BMJ Christmas issue

It's always fun at this time of year to have a look at the more lighthearted issue BMJ puts out each Christmas.  This year's offerings include:

• Open toe sandals syndrome which looks at seasonal variation in foot infections in the summer in southern England.
• Gotta catch’em all! Pokémon GO and physical activity among young adults: difference in differences study - which demonstrated that people playing Pokemon GO did show an increase in the number of steps they took in the first few weeks, but that the effect petered out. 
• Is caviar a risk factor for being a millionaire? - which is really a study on what is actually meant by "risk factor". 
• Sniffing out significant “Pee values”: genome wide association study of asparagus anosmia  - not everyone has this smell, apparently...  
• Dispelling the nice or naughty myth: retrospective observational study of Santa Claus - which has as its objective "To determine which factors influence whether Santa Claus will visit children in hospital on Christmas Day".  Sadly, it seems that socioeconomic factors play a greater role in the appearance of Santa than does the children's behaviour.

Top ten most discussed journal articles of 2016

Altmetrics tracks mentions of scientific journal articles in news stories, blog posts, tweets, Facebook and other social media sites, in order to establish the wider "impact" of scientific literature outside academia. They have published their Top 100 articles for 2016, which includes a large number of health articles (with links):

• Number one is Barak Obama's article in JAMA on US health care reform
• Number two is an article in BMJ, about medical error being the third leading cause of death in the US
• Number five is another JAMA article about the sugar industry and coronary heart disease
• Number six was from NEJM about Zika Virus and birth defects
• Number seven, again from JAMA, was related to the association between income and life expectancy in the US

Elective surgery waiting times 2015-16

In 2015–16 almost 712,000 patients were admitted to Australian public hospitals from elective surgery waiting lists, either as elective or emergency admission, according to this report from the AIHW, Elective Surgery Waiting Times 2015-16: Australian hospiital statistics

Admissions from public hospital elective surgery waiting lists has increased by 2.4% on average each year since 2011. The most common surgical specialties for admitted patients were General surgery and Orthopaedic surgery, accounting for 38%. The most common surgical procedure for admissions from public hospital elective surgery waiting lists was Cataract extraction.

Between 2011–12 and 2015–16 (excluding the Australian Capital Territory), the overall median waiting time was relatively stable and was 37 days in the most recent report.  

Boating and watercraft drowning deaths

The Royal Life Saving Society has just released the report, Boating and watercraft drowning deaths: 10 year analysis report, which shows that 473 people drown in Australian waterways between 2005 and 2015,

Males accounted for 92% of all boating and watercraft related drowning deaths, even higher than the annual percentage of all male drowning deaths (83%) for 2015/16,  Almost one fifth of boating and watercraft drowning deaths (19%) occurred in people over the age of 65 years. Drowning occurred whilst fishing (28%) and when moving (27%), and most often in small powered boats under 5 meters or paddle craft. The study found that only 8% of people were wearing a lifejacket at the time of death, 31% had consumed drugs, of which 31% were illegal drugs; 26% of people had alcohol in their system, with 59% above the legal driving limit.

Fixing rural and remote health

This National Press Club Address, Fixing Rural and Remote Health, outlined key reform priorities in rural and remote health, including the need for greater fairness for the seven million people who live in rural and remote Australia. If disparities in health outcomes between people from rural and remote areas and people from cities can be addressed, there is potential for increased productivity and economic growth.

The speakers on November 22 were Geri Malone, Chair of the National Rural Health Alliance; Janine Mohamed, CEO of the Congress of Aboriginal and Torrs Strait Islander Nurses and Midwives; and Martin Laverty, CEO of the Royal Flying Doctor Service of Australia.

Healthy Communities - Obesity and smoking rates in Australia

Two new reports from the Healthy Communities series have been released by the Australian Government.  Both are well-illustrated with infographics and easily accessible.

Healthy communities: overweight and obesity rates across Australia, 2014-15 presents local rates of overweight and obesity by Primary Health Network areas, which in 2014-15 ranged from 53% in Northern Sydney to 73% in Country South Australia. There were higher rates for people in regional areas than in cities.  

Healthy communities: Tobacco smoking rates across Australia 2014-15 shows that although national smoking rates have been steadily declining in recent years, there are some local areas where smoking rates remain relatively high. In 2014-15, daily smoking rates ranged from 5% in Northern Sydney to 23% in Western NSW and that regional PHN areas generally had higher smoking rates than metropolitan PHN areas. Across Australia in that period, 14.5% of adults smoke daily.

Management of multimorbidity and polypharmacy in Australia

Published recently in the journal Age and Ageing, this Australian qualitative research aimed to explore the overall healthcare team implementation of best practice for patients with multimorbidity and polypharmacy.  Most of the health care professionals interviewed "did not routinely use structured approaches to incorporate patients’ preferences in clinical decision-making, address conflicting prescriber advice, assess patients’ adherence to treatment plans or seek to optimise care plans".  The authors conclude that there are extensive shortcomings in team-based care for the management of these patients and suggest that delegating coordination to specific health care professionals may support their overall care.

McNamara, K.P. et al. (2016). Health professional perspectives on the management of multimorbidity and polypharmacy for older patients in Australia. Age and Ageing, DOI:10.1093/ageing/afw200   

Consumer companion guide to dementia care

Alzheimer's Australia launched its Consumer Companion Guide: Diagnosis, treatment and care for people with dementia last month.  It lays out the level of care that people with dementia and their carers and families should expect, and is based on the Clinical Practice Guidelines and Principles of Care for People with Dementia that were developed earlier in the year. 

Both documents were produced in a collaborative project between people living with dementia, carers, researchers and clinicians that was funded by the National Health and Medical Research Council's (NHMRC) Cognitive Decline Partnership Centre.

Suicide in the Australian Defence Force

In response to public interest and concern about the incidence of suicide in Australian Defence Force (ADF) personnel, the Australian Institute of Health and Welfare has published this fact sheet: Incidence of suicide among serving and ex-serving Australian Defence Force personnel 2001-2014.

The data shows that between 2001 and 2014, there were 292 suicide deaths of people who had served with the ADF.  Of these, 84 were serving full-time, and 272 were men.  Comparing the men with all Australian men, this was lower for men serving full-time or in the reserve, and higher than the general population for ex-serving men.

Youth survey report

Almost 22,000 peope aged between 15 and 19 completed this survey from Mission Australia. Compared to previous surveys, more young people are reporting concerns about drugs and alcohol, mental health issues and discrimination. The leading causes of discrimination concerns were gender and race/cultural background.

The Youth Survey Report 2016 was consistent with previous years in that young people nominated coping with stress, school or study problems and body image as their top three issues of personal concern.  Catherine Yeomans, the CEO of Mission Australia, commented in her introduction that "It concerns me that mental health continues to grow as an issue of concern for Australia. There are some wonderful youth mental health programs and a range of support services. We must ensure these continue to be funded, adequately supported and accessible." 

Australia's mothers and babies 2014

Australia’s mothers and babies 2014 - in brief presents key statistics and trends on pregnancy and childbirth, and the characteristics and outcomes of births and babies. This publication is designed to accompany the perinatal dynamic data display.

This AIHW report presents data showing that in 2014, 307, 844 women gave birth in Australia, an increase of 18% since 2004, with 51% being male. The average age of women who gave birth was 30.2, compared with 29.7 in 2004 and 30 in 2009.  The rate of multiple pregnancies has decreased, and the rate of around 7 stillborn babies per 1000 has not changed much since 2004.

Australia's health and medical research workforce

Australia’s health and medical research workforce: expert people providing exceptional returns is a report for the Australian Society of Medical Research (ASMR), prepared by Deloitte Access Economics. The ASMR had noted that this particular workforce had been eroding over the past few years, principally due to static funding at the NHMRC. 

This report's findings included the calculation that each $1 invested into the NHMRC-funded health and medical research workforce for the last 15 years returned $3.20 - a net benefit of $23.4 billion. Some health conditions demonstrated very high returns, such as cardiovascular disease, which returned $9.80 per dollar invested.

The report authors concluded that their data provided "evidence of the exceptional health and economic returns of investing in Australia’s productive and highly talented research workforce. ... Australia still has capacity to provide greater output and benefits as a result of investing further in the NHMRC and the workforce it supports."

Clinical Education in Midwifery

The current issue of the Journal of Midwifery & Women’sHealth includes a supplement on Clinical Education that focuses on some of the resources and methods that clinical educators can use to strengthen their existing precepting skills or guide them as they consider becoming preceptors for the first time. The role of preceptors and clinical educators in clinician education cannot be underestimated and those in any field would find these articles valuable. Preceptors have an important role in teaching the clinical and interpersonal skills that the next generation of clinicians will need to provide high-quality health care.

Journal of Midwifery & Women’s Health November/December 2016, Supplement on Clinical Education. 61(S1), p. 1–49

Guidelines and Quality Standards from NICE [UK]

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 Quality Standard QS16 Hip fracture in adults  https://www.nice.org.uk/guidance/qs16
• NICE Quality Standard QS136 Transition between inpatient hospital settings and community or care home settings for adults with social care needs  https://www.nice.org.uk/guidance/qs136
• NICE Guideline NG58 Coexisting severe mental illness and substance misuse: community health and social care services  https://www.nice.org.uk/guidance/ng58
• NICE Guideline NG59 Low back pain and sciatica in over 16s: assessment and management  https://www.nice.org.uk/guidance/ng59
• NICE Guideline NG60 HIV testing: increasing uptake among people who may have undiagnosed HIV  https://www.nice.org.uk/guidance/ng60
  NICE Clinical Guideline CG95 Chest pain of recent onset: assessment and diagnosis  https://www.nice.org.uk/guidance/cg95
• NICE Clinical Guideline CG145 Spasticity in under 19s: management  https://www.nice.org.uk/guidance/cg145

Shared from 'On The Radar' an information resource of the Australian Commission on Safety and Quality in Health Care, edited by Dr Niall Johnson. 

Sepsis and Septic Shock

With early recognition and intervention sepsis can be avoided. A popular nurse education blog "Blogging for Your Noggin" looks into the past definition of sepsis and explains the difference with the criteria to recognise sepsis within the new Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3).

Society of Critical Care Medicine. (2016). The third international consensus definitions for sepsis and septic shock (sepsis-3): The sepsis definitions task force. 

Bloggin For Your Noggin. Nursing Education Made Entertaining and Easy.

Clinical Teacher's Toolbox

Articles in The Clinical Teacher’s Toolbox series offer a concise, practical and evidence-guided introduction to core topics in learning, teaching and writing about education, which are designed to be accessible to all clinical teachers. Included in this special issue of The Clinical Teacher are articles on coaching, undertaking and reporting qualitative research, patients as teachers and writing for publication.

(2016) Virtual Issue The Clinical Teacher. The Clinical Teacher's Toolbox

Healthcare in rural, regional and remote NSW

The main aim of this report is to capture the challenges to rural healthcare posed by geography and isolation. It describes the diversity and responsiveness that are hallmarks of healthcare in NSW and compares performance across the rural–urban continuum, identifying areas of achievement and highlighting areas for potential improvement.

Low population density, long travelling times, difficulties recruiting a skilled workforce and an ageing population are just some of challenges assessed in rural, regional and remote NSW. 

Bureau of Health Information. The Insights Series –Healthcare in rural, regional and remote NSW. Sydney (NSW); BHI; 2016.