28 July 2016

Non-beneficial treatments at the end of life

A literature review was recently published in the International Journal for Quality in Health Care, Non-beneficial treatments in hospital at the end of life: a systematic review on extent of the problem. Across the 38 studies from 10 countries (including two from Australia), 33-38% of palliative patients had received non-beneficial treatment, that is a treatment that was given with little or no hope of benefit.

The most commonly reported non-beneficial treatments were admissions to ICU for patients with advanced incurable disease, CPR for terminal patients, and the initiation or continuation of chemotherapy in the last 2-4 weeks of life.  The authors concluded that this problem "has been recognized for at least two decades and it remains today despite much literature about its negative repercussions for patients, families, healthcare professionals and the health system."

M Cardona-Morrell, JCH Kim, RM Turner, M Anstey, IA Mitchell, K Hillman
International Journal for Quality in Health Care. 2016.

2015 Regional Wellbeing Survey

Wellbeing, resilience and liveability in rural and regional Australia: the 2015 Regional Wellbeing Survey has been recently published by the University of Canberra.  This survey of over 12,000 respondents living outside Australia's major cities, revelead that 70% of rural and regional Australians are satisfied with their lives and feel the things they do in life are worthwhile. On the other hand, that means that 30% do not feel satisfied with their lives. "This suggests that rural and regional communities are supporting the wellbeing of most, but not all, of their residents."

There are many details in the report about health, financial prosperity, the need to relocate, facilities and isolation issues.

Schirmer, J.; Yabsley, B.; Mylek, M. and Peel, D. 2016. Wellbeing, resilience and liveability in regional Australia: The 2015 Regional Wellbeing Survey. University of Canberra, Canberra.

The economic burden of physical inactivity

Researchers from the University of Sydney have calculated that physical inactivity cost the world 90 billion Australian dollars in 2013 and they have published their findings in The Lancet. The cost burden of several lifestyle diseases on health budgets and the cost of premature death due directly to physical inactivity were analysed for 142 countries, representing 93.2% of the world's population. The high income countries bear a larger proportion of this economic burden, and the lower income countries have a higher proportion of the disease burden.

Author Dr Melody Ding and her colleagues conclude, "In addition to morbidity and premature mortality, physical inactivity is responsible for a substantial economic burden. This paper provides further justification to prioritise promotion of regular physical activity worldwide as part of a comprehensive strategy to reduce non-communicable diseases."

26 July 2016

Does nurses’ health affect their intention to remain in their current position?

An online survey of health and work-related assessments was distributed through the New South Wales Nurses and Midwives Association and professional contacts between June 2014 and February 2015. Results showed that nurses and midwives reported good-very good health overall. With 22.2% intending to leave in the next 12 months, the study findings flagged the importance of health as an influence on intention to leave. Alongside job satisfaction and shift-working, health presents opportunities for workplace initiatives to maintain nurses in the workforce.
 Perry, Lin,  Gallagher, Robyn,  Duffield, Christine, Sibbritt, David, Bichel-Findlay, Jen, Nicholls, Rachel. (2016).  Does nurses’ health affect their intention to remain in their current position? Journal of Nursing Management, DOI: 10.1111/jonm.12412 (early online view, Open Access)

Diabetes Standards and Guidelines

The UK’s National Institute for Health and Care Excellence (NICE) has published new (or updated) guidelines and quality standards. The latest updates are:

Self Managing Chronic Pain

The Pharmacy Guild of Australia and Painaustralia have produced a joint fact sheet to assist people suffering from chronic pain. You can download this fact sheet and numerous others on the Painaustralia website.    

Perils of Place: Identifying Hotspots of Health Iequality

Stephen Duckett has authored a new report published by the Grattan Institute. The report titled "Perils of Place: Identifying Hotspots of Health Inequality", looks a the unfair, unnecessary and avoidable inequalities throughout the population in Australia.
In the report health inequalities are defined, with the outcome measure being potentially preventable hospitalisations. An overview of the methodology for identifying and prioritising hotspots of health inequalities is provided and specific options for reducing these hospitalisations and recommendations are listed.
You can choose to download the report or listen to a podcast of Stephen Duckett talking about the report here.    

22 July 2016

Skin cancer in Australia

Skin cancer accounts for the largest number of cancers diagnosed in Australia each year. This year it is estimated that over 13,000 new cases of melanoma will be diagnosed in Australia, and approximately 1,700 people will die from this disease. Skin Cancer in Australia has been published by the Australian Institute of Health and Welfare and provides comprehensive national information and statistics on skin cancer, with estimates to 2016 and trends over time.  

Although the incidence of melanoma has increased over the last thirty years, for people under 40 years of age, the incidence has dropped since 2002.  In 2013–14, there were 23,437 melanoma-related hospitalisations in Australia, a 63% rise from 2002–03.

Delirium Clinical Care Standard

About 10% of Australians aged over 70 years have delirium at the time of admission to hospital, and a further 8% develop delirium during a hospital admission. Despite delirium being so common, the condition is poorly recognised.  The Australian Commission on Safety and Quality in Health Care has developed the Delirium Clinical Care Standard and supplementary resources to guide and support its implementation.

The standard aims to ensure that patients presenting to hospital with delirium receive optimal treatment, and that patients at risk of delirium are identified promptly with preventative strategies put in place. Additional resources include an Indicator Specification, fact sheets for clinicians and consumers, and a list of supporting evidence sources.

US Health care reform - Barack Obama

The US President, Barack Obama, has published an article in the Journal of the American Medical Association (JAMA) to explain his health reform package. United States Health Care Reform: Progress to Date and Next Steps reviews the Affordable Care Act, looking at its effects so far and recommend further improvements.

Unsurprisingly, Obama finds much evidence to support his reform policy and urges increased federal funding in the sector as well as a reduction of prescription drug costs. "Although partisanship and special interest opposition remain, experience with the Affordable Care Act demonstrates that positive change is achievable on some of the nation’s most complex challenges."

JAMA. Published online July 11, 2016. doi:10.1001/jama.2016.9797

New hypertension guideline

The National Heart Foundation of Australia has this week released Guideline for the diagnosis and management of hypertension in adults 2016.  There are several changes since the last update in 2010, including both a primary and secondary prevention focus "in the context of an ageing population with increasing complexities", and one area of change is a new lower pressure target of 120mmHg in selected high cardiovascular risk populations.

Brett Montgomery of the University of Western Australia has written an explanatory piece in The Conversation, Blood pressure targets – what does the new guideline say and how low should you go? Here, he explains the evidence behind the new target and why it's not for everyone.

Mental health care at University

The uni virtual clinic (UVC) has been established as a comprehensive online service developed in partnership between the Centre for Mental Health Research at the Australian National University and the Young and Well Cooperative Research Centre.  It has been designed to prevent and treat mental health problems and related issues in university students as an anonymous, free service, incorporating evidence-based treatments and information. 

The uni virtual clinic: changing the way mental health care is provided to young people at university has been published after the completion of a pilot version at ANU and outlines the argument for extending the UVC program across Australian Universities.

According to the report, half of all university students will experience a mental disorder and one in ten will contemplate suicide.  Only a third of young people seek help for mental health problems and this figure is even lower among university students.  Making this program anonymous is one way of increasing help-seeking in this vulnerable group.

Complex multimorbidity in Australia

This research published in the Australian & New Zealand Journal of Public Health used a random sample of 8707 patients visiting 290 general practitioners to measure the prevalence of multimorbidity and complex multimorbidity in the Australian population and to identify the most prevalent patterns of chronic conditions and body systems affected. 

The authors of The prevalence of complex multimorbidity in Australia estimate that 47.4% of patients at GP encounters and one-third of the population had multimorbidity, with 27.4% of patients at GP encounters and 17% of the Australian population experiencing complex multimorbidity. The most prevalent combination of conditions was hypertension with hyperlipidaemia and osteoarthritis, and the most prevalent combination of body systems was circulatory, musculoskeletal and endocrine/nutritional/metabolic systems. "To meet the challenge posed by complex multimorbidity, the single disease focus of our healthcare system needs to be re-evaluated."

Harrison, C., Henderson, J., Miller, G., Britt, H. The prevalence of complex multimorbidity in Australia.Aust N Z J Public Health. 2016 Jun;40(3):239-44. doi: 10.1111/1753-6405.12509  

Know your bones - self assessment tool

'Know your bones' is a bone health self-assessment tool created by Osteoporosis Australia and the Garvan Institute of Medical Research.  Its aim is to help adults assess their likelihood of fractures, given that 7,5 million Australians have osteopenia or osteoporosis, and new figures reveal a bone break every 3.4 minutes in Australia due to poor bone health. 

The online tool includes demographic questions, medical history and lifestyle factors. A summary of risk of fracture over the next five and 10 years is provided for people over 50 years of age.

15 July 2016

Elder abuse issues paper

Earlier this year, the Australian Law Reform Commission (ARLC) was directed by the Attorney-General to identify a legal framework to protect older people from physical and psychological abuse in Australia.  The Elder Abuse: Issues paper is the first consultation document in the Inquiry. It introduces the scope of the issues involved and requests submissions from stakeholders.   

For more information, you can listen to the Elder Abuse issues paper podcast.  Here, Sabina Wynn, (Executive Director of the ALRC), interviews Professor Rosalind Croucher, President of the ALRC, and the Commissioner who is leading the Inquiry about the growing problem of elder abuse in our communities and why this Inquiry is so necessary.