ACSQHC Update - Precautions for aged care homes

The Australian Commission on Safety and Quality in Health Care has developed a number of resources to assist healthcare organisations, facilities and clinicians including PPE use for aged care staff caring for residents with or suspected of having COVID-19. The Australian Government Infection Control Expert

Group provides guidance regarding use of particulate respirators (e.g. P2/N95) and other personal protective equipment (PPE) in circumstances where the risk of transmission of COVID-19 is assessed as high.

This recently updated poster includes easy to follow instructions for aged care workers on how to put on and remove PPE (including gowns, P2/N95 respirators, protective eyewear and gloves) when they are caring for residents with suspected or confirmed COVID-19. It also includes instructions on how to fit check P2/N95 respirators.

Source: https://www.safetyandquality.gov.au/

Note the section highlighted in red 

Important -To protect yourself and your family and friends, when your shift finishes, change into clean clothes at work if possible and put your work clothes in a plastic bag. Go straight home, shower immediately and wash all of your work clothes, and the clothes you wore home.

Other COVID-19 resources are available including visitor restrictions posters, and general information to break the chain of COVID-19 transmission. FAQs for clinicians and consumers on elective surgery as well as the latest information on mask wearing in multiple languages.

NSW Health Report - Vaccination among COVID-19 cases in the NSW Delta outbreak

 The NSW Health in focus report, Vaccination among COVID-19 cases in the NSW Delta outbreak Reporting period: 16 June to 7 October 2021  describes the vaccination status of locally acquired cases of COVID-19 with reported onset of infection with the dates mentioned.

Of 61,800 COVID-19 cases, the vast majority were unvaccinated; 6.1% of cases had two doses of vaccine, 9.2% had one dose, 63.1% reported having no vaccine. The proportion of those who were vaccinated increased with the age of the patients. This could be a reflection of the way that the role out was conducted in that the older people were eligible earlier.

8,660 cases were hospitalised, 1,015 admitted to ICU and 412 died with COVID-19. Of these, 493 of the hospitalised, 30 of those admitted to ICU and 47 of those who died had received two doses of vaccine. Of the 47 cases who died with COVID-19 having received two doses of vaccine, their average age was 82 years; 29 (61.7%) were residents of aged care facilities and the other 18 had significant comorbidities. Of the 30 admitted to ICU, 26 (86.7%) had significant co-morbidities and 4 had no reported comorbid conditions. 

Source: Vaccination among COVID-19 cases in the NSW Delta outbreak Reporting period: 16 June to 7 October 2021 health.nsw.gov.au

In the peak fortnight of the outbreak (25 August to 7 September), the COVID-19 case rate among 2-dose vaccinated people was 49.5 per 100,000 while in unvaccinated people it was 561 per 100,000, a more than 10 times more. The rates of COVID-19 ICU admissions or deaths peaked in the fortnight 8 September to 21 September at 0.9 per 100,000 in 2-dose vaccinated people compared to 15.6 per 100,000 in unvaccinated people, a more than 16-fold difference.

The effect of the vaccine proved greatest against serious disease, but vaccination also protected against infection. Protection seemed greater in younger compared to older people. In the fortnight 8-21 September, the rates of infection in the 2-dose vaccinated population compared to the unvaccinated population was 21 versus 488 per 100,000 in those aged 12-19 years and 61 versus 193 per 100,000 in those aged 80+ years. 

Throughout the NSW outbreak, across all ages, people who have received 2 doses of vaccine have significantly lower rates of COVID-19 and severe COVID-19 than unvaccinated people. But, vaccination does not completely protect people from infection and the other recommended public health measures should continue to be followed. 

These facts might help clinicians convince those who are still unsure to get vaccinated. Download the full report using the link above.

Mental Health Literacy Development

The Health literacy development program, developed with the Mental Health Commission of New South Wales, offers digital resources to help organisations improve mental health literacy responsiveness.

Mental health literacy responsiveness is the provision of services, programs, information and support in ways that promote equal access and engagement for all members of the community. Mental health literacy responsive organisations and services are those that meet the many and varied mental health literacy strengths, needs and preferences of all people; and support individuals with lived experience, their families and kinship groups, and wider communities to make decisions regarding their health and wellbeing. 

Source: blog.f1000.com

The resources are available to any health and social care organisation that is providing services to members of the community, including.

• Primary Health Networks
• Community manage organisations
• Local Health Districts
• Other care workers, health administrators, academics and community members

The resources are designed to be used together or individually as part of educational programs or by services as part of quality improvement activities. They are inter-related so you can select and match resources depending on your needs.

Go through each tab and explore. I don't find the site at all intuitive nor do the tab / section names really explain what they are. There are some moving video stories and well as downloadable resources and fact sheets. Special mention goes to the "Let's learn from research" section. These stories can be used to generate ideas for quality improvement activities.

The "Take actions to respond to communities" section shows 11 action areas, while the "Resources for action" section provides the tools you need to get the action started. Resources include complete toolkits for training and refreshers for staff involved at every stage of a person's journey; facilitator guides to run workshops complete with training videos and slides.

Check out these resources today!

  

Reliable Dermatology Information, Images and More - Free!

Are you a clinician looking for reliable information and images to help you make informed, evidence-based decisions on how to treat skin conditions without expense?

DermNet NZ : All about the skin, is what you are looking for.

DermNet NZ is supported by and contributed to by New Zealand dermatologists on behalf of the New Zealand Dermatological Society Incorporated. 

The images section might be just what you are looking for to include in an educational presentation or as an example to show a patient. The images are free. They have a small watermark on them that does not spoil the image as you can see in the example below, and you can purchase a watermark free copy if you wish.

There is a A-Z topics section that is easy to navigate. The topics and some useful patient information is printable.

Under the "More" tab there is a quizz section that is recommended for family physicians and dermatologists in training. Questions are presented as cases and solutions are provided.

The site does include adds but that would be expected on a free site.

CPD Reading Materials

Did you know that you can accumulate CPD hours by reading articles related to your field of expertise?

NSW Health employees can search CiAP for the following articles or request them from the library.

Source: BMJ

Subacute small bowel obstruction or chronic large bowel obstruction, by Marc Winslet, Kevin Barraclough and Gregory Campbell Hewson. BMJ 21-28 August 2021, pp 241-243. 

This is one of a series of occasional articles highlighting conditions that may be missed at first presentation.

Long covid - mechanisms, risk factors, and management, by Harry Crook, Sanara Raza, Joeph Nowell, Megan Young and Paul Edison. BMJ 21-28 August 2021, pp 244-247.

This article is a summary of a State of the Art Review that discusses the epidemiology, risk factors, and long term impact of symptoms of long covid, and the evidence about how to manage it.

Does depression screening in primary care improve mental health outcomes? by Brett D. Thombs, Sarah Markham, Danielle B. Rice and Roy C. Ziegelstein. BMJ 7-14 August 2021, pp 199-201.

This is one of a series of occasional articles the highlights areas of practice where management lacks convincing supporting evidence.

Ward based management of behavioural and psychological symptoms of dementia, by Jenny Nguyen, Ina Ko, Santiago Martinez-Sosa and Ruth Mizogichi. BMJ 7-14 August 2021, pp 202-206.

Each of these articles is worth .5 CPD hours. You can create an account with BMJ Practice if you wish to to record your points that way and download certificates. It's free to all NSW Health employees. Alternatively keep your own records. Happy reading!

Health Services Library Newsletter - Oct / Nov 2021

Contact the Library for information regarding services available for Hasting Macleay Network staff.

Should health and care staff have to have a covid vaccine?

Mandatory COVID-19 vaccination has been approved by law makers in the United Kingdom, Italy France and Greece, and now also in NSW Australia. Medical exemptions are available. In NSW anyone who works in health care and social assistance must have their first dose of vaccine by September 30. 

 Credit: abc.net.au

A recent article in the BMJ 2021;374:n1903 presents a debate on this complicated issue. The 'Yes' argument by Michael Parker, professor of bioethics and the 'No' argument by Helen Bedford, professor of children's health, state their positions. There is an interesting 'Patient Commentary' on page 184 for a quick insight into a patient's perspective entitled Protect patients, with staff exemptions only for medical reasons.

NSW Health staff can read this via CiAP. Use your single sign on information. Problems? Contact your librarian through the Library website.

COVID-19 Resources

COVID-19 Resources

The Commission has developed and provided a range of resources to give advice on how to reduce the risk of Coronavirus (COVID-19) exposure and infection. These resources are freely available for Australian health service organisations, healthcare professionals and consumers.

The Commission supports all healthcare professionals in continuing to provide safe, high-quality care during the pandemic, with advice on infection prevention and control, risk assessment and management, managing medications and caring for people with cognitive impairment.

On the resources page find helpful information graphics, guidelines, fact sheets and brochures.

 

Mask wearing and headaches

Personal protective equipment (PPE) has become a fact of life for anyone working in health care in Australia, even those without much patient contact.

I've been asked about whether wearing a simple surgical mask can cause headaches. The answer is yes it can! The first step is make sure you are wearing an appropriately sized mask for your body size and face shape. See your manager if none of the masks supplied works for you. You may just need help with correctly fitting the masks or perhaps an alternative option can be ordered.

Combining masks with protective eyewear or a shield puts further pressure on your head and can alter your posture and putting extra pressure on soft tissue.

Tips are to make sure to take adequate breaks. Headaches are associated with wearing PPE longer than four hours at a time. Breaks are essential to preventing headaches as the mask is a physical barrier to drinking. In previous times you might have had a drink bottle handy to take sips between patients, but with the inconvenience of glove, mask and perhaps eyewear removal you just soldier on. On the other hand if you normally drink coffee, tea or caffeinated fizzy drink throughout your day, you might be drinking less because you have a mask on, which could lead to painful withdrawal headaches.

Keep your drink bottle or coffee cup in your work area as a visual reminder that you need to take a break for a drink or set a timer on your smart watch if you have one. While on your break stretch your head and neck, maybe wash your face and apply moisturiser before resuming work.

Take care people!

PRISMA 2020

If you are undertaking an systematic review you need to be aware of the updated guidelines. The Preferred Reporting Items for Systematic reviews and Meta-Analyses ( PRISMA) statement, published in 2009 has been updated. The PRISMA 202 replaces the 2009 statement and includes new reporting guidance that reflects advances in methods to identify, select, appraise, and synthesise studies. An article published in the British Medical Journal (BMJ), presents the updated 27 item checklist detailing the reporting recommendations for each item, the PRISMA 2020 abstract checklist, and the revised flow diagrams for original and updated reviews.

The PRISMA 2020 statement: an updated guideline for reporting systematic reviews

BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n71 (Published 29 March 2021)

                                                                                Source: norecopa.no

The PRISMA 2020 statement is also available via Open Access in PLOS Medicine and various other journals. 

Prisma 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews  BMJ 2021;372:n160. doi: 10.1136/bmj.n160 

Links to the checklist in PDF or word format can be obtained from the PRISMA website The flow diagram ready for you to use is available in word format.

If MNCLHD employees need any help accessing this information contact the Library.

AIHW Photo Competition - People's Choice Award

The Australian Institute of Health and Welfare photo competition has closed BUT the People's Choice Award is open for voting.

A $500 prize is available to the entry that is judged to be the most popular by the public.

Vote here.

Image below is one of the photos that can be voted for.

Image title: In Nancy’s Hands

Location: Cook, ACT

Suicide prevention and mental health receive $2.3 billion of funding in 2021 Australian budget

Three months of follow-up care for people discharged from hospital after a suicide attempt will be funded with $156.8 million from the federal government.

It is one of several new or expanded programs that have been promised in the budget, with $2.3 billion committed to mental health and suicide prevention over the next four years.

The budget spending on mental health has a focus on suicide prevention, but that is only one piece of the puzzle when it comes to Australia's mental health spending. The government will expand the headspace program, which focuses on youth mental health, with $278.6 million in funding going to expanding the program.

People impacted by recent bushfires will also receive specific mental health spending, with $4 million set aside to provide up to 10 free trauma and distress counselling sessions to them.

Extra support will also be funded for people with eating disorders and their families, with $26.9 million committed to establish a National Eating Disorder Research Centre and improve services.

Read the full article here on ABC News.

For more information see the following trusted websites:

Australian Government Department of Health - Budget 2021-2022

Research Australia - Budget update

                                                           Photo by Matthew Ball on Unsplash

New Australian and New Zealand Guideline for Mild to Moderate Head Injuries in Children

 An Original Research article published in Emergency Medicine Australasia Volume 33 issue 2 April 2021, by Franz E. Babl, Emma Tavender, Dustin W. Ballard et al.

Abstract

Objective: Children frequently present with head injuries to acute care settings. Although international paediatric clinical practice guidelines for head injuries exist, they do not address all considerations related to triage, imaging, observation versus admission, transfer, discharge and follow-up of mild to moderate head injuries relevant to the Australian and New Zealand context. The Paediatric Research in Emergency Departments International Collaborative (PREDICT) set out to develop an evidence-based, locally applicable, practical clinical guideline for the care of children with mild to moderate head injuries presenting to acute care settings.

Source: pexels.com

A multidisciplinary Guideline Working Group (GWG) developed 33 questions in the three key areas of triage, imaging and discharge. The results of their search and review of existing guidelines and discovered new evidence resulted in 71 recommendations relevant to the Australian and New Zealand setting. The guideline is presented as three documents; a detailed Full Guideline, a Guideline Summary and a Clinical Algorithm.

This article is available to all NSW Health employees via CiAP or by contacting your Library service. MNCLHD employees can go to the document request page.

For parents, concerning features to watch out for go to the Sydney Children’s Hospitals Network page – Head Injuries in Children. If in doubt go to emergency or see your GP. Never feel that your concern for your head injured child is wasting anyone’s time.

Curious about the COVID-19 AstraZeneca vaccine? Get your information from reliable sources!

It's easy to get confused about what is fact and what is not when guidelines change and social media is going off about recent events regarding the vaccine rollout.

The most important thing to do when making your own informed decisions about this is to get information from authoritative reliable sources.

If you like to watch and or listen to information the NSW COVID-19 update available on YouTube is work a look. A video is helpful because you can go back and repeat any information that you might not understand completely. Dr. Ketaki Sharma explains in depth the thrombosis with thrombocytopenia syndrome situation as the limited data allows. Basically it's a really rare condition. The age recommendation of 50 plus is because in younger groups being vaccinated in the UK the data on incidence shows while still rare is increasing. The panel of experts A/Prof Charlotte Hespe, A/Prof Penny Burns, Dr Kerry Chant, put questions to Dr Sharma, and ask for further clarification. 

                                       Source: University of Cambridge : Winton Centre for Risk and Evidence Communication

Despite having a history of varicose veins and a prior blood clot, I'm comfortable getting this vaccine. There is no evidence that people who have had a past history of blood clots, have an increased risk of thrombosis with thrombocytopenia syndrome (TTS). Only people that have had TTS after the first dose should not have the second dose. There have been no cases reported after the second dose.

This information will allow health professionals to confidently vaccinate their patients and explain clearly to those who have questions. The important message is to also explain the risks associated with the disease being vaccinated against, which in most age groups outweigh the risks of the vaccination.

Australian Cancer Atlas update highlights geographical disparities

 A recent Hospital & Healthcare article discusses a recent update to the Australian Cancer Atlas, an interactive online resource helping researchers, members of the community, medical professionals and policymakers understand how Australia’s cancer burden varies across geographical areas.

The recent update means the resource now includes latest national data on how cancer diagnosis and excess death rates vary by geographical area across Australia. The Atlas enables users to easily visualise these variations, offering critical insight into how the patterns of cancer and outcomes in Australia vary depending on where people live, which can be used to drive research priorities and policies going forward. This gives health agencies and policymakers a better understanding of geographic disparities and health requirements across the country.

The Atlas is a collaborative project between Cancer Council Queensland and the Queensland University of Technology (QUT).

Read the full Hospital & Healthcare article here and view the Atlas here.

                                                             image source: atlas.cancer.org.au

International Women's Day in Healthcare

What do women in health care choose to challenge this International Women’s Day?

Four inspirational women tell us what #ChooseToChallenge means to them and women in health care.

Read more at Hospital and Healthcare here.

One of the MISSIONS for IWD is "To assist women to be in a position of power to make informed decisions about their health."

Read more about the IWD missions here.

Source: IWD

The Aboriginal Health Specialty Guide is now available on CIAP!

The Aboriginal Health Specialty Guide is now available on CIAP!

The guide includes resources for clinicians, patients, researchers, Aboriginal and Torres Strait Islander workforce, and anyone interested in learning more about Aboriginal Health.

Access this and other Specialty Guides directly from the Specialty Guides page on CIAP.

Get in touch with CIAP if you’d like to become a contributor to their guide. 

MNCLHD Staff publication included in special issue of Health Promotion Journal of Australia

Health Promotion Journal of Australia Volume 32 Issue S1.

Special Issue: Equity and Health Literacy February 2021

This issue contains ground breaking work researching men in Tasmania who experience substantially poorer health outcomes and socio-economic disadvantage than most Australians.

The article is entitled "Engaging “hard‐to‐reach” men in health promotion using the OPHELIA principles: Participants' perspectives". Lead author Leigh Kinsman, Professor of Evidence Based Nursing, is especially proud of the work the team put in, as well as contributions made by some of the participants. This work was selected from many under consideration to have a "Video Short" that gives a brief pictorial introduction and overview of the research and solutions found during the research.

Source: https://onlinelibrary.wiley.com

Experiences of isolation, lack of trust in the health system, no-adherence to medication, mental health problems and long term pain were revealed. This informed the generation of ideas to to improve their health and well-being and give a better understanding of health. Specially tailored interventions were implemented including "Numeracy for Life" and "Healthy Sheds" courses. Post course interviews showed that the process contributed to a sense of worth, social support and a way to break old habits.

Scroll down in the linked article above to see the video. The article is available online. MNCLHD staff can contact the Library if they have any problems downloading it.

Congratulations Leigh Kinsman, Jan Radford, Shandell Elmer, Kathryn Ogden, Sarah Randles, Alycia Jacob, Denise Delphin, Nettie Burr, and Mick Goss on the production of a body of work that will impact on the lives of many.

What do we know about "long COVID"?

 "Long covid" is a term that is being used to describe illness those who have either recovered from covid-19 but are still reporting effects of the infection, or those who have had the usual symptoms for a far longer period of time than would be expected. A lot of people, doctors included, have been infected and have shared their anecdotal experiences on social and other media platforms. Read feature article in the BMJ "Covid-19: What do we know about long covid"? 

Professor of Infectious Diseases, Paul Garner who works at Liverpool School of Tropical Medicine, talked about his "frighteningly long" seven week experience with the virus for BMJ Opinion describing a "roller coaster of ill health, extreme emotions, and utter exhaustion". His long list of symptoms lasted for weeks and left him feeling like he was unable to function.

In the UK the Royal College of Practitioners expects GPs to see and influx of patients with "Long COVID" and has called for a rapid review for GPs to enable a streamlined approach to treatment as the approach introduced during the pandemic. A great deal of pressure is going to weigh on GPs as a direct result of covid-19.

Read evidence from a team of Italian researchers published in JAMA who reported that nine in ten patients discharged from a Rome hospital after recovery were still experiencing at least one symptom at sixty days post onset of the virus.

Currently the media is focused on two possibilities with COVID-19 either you get very sick requiring hospitalisation or you get a very mild case that is barely a sniffle. "You'll be right" just go home and isolate. The possibilities for a more chronic long term illness is not being brought to the attention of the public as it should be. Those who are considering not taking up the vaccine, thinking that because most of the population will be vaccinated, they might be protected. I think these people need to think again. 

Another article in the Pharmaceutical Journal tells the story in-depth of one patient who could not function even six months later. "Thousands of people who had been thought to have recovered are now reporting persistent or severe symptoms. Read the NSW government COVID-19 Critical Intelligence Unit's evidence check here.

Any escape of the virus to non-vaccinated members of the Australian population could have serious implications for the long term health of the people involved as well as Health System in Australia. 

Coffs Harbour and Port Macquarie Library Feedback Request

Feedback Request

We value your feedback at the library as it enables us to improve our services.

Please scan the QR code below to complete the short feedback form on your mobile or 

click this link to complete the form online.

Practical Innovations for Health Care Leaders

Coffs Harbour Health Library staff, students and doctors - take advantage of full access to NEJM Catalyst Innovations in Care Delivery. It is focused on the most promising ideas driving health care delivery transformation and includes a rigorous selection of case studies, articles, and research reports. This digital journal covers critical topics like new models of care, health technology, patient-centered care, analytics, and outcomes.

As health care becomes more dynamic and complex, NEJM Catalyst Innovations in Care Delivery explores insights that impact day-to-day and long-term decisions about health care delivery. Each issue provides real-world examples and practical solutions to the urgent challenges of health care delivery today. An editorial board of seasoned clinical, executive, and academic leaders work in partnership with the journal’s editors to ensure the highest quality and relevance of articles, case studies, interviews, and more.

Create your free account here and click Create Account.

Watch this interview with Tom Lee, MD, MSc, editor-in-chief of NEJM Catalyst Innovations in Care Delivery on changes in health care delivery now and in the future.

What you need to know about the Australian COVID-19 vaccines

The Australian Government has a strategy to deliver vaccines and treatments that researchers and companies across the world are developing. 

This video explains how the COVID-19 vaccines are being assessed and what happens once the vaccines are rolled out.

The Australian Government requires vigorous scientific data and analysis before supporting a vaccine candidate. This is a critical part of the scientific process. 

Advising the Government on COVID-19 vaccines are:

• The COVID-19 Vaccine and Treatments for Australia – Science and Industry Technical Advisory Group
• The Australian Technical Advisory Group on Immunisation (ATAGI)

To ensure information about COVID-19 is trustworthy, it is recommended to rely in information from the following reputable sources:

• Therapeutic Goods Administration
• Australian Academy of Science
• World Health Organisation
• National Centre for Immunisation Research and Surveillance

The National coronavirus and COVID-19 vaccine helpline is 1800 020 080. The line operates 24 hours a day, 7 days a week.

More information can be found at The Australian Government Department of Health.

What’s your risk of catching COVID?

Several tools have been developed to help predict the chance of infection and illness depending on what you’re doing and where you are.

Since January 2020, millions have struggled with questions about what is and isn't safe to do during the pandemic.

These COVID risk calculators below can assist users while Scientists and clinicians are still learning about the epidemiology and pathology of the coronavirus SARS-CoV-2.

COVID risk calculators

Tool	Data it collects from the user	What it returns
19 and Me	Location, health status, safety precautions being taken and exposure to non-household members.	Numerical score reflecting risk of contracting COVID-19, or of developing severe disease.
MyCOVIDRisk	Location, the nature of the activity being done, the number of people involved and mask usage.	Relative risk of exposure and infection, on a scale from very low to very high.
COVID-19 Event Risk Assessment Planning Tool	Location and size of gathering.	The likelihood of coming into contact with someone who has COVID-19.
COVID-19 Mortality Risk Calculator	Information on demographic, pre-existing conditions and lifestyle.	Risk of dying from COVID-19 relative to the general population.

The full article published in Nature.com can be read here. 

Evidence check: new COVID-19 variants

Over the past few weeks there has been widespread reporting on the emergence of new variants of SARS-CoV-2, the virus that causes COVID-19.

It is known that viruses can mutate and new variants frequently occur, however two relatively recent SARS-CoV-2 variants (one first seen in the UK and one in South Africa), have been shown to be more infectious than previous strains. 

Current advice states that approved vaccines should provide protection against the variants. Public health measures including physical distancing, face masks, and limitations on large gatherings will also remain effective. However, control of a more transmissible variant may require enhanced adoption of these measures.

Read the rapid evidence check from the Agency for Clinical Innovation - COVID-19 Critical Intelligence Unit.

Rapid evidence checks are based on a simplified review method and may not be entirely exhaustive but aim to provide a balanced assessment of what is already know about a specific problem or issue. This brief has not been peer reviewed. Information current as at 21 January 2021.

Understanding the heart - views of Aboriginal women

 An original article published recently in Heart, Lung and Circulation:

Good Heart: Telling Stories of Cardiovascular Protective and Risk Factors for Aboriginal Women, by Katherine F. McBride et. al

Heart, Lung and Circulation (2021) 30, 69–77 

https://doi.org/10.1016/j.hlc.2020.09.931

Gives health workers insight and understanding of how the women they treat view the world, as well as the knowledge and beliefs they hold as essential to maintaining heart health. An essential read for those working in Cardiovascular Care.

The adapted grounded theory study seeks to explore Australia Aboriginal women's views of cardiovascular protective and risk factors. A total of twenty-eight women from Central and South Australia participated. The women identified the heart as being central to their wellbeing, both spiritually and physically. Attributes identifies  that keep a woman's heart strong, as well as those that make it sick as well as socio-ecological factors that impact on a woman's ability to care for her heart. Identifying as Aboriginal women, the connection to family and community. having a healthy life and body and being engaged in their own health care are identified as being essential to maintaining a healthy heart.

Figure 2 Visual depiction of Aboriginal women’s stories of a strong, healthy heart.

Source: Heart, Lung and Circulation (2021) 30, 69–77 

The authors conclude that there are gaps in the way cardiovascular risk assessment is provided and managed, gaps in the cultural safety of primary health care services, and gaps in the communication of the sex-specific warning signs of a heart attack, all of which must be addressed.

"This research is unique in terms of exploring Australian Aboriginal women’s conceptualisation of heart health. Aboriginal women have identified what is important for a healthy heart; this is not matched in the delivery or quality of services to meet cultural, spiritual and psychological health needs. There is an urgent need for the health system’s responses to improve the knowledge and provision of cardiovascular risk assessment and management for women; address the emotional and cultural safety of primary health care services and; effectively communicate the warning signs of myocardial infarction to and with Aboriginal women. Further to this, addressing social, economic and political drivers are fundamental for enabling Aboriginal women to care for their heart."

Hospital Libraries and the Librarian-mediated literature search service

Did you know that the Librarians in the Mid North Coast Local Health District offer a literature search service? As NSW Health employees the library is there to support you in your work and study and this is one of the many services provided.

Why might you request a search? There are many reasons, but most often searches are requested for: research or publication, teaching or training, informing a policy or standard practice, personal study, direct patient care, quality improvement projects, and personal knowledge improvement.

How can you request a literature search? You can request a search by: directly e-mailing your librarian or library generic e-mail box, using the online form through the library’s website, filling in a hard copy form at the library, via telephone or in person. Verbal communication is often the best way to be able to correctly interpret the topic and direction of the literature you are seeking, however this is not always an option. The Librarian will e-mail or call you to clarify any points after your initial contact if required so be sure to add that contact information to your inquiry. It helps the librarian to know the purpose of the search request, whether you have any known articles on the subject, preferred age groups being studied where relevant, and the time period to be searched. 

Do you expect to find a lot of results or just a few? This can determine how specific you need to be. If the main topic has a large number of results. For example, heart failure, you need to be very specific about the patient group, age, sex, or specific circumstance.

How does this service help you? Librarian-mediated literature searching is one of the key services that health sciences librarians provide. The literature shows that health service staff can save time, gain access to evidence that can influence clinical decision making, and positively impact on patient outcomes by utilising their health Librarian.

I have my search results and want some of the articles but can't get full-text. The Library offers a document delivery service to obtain articles from your own searching or from literature searches provided by the Library. Contact the library via e-mail as linked above or request using the online form.

The Library staff at Hastings Macleay Clinical Network (based at PMBH) and Coffs Clarence Clinical Network (based at CHHC) are available to help. Check out the website to discover what we can do for you.

Can we really change our life in 28 days?

There are ways to develop good habits — and make them stick — that are backed by scientific evidence.

And it all begins in the brain.

Most of our daily life is made up of habitual actions and we run on autopilot without really noticing, such as the daily drive work when we pull up and sometimes can't remember much of the drive. 

The actions we repeat that can go on to form a habit are known as goal-directed actions.

Read this article by ABC Science reporter Belinda Smith about the science of making, breaking and replacing habits. 

Photo by Drew Beamer on Unsplash

Child protection in a COVID-19 environment - an AIHW report

Child protection services seek to protect children from abuse and neglect in family settings. One in every thirty-three children in Australia—or 174,700 children—received child protection services in 2019–20, a similar rate to 2018–19.

Child abuse or neglect suspicions are often reported by schools, child care centres, and other people or services children come into contact with. The COVID-19 pandemic has affected daily life through restrictions on people’s movements and interactions, while also affecting how businesses and services can operate— this potentially limits opportunities for child abuse and neglect to be detected and reported.

                                                                                            Source: AIHW

The pandemic has also affected the way families live and work, with many people experiencing financial hardship and other stresses. All families experience challenges when caring for their children, but the COVID-19 pandemic may have made some more vulnerable. While this does not necessarily mean a child will be harmed, these factors may impact on the likelihood of abuse and neglect occurring. The concerns raised are based on experiences from previous crises including disease outbreaks, natural disasters and financial downturns.

This Australian Institute of Health and Welfare report presents child protection data from March to September 2020 (including the ‘first wave’ of COVID-19 restrictions for Australia, and some of the ‘second wave’ of restrictions for Victoria) with comparisons to the same period in 2019. Information is also presented on a number of risk factors for child abuse and neglect, including financial and housing stress, parental mental health and substance use, and domestic violence. This report complements the regular annual national reporting on child protection, for example, Child protection Australia 2019–20 (AIHW forthcoming 2021).

What help is being offered and sought? 

Parental access to support reduces the risk of child abuse and neglect. The social and financial impact of COVID-19 restrictions may not only increase parental need for support but also make accessing support more difficult.

Recommended reading for health and other workers involved in Child Protection Services.

Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) (AstraZeneca) against SARS-CoV-2.

 A recent article published in The Lancet, Safety and efficacy of the ChAdOx1 nCoV-19 vaccine (AZD1222) against SARS-CoV-2: an interim analysis of four randomised controlled trials in Brazil, South Africa, and the UK by Merryn Voysel et al on behalf of the Oxford COVID Vaccine Trial Group.  VOLUME 397, ISSUE 10269, P99-111, JANUARY 09, 2021 DOI:https://doi.org/10.1016/S0140-6736(20)32661-1 provides the preliminary safety and efficacy analysis from ongoing blinded, randomised, controlled trials done across the UK, Brazil, and South Africa.

The finding show that the vaccine has efficacy ranging from 62.1% to 90% depending on dosage and or pooling of results but no safety concerns.

Contact the Library to request a copy of this article.

                                                                                                                Source: Sciencemag.org

The World Health Organisation have indicated a minimum efficacy of 50% in it's target product profile. Some infectious diseases experts have voiced concerns as to whether the Oxford AstraZeneca vaccine will be effective enough to deliver the desired herd immunity in Australia given that the Australian government has purchased 54 million doses of that vaccine as opposed to 10 million of Pfizer's more effective vaccine. It has been suggested that the government look at boosting supplies of the Pfizer and Moderna vaccines that have higher efficacy rates. 

However, a logistics problem for the vaccine efficacy frontrunners could be a pivotal factor with Australia being in the height of it's summer and average temperatures of between 21-35 degrees Celsius. The Pfizer vaccine needs to be kept extremely cold at minus 70 degrees Celsius and the Moderna vaccine at minus 20 degrees Celsius. The AstraZeneca vaccine can be stored and transported at a normal refrigerator temperature of 2 to 8 degrees Celsius. This could give this vaccine the edge as it can be stored and administered in existing healthcare settings.

Who gets what vaccine has been determined by the government -  workers dealing with international arrivals and quarantine, frontline health workers, aged care and disability workers and those living in aged care or with a disability would be first receiving the Pfizer vaccine.

The Therapeutic Goods Administration (TGA) should have enough information to make a decision on whether to approve the AstraZeneca Vaccine for use in Australia by February. The Prime Minister has confirmed that the vaccine would be voluntary.

Congratulations to MNCLHD Staff on the following Publications!

Congratulations to the highlighted Mid North Coast Local Health District staff on the publication of their articles.

Aherne, N. J., A. Dhawan, J. G. Scott and H. Enderling (2020). "Mathematical oncology and its application in non-melanoma skin cancer - A primer for radiation oncology professionals." Oral Oncol 103: 104473.

 Alqahtani, J. S., C. M. Njoku, B. Bereznicki, B. C. Wimmer, G. M. Peterson, L. Kinsman, Y. S. Aldabayan, A. M. Alrajeh, A. M. Aldhahir, S. Mandal and J. R. Hurst (2020). "Risk factors for all-cause hospital readmission following exacerbation of COPD: a systematic review and meta-analysis." Eur Respir Rev 29(156).

 Banjade, D., J. Allan, K. Thuraisingam, A. Mishra, B. Newham, S. J. E. Tan, A. Renshaw, R. Hammond, G. Stevens and G. Warr (2020). "Implementation of advanced radiotherapy technology to improve clinical outcomes in rural NSW." Aust J Rural Health 28(3): 311-316.

 Borghaei, H., C. J. Langer, L. Paz-Ares, D. Rodríguez-Abreu, B. Halmos, M. C. Garassino, B. Houghton, T. Kurata, Y. Cheng, J. Lin, M. C. Pietanza, B. Piperdi and S. M. Gadgeel (2020). "Pembrolizumab plus chemotherapy versus chemotherapy alone in patients with advanced non-small cell lung cancer without tumor PD-L1 expression: A pooled analysis of 3 randomized controlled trials." Cancer 126(22): 4867-4877.

 Cardoso, M., A. Choudhury, D. Christie, T. Eade, F. Foroudi, A. Hayden, T. Holt, A. Kneebone, G. Sasso, T. P. Shakespeare and M. Sidhom (2020). "FROGG patterns of practice survey and consensus recommendations on radiation therapy for MIBC." J Med Imaging Radiat Oncol 64(6): 882-893.

 Chojnowski, J. M., J. R. Sykes and D. I. Thwaites (2020). "Practical beam steering of X-ray beams on Elekta accelerators: The effect of focal spot alignment on beam (symmetry and position) and radiation isocentre (size and position)." Phys Eng Sci Med.

 Chojnowski, J. M., G. B. Warr, J. R. Sykes and D. I. Thwaites (2020). "Assessment of error in the MV radiation isocenter position calculated with the Elekta XVI software." J Appl Clin Med Phys 21(5): 93-97.

 Desai, J., H. Gan, C. Barrow, M. Jameson, V. Atkinson, A. Haydon, M. Millward, S. Begbie, M. Brown, B. Markman, W. Patterson, A. Hill, L. Horvath, A. Nagrial, G. Richardson, C. Jackson, M. Friedlander, P. Parente, B. Tran, L. Wang, Y. Chen, Z. Tang, W. Huang, J. Wu, D. Zeng, L. Luo and B. Solomon (2020). "Phase I, Open-Label, Dose-Escalation/Dose-Expansion Study of Lifirafenib (BGB-283), an RAF Family Kinase Inhibitor, in Patients With Solid Tumors." J Clin Oncol 38(19): 2140-2150.

 Gortman, A. M., N. J. Aherne, J. Amalaseelan, A. Last, J. Westhuyzen, L. Chamberlain and T. P. Shakespeare (2020). "Long-term outcomes of patients with conserved breast cancer treated with adjuvant hypofractionated prone breast intensity-modulated radiation therapy." J Med Imaging Radiat Oncol 64(6): 845-851.

 Grimison, P., A. Mersiades, A. Kirby, N. Lintzeris, R. Morton, P. Haber, I. Olver, A. Walsh, I. McGregor, Y. Cheung, A. Tognela, C. Hahn, K. Briscoe, M. Aghmesheh, P. Fox, E. Abdi, S. Clarke, S. Della-Fiorentina, J. Shannon, C. Gedye, S. Begbie, J. Simes and M. Stockler (2020). "Oral THC:CBD cannabis extract for refractory chemotherapy-induced nausea and vomiting: a randomised, placebo-controlled, phase II crossover trial." Ann Oncol 31(11): 1553-1560.

 Hoffmann, M., K. Waller, A. Last and J. Westhuyzen (2020). "A critical literature review on the use of bellyboard devices to control small bowel dose for pelvic radiotherapy." Rep Pract Oncol Radiother 25(4): 598-605.

 Hurley, J., M. Hutchinson, D. Kozlowski, M. Gadd and S. van Vorst (2020). "Emotional intelligence as a mechanism to build resilience and non-technical skills in undergraduate nurses undertaking clinical placement." Int J Ment Health Nurs 29(1): 47-55.

 Isobel, S., A. Wilson, K. Gill and D. Howe (2020). "'What would a trauma-informed mental health service look like?' Perspectives of people who access services." Int J Ment Health Nurs. Epub date 2020/11/22.

 Isobel, S., A. Wilson, K. Gill, K. Schelling and D. Howe (2020). "What is needed for Trauma Informed Mental Health Services in Australia? Perspectives of clinicians and managers." Int J Ment Health Nurs. Epub date 2020/11/11.

 Johnston, J. J., J. M. Longman, D. P. Ewald, M. I. Rolfe, S. Diez Alvarez, A. H. B. Gilliland, S. C. Chung, S. K. Das, J. M. King and M. E. Passey (2020). "Validity of a tool designed to assess the preventability of potentially preventable hospitalizations for chronic conditions." Fam Pract 37(3): 390-394.

 Lock, M., O. Burmeister, F. McMillan and G. Whiteford (2020). "Absence of rigorous evidence undermines cultural safety reforms." Australian Journal of Rural Health 28(1): 4-5.

 Lower, T., L. Kinsman, M. M. Dinh, D. Lyle, R. Cheney, J. Allan, A. Munro, B. Taylor, J. H. Wiggers, A. Bailey, L. Weller, A. Jacob and A. S. Stephens (2020). "Patterns of emergency department use in rural and metropolitan New South Wales from 2012 to 2018." Aust J Rural Health 28(5): 490-499.

 Lwin, N., J. Burgess, C. Johnston, N. Johnson and S. Chung (2020). "Hospital-in-the-Home experience of first 23 COVID-19 patients at a regional NSW hospital." Intern Med J 50(10): 1271-1273.

 Njoku, C. M., J. S. Alqahtani, B. C. Wimmer, G. M. Peterson, L. Kinsman, J. R. Hurst and B. J. Bereznicki (2020). "Risk factors and associated outcomes of hospital readmission in COPD: A systematic review." Respir Med 173: 105988.

 Rawther, T., B. J. Rebolledo, K. K. Das and N. Joshi (2020). "Circumaortic left renal vein: a rare but important anatomical variation to consider prior to a radical nephrectomy." ANZ J Surg 90(9): 1781-1782.

 Salindera, S. and M. Brennan (2020). "Development of the 'People-Processes-Paradigm' critical analysis tool for mortality and morbidity reviews: improving understanding of systems factors." ANZ J Surg 90(6): 984-990.

 Shakespeare, T. P., J. Westhuyzen, T. Lim Yew Fai and N. J. Aherne (2020). "Choosing between conventional and hypofractionated prostate cancer radiation therapy: Results from a study of shared decision-making." Rep Pract Oncol Radiother 25(2): 193-199.

 Southey, M., A. Kathirgamalingam, B. Crawford, R. Kaul, J. McNamara, F. John-Leader, J. Heslop and S. W. Pit (2020). "Patterns of ecstasy use amongst live music event attendees and their opinions on pill testing: a cross sectional study." Subst Abuse Treat Prev Policy 15(1): 55.

 Sutherland, R., E. Campbell, M. McLaughlin, N. Nathan, L. Wolfenden, D. R. Lubans, P. J. Morgan, K. Gillham, C. Oldmeadow, A. Searles, P. Reeves, M. Williams, N. Kajons, A. Bailey, J. Boyer, C. Lecathelinais, L. Davies, T. McKenzie, J. Hollis and J. Wiggers (2020). "Scale-up of the Physical Activity 4 Everyone (PA4E1) intervention in secondary schools: 12-month implementation outcomes from a cluster randomized controlled trial." International Journal of Behavioral Nutrition & Physical Activity 17(1): 100.

 Travers, A., A. Jalali, S. Begbie, C. Semira, S. Kosmider, S. Ananda, R. Wong, M. Lee, J. Shapiro, M. Burge, D. Yip, J. Torres, B. Ma, L. Nott, A. Dean, J. Tie, A. Khattak, S. Lim, H. L. Wong and P. Gibbs (2020). "Real-World Treatment and Outcomes of Metastatic Colorectal Cancer Patients with a Poor or Very Poor Performance Status." Clin Colorectal Cancer. DOI. 10.1016/j.clcc.2020.08.002.

 Unwin, M., E. Crisp, J. Stankovich, D. McCann and L. Kinsman (2020). "Socioeconomic disadvantage as a driver of non-urgent emergency department presentations: A retrospective data analysis." PLoS One 15(4): e0231429.

Venchiarutti, R. L., J. R. Clark, C. E. Palme, T. P. Shakespeare, J. Hill, A. R. M. Tahir, P. Dwyer and J. M. Young (2020). "Influence of remoteness of residence on timeliness of diagnosis and treatment of oral cavity and oropharynx cancer: A retrospective cohort study." J Med Imaging Radiat Oncol 64(2): 261-270.

 Wilson, A., J. Hurley, M. Hutchinson and R. Lakeman (2020). "'Can mental health nurses working in acute mental health units really be trauma-informed? An integrative review of the literature." J Psychiatr Ment Health Nurs. doi: 10.1111/jpm.12717.

 Wilson, C. L., E. J. Tavender, N. T. Phillips, S. J. Hearps, K. Foster, S. L. O'Brien, M. L. Borland, G. O. Watkins, L. McLeod, M. Putland, S. Priestley, C. Brabyn, D. W. Ballard, S. Craig, S. R. Dalziel, E. Oakley and F. E. Babl (2020). "Variation in CT use for paediatric head injuries across different types of emergency departments in Australia and New Zealand." Emerg Med J 37(11): 686-689.

 Yoong, S. L., K. Bolsewicz, A. Grady, R. Wyse, R. Sutherland, R. K. Hodder, M. Kingsland, N. Nathan, S. McCrabb, A. Bauman, J. Wiggers, J. Moullin, B. Albers, M. E. Fernandez, A. Hall, J. Sims-Gould, N. Taylor, C. Rissel, A. Milat, A. Bailey, S. Batchelor, J. Attia and L. Wolfenden (2020). "Adaptation of public health initiatives: expert views on current guidance and opportunities to advance their application and benefit." Health Educ Res 35(4): 243-257.

MNCLHD Staff Publications Database - HMCN Health Services Library