27 February 2017

Stress and burnout in intensive care medicine

The authors of an opinion piece just published in the Medical Journal of Australia warn of an increasing risk of burnout in intensive care medicine, which could have a major impact on patient care.  ICU doctors and nurses have been shown to have higher rates of burnout symptoms than workers in other health specialties including emotional exhaustion, depersonalisation and reduced professional achievement. 

The article points out that intensive care medicine is becoming increasingly complex, with repeated exposure to “high stakes, ethically challenging decision-making processes”. The authors call for a multilevel response to improve the welfare and sustainability of the intensive care medicine workforce.

Simpson N, Knott CI. Stress and burnout in intensive care medicine: an Australian perspective
Medical Journal of Australia. 2017;206(3):107-8.

Understanding health research tool

Understanding health research: A tool for making sense of health studies is a tool designed to help people understand and review published health research to decide how dependable and relevant a particular study is.  

The tool askes a series of questions to ask about the specific study the user is concerned about, and explains what the answers to those questions mean in terms of the quality of the research.  Funded by the Medical Research Council in the UK, the site also has some very useful links to sources of pre-appraised research, other critical appraisal tools and handy scientific information like common sources of bias, correlation versus causation and sampling methods. 

Economic cost of dementia in Australia

The economic impact of dementia is a major concern in Australia and internationally as the numbers of people with the condition rise. The National Centre for Social and Economic Modelling has released a report commissioned by Alzheimer's Australia, Economic cost of dementia in Australia 2016-2056. 

The total cost of dementia was estimated to be $6.6 billion in 2002, and $14.25 billion in 2016. The report projects likely future costs of dementia over the next 40 years, providing data on the likely incidence over that time, describing some of the social and economic characteristics of people with dementia, and identifiying its impact on mortality and burden of disease.

The report emphasises the future need for care and provision of care services, both formal and informal and in both the community and in residential care facilities.

Golden staph infections in Australian Hospitals

The Australian Institute of Health and Welfare has released an updated report on the rates of healthcare associated Staphylococcus aureus bloodstream infections (Golden Staph) for public hospitals in 2015-2016. 

In this period, the national benchmark was set at 2 cases per 10,000 days of patient care.  All public hospital peer groups came in well below this benchmark, although major hospitals still have the highest rates of infection.  A new interactive table allows users to see how rates in public hospitals compare over a six-year period.

23 February 2017

Trends in Symptoms of Postpartum Depression

In the Morbidity and Mortality Weekly Report, CDC provides the percentage of women with symptoms of postpartum depression overall and over time using Pregnancy Risk Assessment
Monitoring System data from 2004, 2008, and 2012.
Postpartum depression is common and associated with adverse infant and maternal outcomes (e.g., lower breastfeeding initiation and duration and poor maternal and infant bonding). Despite the decline in postpartum depression, symptoms remain common, affecting about 1 out of 9 women in 2012. This report highlights the differences in the percentage of women with symptoms of postpartum depression by state and by characteristics. Ongoing monitoring and activities to promote appropriate screening, referral, and treatment are needed to reduce symptoms of postpartum depression among women. 
 Ko JY, Rockhill KM, Tong VT, Morrow B, Farr SL. Trends in Postpartum Depressive Symptoms — 27 States, 2004, 2008, and 2012. MMWR Morb Mortal Wkly Rep 2017;66:153–158.

Surgical Site Infections

This guideline from the National Institute for Health and Care Excellence (UK) covers preventing and treating surgical site infections in adults, young people and children who are having a surgical procedure involving a cut through the skin. It recommends effective methods to use before, during and after surgery to minimise the risk of infection.

Clinical Guideline CG74. Surgical site infections: prevention and treatment. NICE 2017

Stress and Burnout in Intensive Care

Clinician burnout is a phenomenon resulting in consequences for both intensive caregivers and patients. This recent article in the Medical Journal of Australia discusses how Intensive care medicine (ICM) is an evolving high stakes specialty. Emerging evidence raises questions about the welfare and sustainability of the ICM workforce.
The College of Intensive Care Medicine and the Australian and New Zealand Intensive Care Society have roles to play in the development of performance indicators for workplace stress and burnout, with complementary advocacy for a safe, sustainable workplace.

Stress and burnout in intensive care medicine: an Australian perspective. Nicholas Simpson and Cameron I Knott. Med J Aust 2017; 206 (3): 107-108 (the article is open access)

Incidence of insulin-treated diabetes in Australia, 2015

This fact sheet from the Australian Institute of Health and Welfare provides the latest available
national data on new cases of insulin-treated diabetes in Australia.
It shows that in 2015 there were 28,775 people who began using insulin to treat their diabetes in Australia-63% had type 2 diabetes, 26% had gestational diabetes, 9% had type 1 diabetes and 2% had other forms of diabetes or their diabetes status was unknown.
The fact sheet is accompanied by a dynamic data display, which provides data on insulin-treated diabetes by age at first insulin use, Indigenous status, remoteness, SEIFA and state/territory.

Closing the Gap

The 9th Closing the Gap Report was presented to Parliament on Tuesday 14 February. The Executive Summary is as follows; "This ninth Closing the Gap report showcases real successes being achieved at a local level across the country—by individuals, communities, organisations and government.
However, at a national level, progress needs to accelerate. Over the long term there are improvements across a number of the targets, however these improvements are not enough to meet the majority of the outcomes set by the Council of Australian Governments (COAG)."

You can download the full report here.


This free virtual issue from Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy, is a compilation of important articles on Vancomycin’s place in therapy and it’s unique pharmacokinetic properties and subsequent monitoring parameters. Analyses of vancomycin resistance and associated toxicity are also included.

Vancomycin, a glycopeptide antibiotic, is an important component of the treatment of staphylococcal and enterococcal infections. Despite nearly 60 years of clinical use, methods to optimize its efficacy and minimize its toxicity continue to be discovered.

Pharmacotherapy: The Journal of Human Pharmacology and Drug Therapy. Read the articles for free until June 30, 2017.   

15 February 2017

Carers' medication errors

Studies of medication safety have mostly been undertaken in the hospital setting, but medications are increasingly being taken at home and administered by carers. This systematic review looked at 36 studies relating to the prevalence of carer medication administration errors, the type and prevalence of these errors and interventions that have been used to prevent them.

The authors of Carers' Medication Administration Errors in the Domiciliary Setting: A Systematic Review reported that “The carer administration error rate ranged from 1.9 to 33% of medications administered and from 12 to 92.7% of carers administering medication.”  These errors included wrong dosage, wrong medication, omitted medication and wrong timing. Carer factors (such as their age), storage facilities, numbers of medications and other individual issues all contributed to the rate of errors. The authors concluded that “home medication administration errors made by carers are a potentially serious patient safety issue ... The home care setting should be a priority for the development of patient safety interventions.”

Parand A, Garfield S, Vincent C, Franklin BD PLoS ONE. 2016;11(12):e0167204.

Public libraries and health information

Are libraries effective settings for accessing health information? is a Sax Institute Evidence Check review. It examines evidence of the effectiveness of using public libraries as settings for health promotion and health education programs.
There have not been many of these programs evaluated so it is difficult to use the current literature to assess the health outcomes of programs in libraries. However public libraries are increasingly considered to be active community spaces trusted for information-seeking across the world.

Rachel Leung, Mary Grace Flaherty, Rima Rudd, John W. Toumbourou 30 November 2016

Cause of death in adults with intellectual disability

A study from the University of NSW has revealed that hundreds of Australian adults with an intellectual disability have died from causes that could have been avoided. 

Cause of death and potentially avoidable deaths in Australian adults with intellectual disability using retrospective linked data looked at over 42,000 individuals who registered for disability services from 2005-2011. It was found that 38% of deaths were potentially avoidable.  The authors concluded that adults with ID "have an over-representation of deaths related to diseases of the respiratory and nervous systems, as well as those of congenital and chromosomal origins and an under-representation of deaths due to age-dependent causes such as diseases of the circulatory system and neoplasms." In short, adults with ID experience premature mortality and over-representation of potentially avoidable deaths.

Trollor J, Srasuebkul P, Xu H, et al.

Cannabis use and associated disorders

Substance use was the focus of a recent issue of Australian Family Physician. One of the articles, Cannabis use and its associated disorders: clinical care, by Jan Copeland, emphasises that cannabis is the most widely used and variably regulated illicit drug in the world. Although the rates of use in Australia have stabilised, levels of cannabis use disorder are on the rise.

The article describes the prevalence of cannabis use, associated disorders and provides information on assessment and management.  

Other articles in this issue of AFP (Dec 2016, Vol 45 (12) look at chronic alcohol abuse, prescription drug abuse, and the inherited chronic pain patient. All articles are free to access online.

Patient preferences in surgical decisions

Surgical decision making: Challenging dogma and incorporating patient preferences is an opinion piece published last month in Journal of the American Medical Association.  Author Karan Chhabra and his colleagues discuss three recent trials where common surgical procedures (appendectomy, colectomy and knee replacement) were compared to less aggressive or non-operative alternatives.

In all cases, the less aggressive treatments were not definitively better than the operative alternatives, but they were safe and had comparative outcomes.  In these situations a shared decision-model with patients should be encouraged.  Although this is challenging, "physicians should create a culture in which patients’ values determine the treatment outcomes that matter most. After all, patients are the ones who must live with the consequences."
Chhabra KR, Sacks GD, Dimick JB. JAMA. 2017;317(4):357-8. (Available via CIAP or contact your health librarian)