The Heroism of Incremental Care

Atul Gawande’s latest piece for The New Yorker looks at ‘incremental care’, that he typifies as being “the kind of steady, intimate care that often helps people more’. In other terms this might be also termed as continuity and integration of care or, more generally, as patient-centred care, particularly in primary care. As ever, Gawande uses compelling stories, including those of his family, to illustrate and enliven his prose. Gawande also touches on some of the issues surrounding primary care, including costs, payments, insurance and the use of information in improving that care. A fascinating read for anyone.

Gawande, A.  The heroism of incremental care. The New Yorker. January 23, 2017. 

Caring for Quality in Health: Lessons learnt from 15 reviews of health care quality

Over the last few years the OECD has published 15 Reviews of Health Care Quality looking at the policies and institutions that underpin the measurement and improvement of health care quality in 15 different health systems. This new report synthesises those 15 in-depth reviews and discusses 12 lessons learnt. 
The report also identifies “two key ingredients are needed to drive sustainable change. The first is a quality culture among both clinicians and service managers, to encourage continuously better and safer care. The second ingredient is a clear accountability”.

Caring for Quality in Health: Lessons learntfrom 15 reviews of health care quality.   

Paris: OECD; 2017. 

The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses

Systematic reviews have currently become a high-output factory where very different stakeholders with various motives are involved: methodologists, academics, scholars, policymakers, health care professionals, altruistic volunteers, eager authorship-seekers, serious business professionals, and many others who may see systematic reviews as marketing tools.
Currently, there is massive production of unnecessary, misleading, and conflicted systematic reviews and meta-analyses. Instead of promoting evidence-based medicine and health care, these instruments often serve mostly as easily produced publishable units or marketing tools.

This article in The Millbank Quarterly finds that the publication of systematic reviews and meta-analyses should be realigned to remove biases and vested interests and to integrate them better with the primary production of evidence.

Ioannidis, John P.A. (2016), The Mass Production of Redundant, Misleading, and Conflicted Systematic Reviews and Meta-analyses. The Millbank Quarterly, 94(3), 485-514

Driving Cessation and Health Outcomes in Older Adults

The object of this study was to determine what effect driving cessation may have on subsequent health and well-being in older adults. Driving cessation in older adults appears to contribute to a variety of health problems, particularly depression. Pooled data from five studies indicate that driving cessation nearly doubles the risk of greater depressive symptoms in older adults.
 These adverse health consequences should be considered in making the decision to cease driving. Intervention programs ensuring mobility and social functions may be needed to mitigate the potential adverse effects of driving cessation on health and well-being in older adults.
This review also sheds light on other health outcomes of driving cessation, including declines in cognitive abilities, diminished physical and social functioning, and greater risks of long term care entry and loss of mobility.

Chihuri, Stanford,[et al].  Driving Cessation and Health Outcomes in Older Adults. Journal of the American Geriatrics Society, 64(2), 332-341. [Open Access]  

Mesh, graft, or standard repair for women having prolapse surgery

PROSPECT was the largest randomised study of the use of mesh or graft in transvaginal prolapse surgery to date. The investigators in this trial assessed augmentation of transvaginal prolapse surgery with synthetic absorbable or non-absorbable mesh (type 1 monofilament macroporous polypropylene) or biological grafts (porcine acellular collagen matrix, porcine small intestinal submucosa, or bovine dermal).
The findings from Glazener and colleagues' study support the limitations of prolapse repair surgery, with persistent symptoms or anatomical support loss in too many patients. In their study, the investigators noted that more than 80% of the participants had at least one residual, postoperative prolapse symptom.

Glazener, Cathryn MA et al. (2017). Mesh, graft, or standard repair for women having primary transvaginal anterior or posterior compartment prolapse surgery: two parallel-group, multicentre, randomised, controlled trials (PROSPECT).  The Lancet , 389(10067), 381-392. 

Hospital discharge – everyone loses when its handled poorly

A recent report in the UK coordinated by Senior Research Fellow at Anglia Ruskin University, Dr Oonagh Corrigan looked at a large number of hospital discharge cases over 2 years. She said, “I think everyone recognises that when the discharge process doesn’t work very well, everyone loses. The hospitals suffer from so called ‘bed blocking’, patients are put through unnecessary stress, and family carers find themselves having to pick up the pieces around ongoing support from social care and the like.”
The key findings revealed that in all too many cases both patients and family carers were not involved in the planning of discharge and follow-up support, which contributed to a lack of continuity of care and sometimes saw patients readmitted.
Being discharged too soon was another key finding. Some patients – particularly some elderly patients and those who had care responsibilities or little family or other support – reported feeling under pressure to leave hospital before feeling ready to be discharged.
Delays on the day of discharge were also commonplace due to hold-ups in the   delivery of take-home medication, hospital transportation and information such as letters for GPs and discharge or care plans. Where assessments for care packages were required, delays could be exacerbated by a lack of coordination between health and social care and the shortage of care  places in the community, care homes, nursing homes and re-ablement services.

Corrigan, Oonah [et al]. Insights into Hospital Discharge: A study of patient, carer and staff experience in Essex. Healthwatch Essex, 2016

Staphylococcus aureus bacteraemia in Australian public hospitals

The Australian Institute of Health and Welfare has released a new report: Staphylococcus aureus bacteraemia in Australian public hospitals 2015-16: Australian hospital statistics.

SAB is a serious bloodstream infection that may be associated with hospital care and hospitals aim to have as few cases as possible. In 2015–16, 1,440 cases of hospital-associated Staphylococcus aureus bacteraemia (SAB) were reported in Australian public hospitals, well below the national benchmark.

Staphylococcus aureus bacteraemia in Australian public hospitals 2015–16: Australian hospital statistics. 2017. Cat. no. HSE 184  

Sepsis Early Alert Tool

Recent data from the Australian and New Zealand Intensive Care Society (ANZICS) adult database
show that sepsis accounts for 11% of admissions to ICU. The Surviving Sepsis Campaign guidelines in Australia recommend administration of appropriate antibiotics within 1 h in patients with severe sepsis. A recent study evaluated the effect of introducing a Sepsis Early Alert Tool (SEAT) in the ED. Outcomes were antibiotic timing, antibiotic choice and obtaining adequate blood cultures. The introduction of a SEAT in the ED is associated with earlier recognition of severe sepsis and improvements in quality of care.

IDREES, Marwan; MACDONALD, Stephen PJ; KODALI, Kiren.  (2017) Sepsis Early Alert Tool: Early recognition and timely management in the emergency department. Emergency Medicine Australasia, 28(4), 399-403 (available full text on CIAP or contact your library) 

Are our busy doctors and nurses losing empathy for patients?

A series of articles on lack of empathy has been published by The Conversation. The most recent written by Sue Dean, lecturer in the Faculty of Health at UTS, Sydney looks at what empathy is and why our doctors and nurses have decreased empathy for patients.
Empathy is fundamental to effective communication. For doctors and nurses, this means placing the patient at the centre of care. This skill leads to increased levels of satisfaction not only in patients but also the doctors and nurses. Importantly, it is also associated with improved patient outcomes.

Dean, Sue. University of Technology (2017) Are our busy doctors and nurses losing empathy for patients? [online], The Conversation
Read the rest The Conversation articles on empathy here.    

Five Tips to Help Someone who Hoards

This short online guide on the SANE Australia website written by one of Centre Advisors, Gina Bennet, breaks down the steps to helping a hoarder. Hoarding behaviour is less about the accumulation of ‘stuff’, but more so the meaning people attach to these items or objects. It recommends an ABC podcast to listen to, a self-help book and self-help support groups.

Five tips to help someone who hoards. Gina Bennett, SANE Australia 2016. 

Improving end-of-life care in Australia

Australia faces an increasing demand for EOL(End of Life) care due to an ageing population and increasing rates of chronic disease. Two-thirds of Australians die between the ages of 75 and 95, and while most of these deaths are expected, the Australian Centre for Health and Research (ACHR) has recently reported that the care most Australians receive at EOL often does not reflect their values, goals or informed choices.

The intention of this brief from the Deeble Institute is to raise awareness of the issues surrounding EOL care and to provide recommendations on what can be done to facilitate discussions on these issues among consumers and all sectors of the health system. 

Jones A, Silk K, Improving End-of-Life Care in Australia. Canberra: Australian Healthcare and Hospitals Association; 2016. Deeble Institute Evidence Brief No 19