World AIDS Day December 1

It's World AIDS Day on December 1.

This day is held each year to raise awareness around the world and within the community about HIV and AIDS. It's a day for communities to show their support for those living with HIV and to remember those who have died of AIDS related conditions or other illnesses associated with HIV.

The theme for Australia's World AIDS Day is Every Journey Counts. The aim is to encourage Australians to learn more about HIV, to reduce transmission by promoting prevention strategies, and to ensure that people living with HIV have the opportunities to participate fully in life among the community, free from stigma and discrimination.

As a caring community and individually, there is a lot we can do in relation to HIV. Working along side people with HIV, we can help others to understand how HIV is transmitted. We can support people to access testing, treatment and care. Commencing treatment at the early stages of HIV results in better outcomes and reduces the likelihood of onward transmission.
The Glasshouse in Port Macquarie will be lit up red on the eastern corner and ground mezzanine levels for the lead up to World Aids Day (WAD), and the Big Banana will glow red and bring awareness of WAD. Go to the WAD website to find more information, resources or an event near you.

Healthcare Environments that Care for Doctors Increase Care for Patients

A recent report from the General Medical Council in the UK states that a working environment that supports clinicians is conducive to their well-being and this in turn flows on to that of their patients.

The main points that come out of the report are that people need:

Autonomy and control - they need to have control over their work lives, and to act consistently with their work and life values. Recommendations cover voice, influence and fairness, working conditions, schedules and rotas.
    

Belonging – clinicians need to be connected to, cared for, and caring of others around us in the workplace and to feel valued, respected and supported. Recommendations cover teamwork, culture and leadership.

Competence – doctors need to experience effectiveness and deliver valued outcomes, such as high-quality care. Recommendations cover workload, training, learning and development, and management and supervision.

A full version of the report can be found here.

In Australia the AMA acknowledges that "doctors need to be well to provide health care to their patients and community, and to experience medicine as a rewarding and satisfying career". Resources to help can be found on the AMA website. 

                                                                                                      Source: https://ama.com.au/

While Australia boast one of the best health care systems in the world junior doctors need help as a myriad of reports such as those found in the Sydney Morning Herald have revealed. It seems that there are many junior doctors that are receiving sub-standard care from the institutions that employ and train them. 

The article points out the comparison with pilots when and interviewed doctor recalled being on a plane that had been taxi-ing for over an hour. The pilot announced that the flight would be delayed as as he had exceeded his on-duty hours, and that a back-up pilot would need to be called in. It was explained that that would never happen in a hospital. If we won't let a pilot fly a plane why do we let doctors make important decisions for their patients having worked for 14 to 18 hours? Many trainees worry that they will make errors because they were overtired.

No student of medicine goes into the field of medicine thinking it is going to be easy. The job is expected to be hard, but the conditions do not need to make it harder. The JMO Wellbeing & Support Forum in 2017 identified key themes for improvement at the LHD level including; improved rostering; increased staff numbers; ensuring overtime is claimed; review of work conditions, including limiting hours; more staff specialists, less VMOs; more senior clinicians on the floor; improved maternity leave policies; flexible working such as job share; improved IT systems. The forum summary can be found here. LHDs need to keep working on the recommendations  to ensure the well-being of Australian doctors to improve the health of the communities that they are working in.

It is time for a new wire BBQ brush?

A recent article coauthored by Mid North Coast Local Health District staff member Rafael Gaszynski, reports an unusual case of an injury from a barbecue wire bristle. 

Gaszynski, R. and K. J. Zhu (2018). "Summer danger: penetrating pancreatic injury from barbecue wire bristle." ANZ Journal of Surgery 88(12): 1354-1355.

The patient presented to emergency 4 times over a 7 day period, he had no significant history but had eaten fish about 7 days earlier. When reviewed he was found to be dehydrated, lethargic and had deranged liver function tests. No abnormalities were found using ultrasound and x-ray. A CT scan was conducted on admission due to persistent pain. A foreign object was found in the duodenum extending into the adjacent pancreatic neck. A surgical consult was sought and the patient was taken for a gastroscopy.

A black needle like foreign object was found and removed. It measured 20mm by 1mm and was consistent with a barbecue wire brush bristle.

A US study found that about 1700 people visited emergency rooms each year due to swallowing bristles! This however, is the first report of pancreatic injury from a barbecue wire bristle.

Ewww - Source: Grillmax.com

With summer fast approaching and the Aussie Barbie in frequent use it is an optimal time to highlight the dangers of BBQ wire brushes which clinicians and the public should be aware of. Patients with persistent abdominal symptoms post barbecue consumption should have a CT scan if at first basic imaging is non-diagnostic.

Basically the problem is that bristles can break off your brush and get into the food you're cooking. Look after your wire barbie brushes people! Don't let it get old and disgusting like the one above! Get a new one every year. It's better to pay for a new one now than pay later... Check your barbie before you cook to ensure that there are no foreign objects on the cooking surface. Maybe go to the barbecue shop and seek alternative options to try?

Thanks for the awesome article Rafael - anyone wanting to read the full article?
MNCLHD employees can request here.

Have a great summer and happy barbecuing!

Antibiotic Awareness Week! BE PART OF THE SOLUTION

Antibiotic resistance presents one of the biggest threats to global health and development today – and the threat is growing. This week antibiotics awareness week is launched with the overarching theme “Antibiotics Handle with Care”, from 18 to 24 November. The week aims to increase awareness of global antibiotic resistance and to encourage best practices among the general public, health care workers and policy-makers to stem its further emergence and spread.

Antibiotic resistance is caused by the misuse and overuse of antibiotics, as well as poor infection prevention and control. Action can be taken at all levels of society to reduce the impact and limit the spread of resistance. Health workers have a the vital role to play in defending the power of antibiotics. WHO/Europe has interviewed health care workers from across Europe about their experiences with antibiotic resistance and how they are trying to help stop the spread. 

The key message that Health care workers can share with their patients is that antibiotics are a precious resource that could be lost. Let them know that antibiotic resistance is happening now and its a worldwide problem that can affect both human and animal health. Pass on an understanding of how it happens, that smart bacteria develop defenses that stop antibiotics from working effectively, that misuse of antibiotics contributes to this, so antibiotics should not be prescribed and taken for conditions that do not call for antibiotic use. Whenever antibiotics are used they should be used with care.

Find more resources and information at the Australian Commission on Safety and Quality in Health Care website.

Drivers influencing antibiotic over-prescribing by GPs

This qualitative literature review explores the drivers influencing antibiotic over-prescribing by GPs in primary care and makes recommendations to reduce unnecessary prescribing, by Joanna Rose, Michelle Crosbie and Anthony Stewart.

Perspect Public Health. 2019 Oct 21:1757913919879183. doi: 10.1177/1757913919879183.
A qualitative literature review exploring the drivers influencing antibiotic over-prescribing by GPs in primary care and recommendations to reduce unnecessary prescribing.
Rose J, Crosbie M, Stewart A.

This is a qualitative literature review which aims to assess and analyse the published literature to discover the hidden reasons for antibiotic over-prescribing by general practitioners (GPs). It explores their views and opinions, and seeks to determine how antibiotic prescribing can be improved removing unnecessary prescribing, that will in turn reduce the threat to public health from antibiotic resistance. The article tries to invoke new was of thinking in this area while adding to the existing knowledge base relevant to GPs’ antibiotic prescribing behaviour.

Three main themes were identified through this literature review.
1. GP attitudes and or feelings.
Basically GPs want to maintain a good relationship with their patients. This means the patient needs to be satisfied with the service they receive from their GP, what could be more satisfying than walking out of the consult room with your anti-biotic script in hand because you "know" it will fix you? Along with this is the thought that anti-microbial resistance pertains more to hospitals and not general dispensing. Along with a GPs general fear of diagnostic uncertainty, risk avoidance and like fears the path is set for the prescription pad to come out.

2. External factors -time pressures and financial incentives.
Here it is basically the quick fix. If the GP writes the script they can get through more patients quickly. Convincing a patient that they do not need antibiotics will take time.

3. Patient Factors.
Pressure from patients who expect to be given antibiotics can be a challenge. Patients who are not educated to understand what antibiotics are for and what they are use for are difficult to refuse so they are just given antibiotics. The don't understand virus versus bacteria...

The findings of this paper show the need for regular GP update training to emphasise the importance of antibiotic resistance and the need to change behaviour to reduce unnecessary prescribing. Improved guidelines, providing consistency could offer GPs more power to refrain from prescribing, having the support of professional regulations. As well as many ideas to promote public awareness around antibiotics and their use via social media campaigns and triage systems  to relieve the pressure from GPs. To read the full article contact your Librarian. MNCLHD staff can request this article through the Library website.

MNCLHD Staff Publications September - November 2019

The Librarian at HMCN collects and compiles MNCLHD staff publications citations so that we can celebrate the successes of staff undertaking research.

Congratulations to the staff highlighted on their recent articles!

Corben, P. and J. Leask (2018). "Vaccination hesitancy in the antenatal period: a cross-sectional survey." BMC Public Health 18(1): 566.

Crocker, B. C. S., S. W. Pit, V. Hansen, F. John-Leader and M. L. Wright (2019). "A positive approach to adolescent sexual health promotion: a qualitative evaluation of key stakeholder perceptions of the Australian Positive Adolescent Sexual Health (PASH) Conference." BMC Public Health 19(1): 681.

Davis, I. D., A. J. Martin, M. R. Stockler, S. Begbie, K. N. Chi, S. Chowdhury, X. Coskinas, M. Frydenberg, W. E. Hague, L. G. Horvath, A. M. Joshua, N. J. Lawrence, G. Marx, J. McCaffrey, R. McDermott, M. McJannett, S. A. North, F. Parnis, W. Parulekar, D. W. Pook, M. N. Reaume, S. K. Sandhu, A. Tan, T. H. Tan, A. Thomson, E. Tu, F. Vera-Badillo, S. G. Williams, S. Yip, A. Y. Zhang, R. R. Zielinski, C. J. Sweeney, E. T. Investigators, A. the, U. New Zealand and G. Prostate Cancer Trials (2019). "Enzalutamide with Standard First-Line Therapy in Metastatic Prostate Cancer." New England Journal of Medicine 381(2): 121-131.

Gaszynski, R. and K. J. Zhu (2018). "Summer danger: penetrating pancreatic injury from barbecue wire bristle." ANZ Journal of Surgery 88(12): 1354-1355.

Huttner, I. G., L. W. Wang, C. F. Santiago, C. Horvat, R. Johnson, D. Cheng, M. von Frieling-Salewsky, K. Hillcoat, T. J. Bemand, G. Trivedi, F. Braet, D. Hesselson, K. Alford, C. S. Hayward, J. G. Seidman, C. E. Seidman, M. P. Feneley, W. A. Linke and D. Fatkin (2018). "A-Band Titin Truncation in Zebrafish Causes Dilated Cardiomyopathy and Hemodynamic Stress Intolerance." Circulation. Genomic and Precision Medicine 11(8): e002135.

Imran, A., R. Calopedos, D. Habashy and P. Rashid (2018). "Acknowledging and addressing surgeon burnout." ANZ Journal of Surgery 88(11): 1100-1101.

Katelaris, A. L., K. Glasgow, K. Lawrence, P. Corben, A. Zheng, S. Sumithra, J. Turahui, J. Terry, D. van den Berg, D. Hennessy, S. Kane, S. B. Craig, E. Heading, M. A. Burns, H. L. Corner, V. Sheppeard and J. McAnulty (2019). "Investigation and response to an outbreak of leptospirosis among raspberry workers in Australia, 2018." Zoonoses Public Health.

Kozlowski, D., M. Hutchinson, J. Hurley and G. Browne (2018). "Increasing nurses' emotional intelligence with a brief intervention." Applied Nursing Research 41: 59-61.

Law, C., R. McGuire, M. J. Ferson, S. Reid, C. Gately, J. Stephenson, S. Campbell-Lloyd, S. Gabriel, T. Housen, V. Sheppeard, P. Corben and D. N. Durrheim (2019). "Children overdue for immunisation: a question of coverage or reporting? An audit of the Australian Immunisation Register." Aust N Z J Public Health 43(3): 214-220.

Lawal, A. K., G. Groot, D. Goodridge, S. Scott and L. Kinsman (2019). "Development of a program theory for clinical pathways in hospitals: Protocol for a realist review." Systematic Reviews 8 (1) (no pagination)(136).

Lieng, H., A. J. Hayden, D. R. H. Christie, B. J. Davis, T. N. Eade, L. Emmett, T. Holt, G. Hruby, D. Pryor, T. P. Shakespeare, M. Sidhom, M. Skala, K. Wiltshire, J. Yaxley and A. Kneebone (2018). "Radiotherapy for recurrent prostate cancer: 2018 Recommendations of the Australian and New Zealand Radiation Oncology Genito-Urinary group." Radiotherapy & Oncology 129(2): 377-386.

Malalasekera, A., P. L. Blinman, H. M. Dhillon, N. A. Stefanic, P. Grimison, A. Jain, M. D'Souza, S. C. Kao and J. L. Vardy (2018). "Times to Diagnosis and Treatment of Lung Cancer in New South Wales, Australia: A Multicenter, Medicare Data Linkage Study." Journal of oncology practice/American Society of Clinical Oncology 14(10): e621-e630.

Rashid, P., D. Habashy and R. Calopedos (2018). "Trainees at risk: the need for support and compassion." ANZ Journal of Surgery 88(11): 1106-1107.

Simpson, G., V. Mitsch, M. Doyle, M. Forman, D. Young, V. Solomon, M. MacPherson, L. Gillett and B. Strettles (2018). "Investigating the Model of Community-Based Case Management in the New South Wales Brain Injury Rehabilitation Program: A Prospective Multicenter Study." Journal of Head Trauma Rehabilitation 33(6): E38-E48.

Staff, M., A. Nyinawingeri, K. Denniss, A. Ingleton, J. Jelfs and P. Corben (2019). "Pertussis Morbidity in Children 12-59 Months of Age: A NSW Public Health Network Study." Pediatr Infect Dis J 38(6): 553-558.

Sutherland, R., E. Campbell, N. Nathan, L. Wolfenden, D. R. Lubans, P. J. Morgan, K. Gillham, C. Oldmeadow, A. Searles, P. Reeves, M. Williams, N. Evans, A. Bailey, R. Morrison, M. McLaughlin and J. Wiggers (2019). "A cluster randomised trial of an intervention to increase the implementation of physical activity practices in secondary schools: study protocol for scaling up the Physical Activity 4 Everyone (PA4E1) program." BMC Public Health 19(1): 883.

Wong, P. K. K., H. Bagga, C. Barrett, G. Chong, P. Hanrahan, T. Kodali, M. Marabani, H. M. Prince, J. Riordan, P. Swarbrick, R. White and L. Young (2018). "A Practical Approach to the Use of Conventional Synthetic, Biologic and Targeted Synthetic Disease Modifying Anti-Rheumatic Drugs for the Treatment of Inflammatory Arthritis in Patients with a History of Malignancy." Current Rheumatology Reports 20(10): 64.

Young, K. G., K. Duncanson and T. Burrows (2018). "Influence of grandparents on the dietary intake of their 2-12-year-old grandchildren: A systematic review." Nutrition & Dietetics 75(3): 291-306.

Zecchin, R., D. Candelaria, C. Ferry, L. A. Ladak, D. McIvor, K. Wilcox, A. Bennett, S. Bowen, B. Carr, S. Randall and R. Gallagher (2019). "Development of Quality Indicators for Cardiac Rehabilitation in Australia: A Modified Delphi Method and Pilot Test." Heart, Lung and Circulation 28(11): 1622-1630.

MNCLHD Staff Publications Database – Maintained & updated by PMBH Health Services Library

               

World Diabetes Day 14 November

The International Diabetes Federation (IDF) and the World Health Organization (WHO)started World Diabetes Day in 1991 in response to the escalating health threat posed by diabetes. Since then it has grown to become a globally celebrated event and an official United Nations (UN) awareness day. It is now the world’s largest diabetes awareness campaign.

Source: worlddiabetesday.org

The aims are to be a leading platform to promote diabetes advocacy efforts; to promote the importance of taking coordinated and concerted actions to confront diabetes as a serious global threat; and to draw attention to the key issues and keep diabetes firmly in the global public and political spotlight.

For further information and resources go to the International Diabetes Federation website

Bushfire Smoke Precautions

The North Coast Public Health Unit is advising residents in the state’s north to take precautions while bushfire smoke impacts on local air quality and hot weather is forecast.

Fine smoke particles affect the people's cardiovascular and respiratory systems and can aggravate existing chronic health conditions by penetrating deep into the lungs and entering the blood system.

Acting Director of North Coast Public Health Unit, Greg Bell, advised that the particles can cause health problems such as itchy or burning eyes, throat and nose irritation and illnesses such as
bronchitis.

People with chronic respiratory or cardiac conditions are urged to be aware of the effects of exposure to bushfire smoke and to take action to protect their health. Smoke exposure can cause people with lung disease or chronic bronchitis to have shortness of breath, coughing or wheezing, sometimes days after the smoke is inhaled. It is recommend these people carefully monitor their symptoms and follow their asthma or Chronic Obstructive Pulmonary Disease (COPD) action plan and to be vigilant with their medication or treatment programs. If symptoms do not settle contact you doctor.

These people are advised to stay indoors until the air clears and avoid strenuous exercise or outdoor work where possible. During hot weather drink plenty of water, stay in cool areas and / or visit air conditioned areas. Look out for your neighbours and family members who may be vulnerable.

Healthy people may also be affected by fine smoke particles. These can irritate the lungs, but generally any symptoms will clear after the smoke disappears.

In the event of an emergency, always remember to dial Triple Zero (000).

For tips on dealing with hot weather, visit:
https://www.health.nsw.gov.au/environment/beattheheat/Pages/default.aspx
More information about bushfire smoke is available at:
https://www.health.nsw.gov.au/environment/air/Pages/air-factsheets.aspx

Antimicrobial Stewardship Information

The following and much more information is from a Clinician Fact Sheet that can be found on the Australian Commission on Safety and Quality in Health Care website.

Antimicrobial Stewardship

The goal of the Antimicrobial Stewardship Clinical Care Standard is to ensure that a patient with a bacterial infection receives optimal treatment with antibiotics. This means that patients are offered the right antibiotic to treat their condition, the right dose, the right route, at the right time and for the right duration. This should be based on accurate assessment and timely review as to lessen the risk of adverse effects and reduce the emergence of antibiotic resistance.

UNDER THIS CLINICAL CARE STANDARD

A patient with a life-threatening condition due to a suspected bacterial infection receives prompt antibiotic treatment without waiting for the results of investigations.

A patient with a suspected bacterial infection has samples taken for microbiology testing as clinically indicated, preferably before starting antibiotic treatment.

A patient with a suspected infection, and/or their carer, receives information on their health condition and treatment options in a format and language that they can understand.

When a patient is prescribed antibiotics, whether empirical or directed, this is done in accordance with the current version of the Therapeutic Guidelines (or local antibiotic formulary). This is also guided by the patient’s clinical condition and/or the results of microbiology testing.

When a patient is prescribed antibiotics, information about when, how and for how long to take them, as well as potential side effects and a review plan, is discussed with the patient and/or their carer.

When a patient is prescribed antibiotics, the reason, drug name, dose, route of administration, intended duration and review plan is documented in the patient’s health record.

A patient who is treated with broad-spectrum antibiotics has the treatment reviewed and, if indicated, switched to treatment with a narrow-spectrum antibiotic. This is guided by the patient’s clinical condition and the results of microbiology tests.

If investigations are conducted for a suspected bacterial infection, the responsible clinician reviews these results in a timely manner (within 24 hours of results being available) and antibiotic therapy is adjusted taking into account the patient’s clinical condition and investigation results.

If a patient having surgery requires prophylactic antibiotics, the prescription is made in accordance with the current Therapeutic Guidelines (or local antibiotic formulary), and takes into consideration the patient’s clinical condition.

Antimicrobial Stewardship Clinical Care Standard

Clinician Fact Sheet, 2014
More information on the Clinical Care Standards program is available from the Australian Commission on Safety and Quality in Health Care website at www.safetyandquality.gov.au/ccs.

Perinatal Anxiety and Depression Week 2019

Perinatal anxiety and depression is serious, there's a lot of stigma involved with mental health, and the health of new and expecting parents is not excluded. If left untreated the consequences can be devastating and some people will be surprised to learn how common an illness it is.

                                                       
Many people in the community don't know the signs and symptoms, or where to go to get support if they're struggling. Many parents are afraid to reveal what they're feeling or hesitate to get help because they fear being seen as bad parents.

We want expecting and new mums and dads, and their families to feel that they can be honest about their feelings. As a community we can help. Health professionals can help by encouraging open and honest conversations about the mental health of expecting and new parents in their work areas.

For more information and tools go to the PANDA website.

MS Gong Ride - the ride to fight MS

This ride took place on November the 3rd with thousands of cyclists hitting the road to ride from Sydney to Wollongong to raise funds for people living with multiple sclerosis (MS).

MS is a chronic and often debilitating disease that attacks the central nervous system (brain, spinal cord,  and optic nerves). MS is the most common neurological disease in young adults and often arises when people are at a time of their life when they are raising young families and building a career.

What can be confounding about MS is that no two cases of MS are identical. There are visible and invisible symptoms that vary from person to person. Check out Australia's animation demonstrating this. MS is a lifelong disease and there is no known cure.

The MS Gong Ride raises money to provide services and assistance to people living with multiple sclerosis. You can still donate at https://www.msgongride.org.au/ . You can learn more about MS and the MS Australia website.

Lung Cancer Awareness Month

November is Lung Cancer Awareness Month. The aim to raise awareness about lung cancer, the most commonly diagnosed cancer in Australia and the fifth most common cause of cancer deaths in Australia according to Australian Institute of Health and Welfare data.

Source: Cancer Council

The Cancer Councils Making Smoking History Manager says that 90% of lung cancer cases in men are directly related to smoking and 65% of case in women. There are thousands of compounds in cigarettes including many known carcinogens from various chemical classes. See the Cancer Council's site for more information.

Symptoms of lung cancer include shortness of breath, wheezing, chest pain, coughing or spitting up blood, a persistent cough. recurring bronchitis or pneumonia, loss of appetite, unexplained weight loss and fatigue. Visit your health professional if you are suffering from any of these symptoms. Early diagnosis increases the success rate treatment.

If you want to quit smoking and need help call the Cancer Council's Quitline on 137848 or visit makesmokinghistory.org.au