included an interview with Professor Marc Feldman, a clinical professor of psychiatry at the University of Alabama and "the world's foremost authority on Munchausen syndrome".  He discussed the phenomenom of Munchausen and how the Internet version has been so gratifying for sufferers.  Professor Feldman also said it was very difficult to treat the condition.

Also interviewed on the Health Report was Taryn Harper Wright, a "Hoax Hunter", who has exposed many people who seek to elicit sympathy for fake tragedies on Facebook and other social media sites. A particularly interesting case was of Dana Dirr, who was a surgeon, pregnant and mother of eleven children, allegedly killed in a car crash one mother's day.  The husband's Facebook posts elicited thousands of sympathetic responses, but the whole story was eventually exposed as false.

You can listen to the interviews on the Health Report, or read the transcript here.

Patients as partners

This publication from the UK’s King’s Fund looked at how patients can be partners in their healthcare and the healthcare system. The author examined the question of what helps to build collaborative relationships among health and care professionals, patients, service users, carers and communities.

The report suggests five approaches to developing an effective relationship: 

• find your collaborative partner(s)
• invest in developing leadership and collaborative relationships
• make time for learning and share that learning
• go where the energy is
• embed collaborative activity at all levels in your system or organisation.

Patients as partners: Building collaborativerelationships among professionals, patients, carers and communities/ Seale B. London: The King's Fund; 2016. 

Black lung disease

A disease that was thought to be eradicated over 30 years ago has recently been diagnosed in four Queensland miners in one week, a recent ABC news report stated. Queensland's mining companies are offering for workers to have new X-rays taken and to have existing X-rays re-read. Ten people in Queensland have now been diagnosed with the disease in the past year.

A recent article in the Medical Journal of Australia looks at Coal Workers’ Pneumoconiosis (CWP), this untreatable but preventable lung disease arising from chronic inhalation of coal dust.

Coal workers’ pneumoconiosis: an Australian perspective. Graeme R Zosky, Ryan F Hoy, Elizabeth J Silverstone, Fraser J Brims, Susan Miles, Anthony R Johnson, Peter G Gibson and Deborah H Yates, Med J Aust ; 204 (11): 414-418.

Nurses and Professional 'Silos"

This article looks at a healthcare experience through a different lens, from that of a healthcare professional entering hospital as a patient.

As healthcare providers we each work within our specific area of expertise or what may be referred to as our “silo.” Each silo is rich in research, knowledge, experience, and expertise regarding best practices for quality patient care. Each silo also assumes that the other healthcare silos always know, respect, understand, and implement their expert advice and wisdom. However, after this 21-plus day experience as a patient’s family member, not as the healthcare provider, it was perceived that each of the wide array of health care “silos” work alone and are not in collaboration with each other. In addition to the fragmentation, there is no unifying body pulling all the parts together to create this individualized quality healthcare experience so often discussed in not only the literature, but also in every healthcare system’s mission statement. Is it the nurse’s responsibility to ensure that quality patient/family centered care is provided by knocking down these silos and unifying care?

Nurses Must Knock Down Professional "Silos" and Create Quality, Safe and Effective Interprofessional Teams. From the Inside Looking Out: A Healthcare Providers Experience Being the Family Member. Journal of Nursing & Care, 5(3). 

Intercostal Catheter Insertion Video

The Intensive Care Network (ICN) has been developed to educate, link and stimulate healthcare professionals involved in critical care. It has recently added a new procedural video from SMACC Chicago " Intercostal Catheter Insertion". Check out the rest of their site for more resources, exam help and podcasts.

Click here to see the video.

Use of medicines by older people with type 2 diabetes

This report from the Australian Institute of Health and Welfare examines the pharmacological management of type 2 diabetes in older Australians using linked data from the Pharmaceutical Benefits Scheme and the National Diabetes Services Scheme. It explores, by age and time since diabetes diagnosis, supply patterns of blood glucose lowering medicines, blood pressure lowering and blood lipid modifying agents, and selected medicines for mental health and eye diseases.

Use of medicines by older people with type 2 diabetes. AIHW July 2016, Cat. no. CVD 76