Incidence of end-stage kidney disease in Australia

End-stage kidney disease is the most severe form of kidney disease and survival usually relies on kidney replacement therapy.  The incidence of the condition is an important indicator of the health of the Australian population and valuable for health-care planning. 

This report from the AIHW estimates that in 2013 there were around 5100 new cases of ESKD in Australia, and only around half of these people were receiving kidney replacement therapy.  The incidence rate of ESKD was 5 times as high in indigenous as non-indigenous Australians from 2009-2013. There are more males than females with ESKD, and the incidence is highest among those aged 75 and over. 

Incidence of end-stage kidney disease in Australia 1997-2013 AIHW October 2016 Cat no. PHE 211

Performing the wrong procedure

Performing the Wrong Procedure is the first article in a new section of JAMA concentrating on performance improvement. This is a case report about a 90-year-old woman ho had a dialysis catheter mistakenly placed instead of a normal central line for antibiotic administration. Various options to correct the error are presented with a root cause analysis and the final outcomes of the case.

Minnier T, Phrampus P, Waddell L. Journal of the American Medical Association. 2016;316(11):1207-8. http://dx.doi.org/10.1001/jama.2016.9134  Access the full text via CIAP if you are an employee of NSW Health.

Misconceptions on ageing and health

The World Health Organisation has published a fact file on Misconceptions on ageing and health with the aim of overcoming some of the most important barriers to developing good public policy on ageing.  Stereotyping and accompanying ageism is addressed, with ten facts about older people which are commonly misunderstood. These include the facts that only a small proportion of older people are care dependent, 70 is not yet the new 60 and expenditure on older populations is an investment, not a cost.

Tobacco indicators - midpoint progress

This report presents the progress being made against the National Tobacco Strategy 2012-2018 indicators. Most indicators are showing a favourable progress, particularly for exposure to tobacco smoke, uptake of smoking, transition to established smoking and regular smoking among young people, adults and Aboriginal and Torres Strait Islander people. However, some groups achieved greater progress than others, and inequalities within particular groups increased for some indicators.

Tobacco indicators: measuring midpoint progress - reporting under the National Tobacco Strategy 2012–2018. Drug statistics series no.30, AIHW 29 September 2016

Informed consent or shared decision-making

When patient-centred care is worth doing well: informed consent or shared decision-making is an editorial from BMJ Quality & Safety which looks at the interactions and differences between informed consent and shared decision making (SDM) in aiming for patient-centred care. 

The authors describe informed consent as being the minimum legal standard where clinicians tell the patient about the procedure, including risks, benefits and possible alternatives, then the patient accepts or rejects this. SDM is presented here as a more evolved response to the need for patient centeredness. "We must not confuse SDM with the distribution of decision aids or patient education materials for patients, expecting patients to find the best answer on their own: there is nothing shared about choosing alone from a menu!"

Kunneman M, Montori VM. BMJ Quality & Safety. 2016 [epub] http://dx.doi.org/10.1136/bmjqs-2016-005969

Hospitalisations for mental health conditions

Healthy communities: hospitalisations for mental health conditions and intentional self-harm in 2013–14 has been published by the AIHW recently. It examines how many people in each community need hospital treatment for mental health conditions, in order to identify local areas that may require more services and support, focusing on the mental health of populations in small areas across Australia.

The report found that in that year, there were enormous inequities in the age-standardized rate of mental health hospitalisations between Primary Health Networks, with the rates being six times higher in some areas than others. The most common group of mental health conditions requiring hospitalisation was from drug and alcohol use. In 2013–14, there were 33,956 hospital admissions (including overnight and same-day) for intentional self-harm, which accounted for 184,332 bed days nationally.

Causes of illness and death in Aboriginal and Torres Strait Islander people 2011

The Australian Institute of Health & Welfare has published this Australian Burden of Disease Study which estimates the total, non-fatal and fatal burden of disease and injuries for the Aboriginal and Torres Strait Islander population for 2011 and 2003. It also provides estimates of the burden attributable to 29 risk factors, and estimates the gap in disease burden between Indigenous and non-Indigenous Australians.

The report indicates that Indigenous Australians experience a burden of disease that is 2.3 times the rate of non-Indigenous Australians and that two thirds of the burden is from chronic diseases.  Coronary heart disease, suicide and self-inflicted injuries, anxiety disorders, alcohol use disorders and diabetes were the leading specific diseases, together contributing 24% of the total burden and are also the main causes of the gap in disease burden.

The report indicates that around 37% of the burden of disease in Indigenous Australians was preventable by reducing exposure to the modifiable risk factors included in this study, notably tobacco and alcohol use, high body mass, physical inactivity, high blood pressure and high blood plasma glucose.

Australian Burden of Disease Study: impact and causes of illness and death in Aboriginal and Torres Strait Islander people 2011 Australian Burden of Disease Study series no. 6. Cat. no. BOD 7. Canberra: AIHW

Egg and peanut allergies in infants reduced by early exposure

The Journal Of the American Medical Association (JAMA) has published the results of a study indicating that the early introduction to infants of egg (from four to six months) and peanuts (from four to 11 months) is linked to lower rates of egg and peanut allergy.

The authors of Timing of Allergenic Food Introduction to the Infant Diet and Risk of Allergic or Autoimmune Disease: A Systematic Review and Meta analysis found moderate certainty-evidence from various clinical trials to support their conclusions.  They also found high-certainty evidence that timing of gluten introduction was not associated with coeliac disease risk. 

You can read a good summary of the evidence from this study in an article published last week in The Conversation by Merryn Netting and Katie Allen.

Despo Ierodiakonou et al. JAMA. 2016;316(11):1181-1192. doi:10.1001/jama.2016.12623. (NSW Health Employees can access the full text via CIAP or contact your librarian).                    

Multimorbidity guideline

Multimorbidity: Clinical assessment and management is a new guideline from the National Institute for Health and Care Excellence (NICE) in the UK. It aims to optimize care for adults with multiple long-term conditions by reducing the treatment burden of polypharmacy and multiple appointments. It also promotes the importance of shared decisions between the client and the health practitioner in regard to treatments, health priorities, lifestyle and goals.

This guideline includes recommendations on tailoring an approach to care, identifying people who may benefit, assessing frailty and delivering the approach to care.

Suicide by health professionals

Suicide by health professionals: a retrospective mortality study in Australia, 2001–2012 has just been published in the Medical Journal of Australia and examines age-standardised rates and methods of suicide by health professionals, compared with suicide rates for other occupations.

The researchers looked at intentional self-harm cases recorded by the National Coronial Information System during the period 2001–2012 and found that suicide rates for female health professionals  were higher than for women in other occupations. For men, medical practitioners did not have a higher suicide rate than other professions, but male nurses and midwives did. The most frequent method of suicide used by health professionals was found to be self-poisoning. The authors concluded that that there was a need for a targeted prevention of suicide for health professionals.

Allison J Milner, Humaira Maheen, Marie M Bismark, Matthew J Spittal. Medical Journal of Australia 19 September 2016

Coping with Violence in Mental Health Care Settings

Coping with and understanding violent and threatening behavior in mental health care settings is a challenging, but integral part of a caregiver's job, and if not handled well, such situations can result in staff and patient injuries. This multiple case study in Archives of Psychiatric Nursing, explores de-escalation processes in threatening and violent situations based on patients and staff members
perspectives.
Berring, L., Pedersen, L. & Buus, N. (2016). Coping with Violence in Mental Health Care Settings: Patient and Staff Member Perspectives on De-escalation Practices. Archives of Psychiatric Nursing, 30(5), 499-507 (Open Access)

When an Elder is the Abuser

Professionals face additional barriers when faced with domestic violence in older people. There may be a lower imperative to enquire about domestic violence owing to assumptions that an older partner lacks the ability to cause physical harm and because of the absence of dependent children at home. The physical signs of domestic violence may be all too easily explained in older people as the result of frailty or a fall.
This open access article in the Medical Journal of Australia raises the concern that intimate partner violence in older couples is under-recognised. Domestic violence perpetrated by an older person requires clinicians and families to consider a different narrative to that predominant in elder abuse, one where the elder is the aggressor and may have been so for decades.

Wijeratne, C. & Reutens, S. (2016). When an elder is the abuser. Medical Journal of Australia, 205(6), 246-247. 

Mentoring to Retain Newly Hired Nurses

Failure of the current transition experience from education to clinical practice is evident when nurses exhibit characteristics of burnout and role stress during their first year of employment. Often nurses become discouraged because their experience is stressful and often the environment is one of bullying. Mismanagement of the early professional experience leads to lack of motivation, low productivity and decreased quality of patient care, which should be a worry to all hospitals.
Supporting the professional socialization of nurses is critical because engaged nurses are satisfied with their careers and stay longer at their employing institutions, which in turn decreases staff turnover and improves patient outcomes satisfaction.
Mentoring is a low cost option and a positive mentoring relationship may be a career lifeline that eases the feelings of loneliness and stress that can stifle professional development.

Gazaway, S., Schumacher, A. and Anderson, L. (2016). Mentoring to retain newly hired nurses. Nursing Management, 47(8), 9-13. (Full text access via CIAP for NSW Health Staff. Otherwise check with your library staff)

Parkinson’s Disease Psychosis

Parkinson's Disease Psychosis (PD-P) remains a challenging clinical disorder for patients, caregivers, and treatment providers.

This virtual issue features 20 key and representative psychosis articles, authored by many leaders in the field of PD psychosis (PD-P), and published over the past decade in either Movement Disorders or Movement Disorders Clinical Practice. This collection spans the spectrum of key research that has occurred in this area, covering prevalence, course, psychiatric and cognitive comorbidity, and overlaps with related neurodegenerative diseases, neurobiology, and assessment instruments.

Parkinson's Disease Psychosis: Articles Collection   

Hip Fracture Care Standard

The Australian Commission on Safety and Quality in Health Care in collaboration with the Health Quality & Safety Commission New Zealand has released the Hip Fracture Care Clinical Care Standard. In Australia, an estimated 19,000 people over the age of 50 are hospitalised with a hip fracture each year, often after falls.
  
The Hip Fracture Care Clinical Care Standard aims to ensure that a patient with a hip fracture receives optimal treatment from presentation to hospital through to the completion of treatment in hospital.