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

Incidence of end-stage kidney disease in Australia

End-stage kidney disease is the most severe form of kidney disease and survival usually relies on kidney replacement therapy.  The incidence of the condition is an important indicator of the health of the Australian population and valuable for health-care planning. 

This report from the AIHW estimates that in 2013 there were around 5100 new cases of ESKD in Australia, and only around half of these people were receiving kidney replacement therapy.  The incidence rate of ESKD was 5 times as high in indigenous as non-indigenous Australians from 2009-2013. There are more males than females with ESKD, and the incidence is highest among those aged 75 and over. 

Incidence of end-stage kidney disease in Australia 1997-2013 AIHW October 2016 Cat no. PHE 211

Performing the wrong procedure

Performing the Wrong Procedure is the first article in a new section of JAMA concentrating on performance improvement. This is a case report about a 90-year-old woman ho had a dialysis catheter mistakenly placed instead of a normal central line for antibiotic administration. Various options to correct the error are presented with a root cause analysis and the final outcomes of the case.

Minnier T, Phrampus P, Waddell L. Journal of the American Medical Association. 2016;316(11):1207-8. http://dx.doi.org/10.1001/jama.2016.9134  Access the full text via CIAP if you are an employee of NSW Health.

Misconceptions on ageing and health

The World Health Organisation has published a fact file on Misconceptions on ageing and health with the aim of overcoming some of the most important barriers to developing good public policy on ageing.  Stereotyping and accompanying ageism is addressed, with ten facts about older people which are commonly misunderstood. These include the facts that only a small proportion of older people are care dependent, 70 is not yet the new 60 and expenditure on older populations is an investment, not a cost.

Tobacco indicators - midpoint progress

This report presents the progress being made against the National Tobacco Strategy 2012-2018 indicators. Most indicators are showing a favourable progress, particularly for exposure to tobacco smoke, uptake of smoking, transition to established smoking and regular smoking among young people, adults and Aboriginal and Torres Strait Islander people. However, some groups achieved greater progress than others, and inequalities within particular groups increased for some indicators.

Tobacco indicators: measuring midpoint progress - reporting under the National Tobacco Strategy 2012–2018. Drug statistics series no.30, AIHW 29 September 2016

Informed consent or shared decision-making

When patient-centred care is worth doing well: informed consent or shared decision-making is an editorial from BMJ Quality & Safety which looks at the interactions and differences between informed consent and shared decision making (SDM) in aiming for patient-centred care. 

The authors describe informed consent as being the minimum legal standard where clinicians tell the patient about the procedure, including risks, benefits and possible alternatives, then the patient accepts or rejects this. SDM is presented here as a more evolved response to the need for patient centeredness. "We must not confuse SDM with the distribution of decision aids or patient education materials for patients, expecting patients to find the best answer on their own: there is nothing shared about choosing alone from a menu!"

Kunneman M, Montori VM. BMJ Quality & Safety. 2016 [epub] http://dx.doi.org/10.1136/bmjqs-2016-005969