Mental health services in Australia - including the use of restraint

New data has been released on the AIHW's mental health services website, which for the first time includes information on the use of restraint in Australia's specialised mental health hospital services.. Restraint refers to "the restriction of an individual's freedom of movement by physical or mechanical means".

The data indicates that in 2015-16 there were about 9 physical restraint events and under 2 mecahnical restraints per 1000 bed days. Rates of physical restraint were highest for forensic services (which include prison based services), at about 110 events per 1,000 beds days. Associate Professor John Allan, Chair of the Australian Health Ministers' Advisory Council's Safety and Quality Partnership Standing Committee, said, "For the first time, we have visibility of what's really going on in our mental health services. This is a ground-breaking step in our efforts to reduce the use of restrictive practices."

Mental health services in Australia - including the use of restraint in acute hospital mental health services

Hip fracture care standard

The Australian Commission on Safety and Quality in Health Care published the Hip Fracture Care Clinical Care Standard, along with indicator specifications and consumer and clinician fact sheets in September last year. Now they have released Hip Fracture Care – the Case for Improvement, as well as a supporting PowerPoint presentation for clinicians and health services to use. These resources explain what each quality statement means, why it matters, and how use of the clinical care standard could improve patient outcomes.  

This latest document highlights the importance of the Standard, why we need it, and what could be achieved with a more consistent approach to the implementation of best practice.

Developing the rural health workforce

Developing the rural health workforce to improve Australian Aboriginal and Torres Strait Islander health outcomes: A systematic review has been published recently in the Australian Health Review. 

26 papers were included in the study and four key findings were identified relating to the experiences Aboriginal people have in the health workforce and how that effects their engagement with education as well as their longevity.  One interesting finding was the importance of student placements affecting the likelihood of people eventually applying for rural and remote health jobs.  

Kylie Gwynne, Michelle Lincoln. Australian Health Review, 41(2), 234-238 2017. dx.doi.org/10.1071/AH15241 [Free full text]

Building resilience in junior doctors

A recent article in The Conversation, What needs to happen to build resilience and improve mental health among junior doctors, highlighted the problems of young doctors coping with extraordinary psychological distress.

Authors Richard Murray and Brendan Crotty referred to two Beyond Blue reports: The Mental health of doctors: a systematic literature review, from 2010, and the 2013 National Mental Health Survey of Doctors and Medical Students. Female doctors particularly are at risk, with one study finding them to have a huge 146% higher risk of suicide than the general population.

Various factors are at play - a culture of not admitting weakness, long hours, workplace bullying, and intense competition for jobs with the current large numbers of medical graduates. Murray and Crotty offer various solutions and a need for changes in the nature of healthcare so that it is "more integrated, person-centred and community-based".

Cervical screening in Australia

Cervical screening in Australia 2014-2015  presents the latest national statistics monitoring the National Cervical Screening Program. The AIHW reports that

• 56% of women in the target age group of 20-69 took part in the program during 2014 and 2015
• Cervical cancer cases and deaths in Australia are low by international standards
• About 9 new cases of cervical cancer were detected per 100,000 women, and 2 deaths per 100,000 women.  This rate has been stable for the past ten years, having halved after the introduction of the NCSP
• There is strong evidence that Indigenous women have a lower screening rate and poorer outcomes than non-Indigenous women.

Older Australia at a glance

The Older Australia at a Glance online information resource from the Australian Institute of Health and Welfare defines older Australians as generally those aged 65 and over. Here you can find information and statistics on issues affecting older Australians - broadly to do with demographics, diversity, social and economic engagement and health.

In 2016, approximately 15% of Australia's population were "older Australians".  This is projected to grow to 22% by 2056. In general, most older Australians have healthy lifestyles, own their own home, and are increasingly still involved in the workforce.

Admitted patient care 2015-16: Australian hospital statistics

Some of the data available in this latest report from AIHW includes:  In 2015-16, there were about 10.6 million separations in Australia's public and private hospitals-about 59% occurred in public hospitals. There were 30 million days of patient care reported for admitted patients-20.2 million in public hospitals and 9.7 million in private hospitals.

Between 2011-12 and 2015-16:

• the number of separations rose by 3.5% on average each year.
• the number of public patient separations rose by an average of 2.9% each year, compared with 5.5% per year for separations paid for by private health insurance.
• the median waiting time for elective surgery for public patients in a public hospital was 42 days, while it was 20 days for patients who used private health insurance to fund all or part of their admission.

Download the report here.             

Arthroscopic Surgery for Degenerative Knee Arthritis and Meniscal Tears

The BMJ has published this item on a clinical practice guideline on arthroscopic surgery for degenerative knee arthritis and meniscal tears. This guideline makes a strong recommendation against the use of arthroscopy in nearly all patients with degenerative knee disease.

Siemieniuk RAC, Harris IA, Agoritsas T, Poolman RW, Brignardello-Petersen R, Van de Velde S, et al. Arthroscopic surgery for degenerative kneearthritis and meniscal tears: a clinical practice guideline.  BMJ. 2017;357:j1982  

Brachytherapy for Patients With Prostate Cancer

The goal of this guideline update is to provide oncologists, other health care practitioners, patients, and caregivers with recommendations regarding the use of brachytherapy for patients with prostate cancer that includes the most recent evidence. Prostate cancer is the most commonly diagnosed cancer in men.

Brachytherapy for Patients With Prostate Cancer: American Society of Clinical Oncology/Cancer Care Ontario Joint Guideline Update. (staff at MNCLHD have free access)

Additional information, which may include a Data Supplement, Methodology Supplement, slide sets, clinical tools and resources, and links to patient information at www.cancer.net, is available at www.asco.org/Brachytherapy-guideline and www.asco.org/guidelineswiki

Osteoarthritis of the Knee Clinical Care Standard

A new clinical care standard for the treatment of osteoarthritis of the knee has been released by the Australian Commission on Safety and Quality in Health Care.

The Osteoarthritis of the Knee Clinical Care Standard aims to guide clinicians in best-practice primary care management of osteoarthritis of the knee. This includes timely comprehensive assessment, conservative treatment and appropriate patient review, which can help patients avoid unnecessary testing and surgery.

Osteoarthritis of the Knee Clinical Care Standard. May 2017

Palliative Care Services in Australia 2017

Between 2010-11 and 2014-15, palliative care-related hospitalisations rose by about 19%. About 155,600 people died in Australia, and almost half of these died as an admitted patient in hospital.
Approximately 46% of these had been a palliative care patient during their final days in hospital with over half being aged 75 and above. This latest report from AIHW looks at palliative care delivery in almost all settings where health care is provided, including neonatal units, paediatric services, acute hospitals, general practices, community settings (such as people's own homes) and residential aged care services.

Read the full AIHW web report here.

Procurement of medical goods and human rights

"The healthcare sector and government in Australia are failing to address labour and human rights violations linked to the production of healthcare goods." This is the conclusion of a recent report by Martijn Boersma published by the Australian Nursing & Midwifery Foundation and The Australia Institute, Do no harm: procurement of medical goods by Australian companies and government.

The existence of labour and human rights abuses in medical goods supply chains means that the health of Australians is coming at the cost of the abuse and exploitation of workers in low-wage countries. The report urges a commitment to the ethical production, procurement and management of medical goods supply chains. This report finds that despite their legal and moral responsibilities, the healthcare sector and government in Australia are failing to address labour and human rights violations linked to the production of healthcare goods. 

Inquiry into funding programs to reduce homelessness

This Australian Housing and Urban Research Institute (AHURI) Inquiry into the funding and delivery of programs to reduce homelessness in Australia comprehensively examines the funding of  Specialist Homelessness Services (SHSs) and other services assisting those experiencing homelessness.

Government funding accounts for 84.6 percent of funding provided to SHSs , and only about one-third of services indicate that they are able to meet client demand with current funding. Non-government funding sources include philanthropic foundations, the corporate sector and other fundraising and sponsorship groups, but they all play a minor role in homelessness services.

Further areas for policy development are suggested in the report, including greater stability of government funding of homelessness services and supportive measures to increase the level of non-government funding.

Meteorology and mood in bipolar disorder

An Australian study looking at seasonal variation of manic and depressive symptoms in bipolar disorder has added to the body of knowledge on this topic. The researchers measured specific meteorological factors such as atmospheric pressure, hours of sunshine, relative humidity, and daily maximum and minimum temperatures compared to self-reported daily mood change in people diagnosed with bipolar disorder. 

Highs and lows, ups and downs: meteorology and mood in bipolar disorder by Ben Bullock, Greg Murray and Denny Meyer was published in PLoS ONE recently, and the results indicated that the daily maximum temperature was the only meteorological variable to predict clinically-relevant mood change. Sunshine hours, humidity and minimum temperatures had no noticeable effect. This contradicts some other studies on these effects, but it was quite a small study.

History of anaesthesia

  Licensed under CC BY 4.0

A short history of anaesthesia: from unspeakable agony to unlocking consciousness by David Liley, Swinburne University of Technology was recently published in The Conversation.  Here he recounts terrifying reminders of how surgery was conducted two hundred years ago and how far we have come.

For more details on this fascinating topic, I recommend the very extensive History of Anaesthesia Society Timeline from the UK. The ANZCA (Australian & NZ College of Anaesthetists) also has a History of Anaesthesia section on their website.

Which all reminds me of a recent episode of the superb podcast, This American Life, where the story of a Russian doctor who performed an appendectomy on himself was recounted in vivid detail from his diary.

Federal budget - analysis of health aspects

The Conversation has run a number of articles in the last week about the latest budget and its implications for health.

• Mental health funding in the 2017 budget is too little, unfair and lacks a coherent strategy by Sebastian Rosenberg, University of Sydney. Discusses how underfunded mental health will remain after this budget.
• New drugs on the PBS: what they do and why we need them - here, Nial Wheate, University of Sydney, looks at notable drugs that were added to the PBS at the beginning of this month. 7. 
• Don’t be fooled, the Medicare Guarantee Fund provides no real guarantee is from the Grattan Institute's Stephen Duckett, who argues that this fund is not new at all and is not helpful for public hospitals. 
• Budget 2017 sees Medicare rebate freeze slowly lifted and more funding for the NDIS: experts respond  - various commentary from Stephen Duckett, Grattan Institute; Chris Del Mar; Elizabeth Savage, University of Technology Sydney; Helen Dickinson, UNSW; Michael Woods, University of Technology Sydney

Latest health research summaries in Signals.

The UK’s National Institute for Health Research (NIHR) Dissemination Centre has released the latest ‘Signals’ research summaries. This latest release includes:

• Repetitive task training can help recovery after stroke
• Fortified donor breast milk led to similar development for very-low-birthweight babies compared with formula milk
• Giving immediate antibiotics reduces deaths from sepsis
• New casting technique is an option for older people with ankle fracture
• Thrombolysis may reduce complications of deep vein thrombosis
• Counselling services help expectant mothers quit smoking
• Antibiotics by injection into the eye can prevent severe infection following cataract surgery
• The “BabyClear” programme helped pregnant women stop smoking in North East England
• MRI scans help confirm ultrasound diagnosis of fetal brain abnormalities.

Incidence of selected cancers in 2006-2010

The Australian Institute of Health and Welfare has released an update on the MyHealthyCommunities website. The update on the incidence of different cancers includes local cancer incidence rates (newly diagnosed cases) for all cancers combined, as well as breast, cervical, prostate, colorectal, lung and melanoma of the skin.

Download Incidence of selected cancers in 2006-2010   

Clinical pathways for suicidality in emergency settings

Rates of self-harm in Australia are increasing and constitute a concerning public health issue. However there is no national pathway for self-harm or other psychiatric conditions that present to the emergency department.
This article looks at the differences between clinical practice guidelines and clinical pathways, and the next steps forward in Australia to address the issue.

Wilhelm Kay, Korczak Viola, Tietze Tad, Reddy Prasuna (2016). Clinical pathways for suicidality in emergency settings: a public health priority. Australian Health Review 41(2), 182-184. (free online)

Using quality assessment tools to critically appraise ageing research

Critical appraisal of research studies can seem daunting, but in this paper aimed at geriatricians, a number of tools which are available for standardising assessment are critiqued. Understanding the language and process of quality assessment is essential when conducting research.  Five different study designs are examined, and an example of published research is given in each.  

Jennifer Kirsty Harrison, James Reid, Terry J Quinn, Susan Deborah Shenkin. Using quality assessment tools to critically appraise ageing research: a guide for clinicians. Age Ageing 2017; 46 (3): 359-365. doi: 10.1093/ageing/afw223 (free online)

HFA Heart Failure Awareness Days Virtual Issue

ESC Heart Failure has published a series of short articles looking into some of the facts and numbers behind different aspects of heart failure. This virtual issue collects all of the Facts and Numbers papers together in one place and will be updated regularly as new articles are published.

The sister journal, European Journal of Heart Failure has also published a number of freely available virtual issues.

Promoting social and emotional development and wellbeing of infants in pregnancy and the first year of life

During its 2012-15 term, the NHMRC’s former Prevention and Community Health Committee (PCHC) identified mental health as a key project area, with a particular focus on the effectiveness of parenting practices and their role in promoting social and emotional health and wellbeing in children and later on as adults.A new report has just been issued and includes a Plain Language Summary  that summarises the findings of 51 systematic literature reviews and analyses the types of interventions aimed at promoting infants’ and children’s social and emotional wellbeing. The report is aimed at governments and other policy makers, researchers and service providers who work with parents of  

infants.

National Health and Medical Research Council. (2017). NHMRC Report on the Evidence: Promoting social and emotional development and wellbeing of infants in pregnancy and the first year of life. 

Conversation - Food as medicine series

The Conversation has published a series of articles this week on Food as Medicine:

  

Food as medicine: how what you eat shapes the health of your lungs by Lisa Wood from the University of Newcastle, explains how increasing the amount of fruit and vegetables you eat can improve lungh function. 

Food as medicine: your brain really does want you to eat more veggies by Felice Jacka from Deakin University explains the importance of diet on our mental and brain health. She describes a trial showing a decrease in depression symptoms after a diet rich in vegetables, fruit, wholegrains, legumes, fish, lean red meat and healthy fats. 

Food as medicine: why do we need to eat so many vegetables and what does a serve actually look like? is by three researchers from the CSIRO: Genevieve James-Martin, Gemma Williams and Malcolm Riley. Here they explain what a "serve" is and how and why we should aim for the 5:2 guideline of vegetables and fruit. 

Annual alcohol poll 2017

The Foundation for Alcohol Research and Education’s (FARE) has reported on its annual survey of Australian's attitudes towards alcohol: Annual alcohol poll 2017: attitudes and behaviours. 78% of respondents indicated that they thought Australia had a problem with alcohol abuse, and 81% believed that more needs to be done to reduce the harm caused by alcohol.  

Community perceptions of the alcohol industry suggest we are sceptical about their motivations and business tactics. 57% of Australians believe that the alcohol industry targets people under the age of 18 years, and that it has too much influence with governments. There is a low level of trust in information provided by the alcohol industry on the number of standard drinks, responsible drinking, drinking during pregnancy, underage drinking, and the health benefits of certain alcohol products.

Alcohol and drug treatment services in Australia

In 2015-16, around 796 alcohol and other drug treatment agencies provided just over 206,000 treatment episodes to an estimated 133,000 clients. This was an icrease of 17% over the five previous years. The most common drugs leading people to seek treatment were alcohol (32%), cannabis (23%), amphetamines (23%) and heroin (6%). Two in three clients were male and 55% were aged 20-39. Treatment for amphetamines is continuing to increase.

The AIHW has presented Alcohol and other drug treatment services in Australia, 2015-16: key findings  a useful summary of the National Minimum Data Set published recently. The site also links to all the available data on alcohol, smoking and illicit drug taking in Australia.

Is Australia prepared for the next pandemic?

Infectious diseases are a continuing threat to global health, and planning for an effective response to the next pandemic is very complex. This article in Medical Journal of Australia has been written by experts in infectious disease and epidemiology and it outlines the requirements for public health experts, clinicians, diagnostic laboratory staff, federal agencies and others to work together with strong leadership to respond to any new pandemic.  Every country needs to be prepared.  

The authors conclude that "Australia has many pieces of the plan in place, but we must continue to fill gaps, test and refine existing systems and continually review what works to make sure we are as ready as possible for the next emerging infectious disease challenge."

McVernon, J., Sorrell, T.C., Firman, J., Murphy, B. & Lewin, R (2017). Is Australia prepared for the next pandemic?. Medical Journal of Australia 206 (7): 284-6