MNCLHD

MNCLHD

Friday, March 31, 2017

Cervical cancer prevention guideline

The American Society of Clinical Oncology (ASCO) has published a new guideline, Primary Prevention of Cervical Cancer. An Expert Panel has reviewed existing guidelines and conducted five systematic reviews to come up with this consensus.

ASCO recommends two doses of human papillomavirus vaccine for girls aged 9 to 14 with an interval of at least six months. Those with HIV positivity should have three doses.

2016 State of the Health Funds report

The State of the Health Funds Report 2016 (SOHFR) has been prepared by the Private Health Insurance Ombudsman, and compares how health funds perform across the criteria of service performance, hospital benefits, medical gap schemes, general treatment (extras) benefits, financial management and health fund operations.

The report is intended to help consumers to decide which health funds to consider. There are a range of indicators included so that people can choose the factors of most importance to individuals and their families.

Argument for decriminalisation of drug use

Can Australia Respond to Drugs More Effectively and Safely is the report from a meeting of 17 experts and practitioners held in late 2015 to consider drug law reform. The group included four former Police Commissioners and Assistant Commissioners, two former heads of Corrective Services, a former Supreme Court Judge and a former Director of Public Prosecution.

Drug-related deaths, diseases, injuries, crimes and social costs continue to rise despite more than 80,000 consumer arrests in Australia each year. Although participants in this group varied in their approach, "Very substantial agreement was reached that Australia’s current approach to illicit drugs is not
working and is inadvertently exacerbating harm.".

Aboriginal and Torres Strait Islander health status 2016

The Australian Indigenous HealthInfoNet has provided an Overview of Aboriginal and Torres Strait Islander Health Status 2016 which provides information about indigenous populations, their health status, risks and protective factors. Link to chapters on birth and pregnancy outcomes, hospitalisation, mortality and the context of Aboriginal and Torres Strait Islander health.

There is also a PowerPoint presentation available for use which includes tables and key facts, free for educators to use in total or part.

Friday, March 24, 2017

Clinical podcast list

The Librarian at Toowoomba Hospital in Queensland has put together a subject-specific list (with links) of clinically oriented, open access podcast sites. Each site is targeted towards health professionals - some academic, others commercial, still others media-driven. The content ranges from lectures, interviews and conversations to opinions and commentary, and they are organised by health specialisation. Thanks to Daniel McDonald in Toowoomba.

NDIS information

The National Disability Insurance Scheme is a huge social reform for Australia and it is currently being rolled out across the country. In NSW it is due to be fully operational by July 2018.

The NSW Parliamentary Research Service has published this NDIS Issues Backgrounder, which collects key sources on the NDIS, including information from the NDIS itself, other government departments annd parliamentary committees. It also links to journal articles, some media coverage, relevant legislation and commentary from non-government organisations.

Thursday, March 23, 2017

Excess mortality in persons with severe mental disorders

Excess mortality in persons and populations with severe mental disorders remains an important global public health problem. Persons with SMD represent a vulnerable group with many health care needs. Despite known risk factors for premature mortality, evidence for effective interventions in persons with SMD is limited.

In this paper, a forum in collaboration with WHO  proposed and described models to better understand the complex relationships among risk factors and correlates of mortality, and to conceptualize interventions at the individual, health system and socio-environmental levels. These models  outlined  key action points for clinical practice, policy and research agendas to move towards health equity for those with SMD.

Lui, Nancy H. [et al] (2017). Excess mortality in persons with severe mental disorders: a multilevel intervention framework and priorities for clinical practice, policy and research agendas.World Psychiatry, 16(1), 30-40.
Forum – The Need for a Comprehensive Approach to Excess Mortality in Persons with Severe Mental Disorders (in collaboration with the World Health Organization)

Obesity and kidney disease: Hidden consequences

A high body mass index is one of the strongest risk factors for new-onset Chronic Kidney Disease. Diseases of the kidneys, including CKD, nephrolithiasis and kidney cancers are among the effects of obesity, and have wide ranging consequences. They can ultimately lead to significant excess morbidity and mortality and excess costs to individuals and the entire society. Population-wide interventions to control obesity could have beneficial effects in preventing the development, or delaying the progression of CKD.

This is a very interesting guest editorial written on behalf of the World Kidney Day Steering Committee, and with the prevalence of obesity expected to increase 40% in the next decade, it is very timely.

Kovesdy, C., Furth, S.L., Zoccali, C. (2017). Obesity and kidney disease: Hidden consequences of the epidemic. Journal of Renal Care, 43(1), 3-10 (Open access)

Appropriate Opioid Use in Chronic Pain Management

This guideline document is produced by the European Pain Federation (EFIC) in order to provide a fair, balanced and evidence-based summary regarding the role of opioid use in pain management. Athough it is published in Europe it recognises some important facts that impact on all countries;

  • it is a mjaor economic cost
  • it is under recognised and under treated
  • major economic cost
  • major public health concern

It provides expert recommendations for primary care physicians and other non- specialist healthcare professionals, particularly those who do not have ready access to specialists in pain medicine, on the safe and appropriate use of opioid medications as part of a multi-faceted approach to pain management, in properly selected and supervised patients.

O'Brien, T. [et al]. (2017). European Pain Federation position paper on appropriate opioid use in chronic pain management. European Journal of Pain, 21(1), 3-19 (Open access) 

Close the Gap - Progress & Priorities report 2017

Despite closing the gap being a national bipartisan priority for over 10 years, it appears that Australian governments at all levels are failing Australia’s First Peoples. As shown by the recent report of the Australian National Audit Office regarding the Indigenous Advancement Strategy, across nearly every government funded program, initiative or portfolio responsibility there is a continuation of imposed, unengaged and often rushed service delivery. It is especially concerning that the target to halve the gap in child mortality by 2018 is not on track and that Aboriginal and Torres Strait Islander child mortality did not improve significantly over the period 2008-2015.

The most recent Closing the Gap report is made up of 3 parts:
  •  Progress in Closing the Gap
  •  A new Relationship
  •  Priorities for Action
Close the Gap – Progress and Priorities Report 2017The Close the Gap Campaign Steering Committee, February 2017.  

Greater nurse autonomy associated with lower mortality

This study published in the Journal of Nursing Scholarship provides evidence that when nurses do not have the ability to exercise their clinical and organisational knowledge, patient safety is put at risk. A professional work environment links to improved patient, personnel and organisational outcomes.
Therefore, it is possible that healthcare organisations are responsible for providing the necessary means for nurses to act autonomously by: formulating clear roles, responsibilities and behaviours; enhancing competence in practice and decision-making; using shared governance organisational structures; and by creating strong visible leadership.

Rao, Aditi D, Kumar, Aparna, McHugh, Matthew. (2017). Better Nurse Autonomy Decreases the Odds of 30-Day Mortality and Failure to Rescue. Journal of Nursing Scholarship, 49(1), 73-79 (this article is freely available to MNCLHD staff)   

Variation in fees for surgery

Three open access articles in a recent issue of Medical Journal of Australia discuss the considerable variation in fees for surgery, noting the considerable out-of-pocket (OOP) costs for patients, and the possible consequences for sustainability. The Royal Australasian College of Surgeons (RACS) and Medibank, Australia’s largest private health insurer, have published reports on surgical variance, which detail the cost and outcomes of care in selected high volume procedures for general surgery, otolaryngology, urology, orthopaedics and vascular surgery.  For example, prices for hip prostheses varied from $4908 and $16178, with a median of $10727.
View the Surgical Variance Reports (access the latest reports here)  

Thursday, March 16, 2017

Controlling healthcare professionals: human resource management

Studies in 20 Australian hospitals by UNSW Business School researchers reveal human resources practices rely too much on control and are preventing medical staff from using their discretion to make autonomous decisions on some basic people management tasks, including hiring to replace a departing staff member.
The upshot of too much control is disengagement and burnout among healthcare professionals and a delay in the introduction of improved standards for patient care. The findings revealed a predominance of a control-based approach to people management.

 Cogin, Julie Ann, Ju Li Ng and Ilro Lee, (2016). Controlling healthcare professionals: how human resource management influences job attitudes and operational efficiency. Human Resources for Health, 14:55 (open access)
  

Experiences of maternity care in NSW public hospitals: Patient Perspectives

This report from the Bureau of Health Information provides detailed information about the experiences of care for women during various stages of the maternity journey, highlighting where NSW performs well, and potential areas for improvement. 
Most women said they were engaged in decisions about their care although women who gave birth to their first baby, and women who had a caesarean section responded to many survey questions less positively. 

 Experiences of maternity care in NSW public hospitals: Patient Perspectives. January to December 2015, Bureau of Health Information. 2017  


End of Life Care for Adults

This quality standard (UK) covers care for adults (aged 18 and over) who are approaching the end of their life. This includes people who are likely to die within 12 months, people with advanced, progressive, incurable conditions and people with life-threatening acute conditions. It also includes support for their families and carers and care provided by health and social care staff in all settings is covered.

End of life care for adults. Quality standard [QS13]. NICE. Updated march 2017

Developing an Organizational Model for Improvement

To meet the goal of achieving the highest quality of care through evidence-informed translation and application in practice, organizations should outline a plan for developing, organizing, implementing, and evaluating evidence-informed improvement interventions. The purpose of this article is to provide an example for developing an organizational model for improvement from concept to application.
Polancich, Shea. (2017). Developing an Organizational Model for Improvement: From Translation to PracticeJournal For Healthcare Quality, 39(1), 28-33   

Cardiometabolic comorbidities, readmission, and costs in schizophrenia and bipolar disorder

Mental illnesses are associated with increased risk of cardiometabolic comorbidities. In this study, Correll et al. evaluate the prevalence of these comorbidities, hospitalisation outcomes and costs among patients with schizophrenia and bipolar disorder. They find that more than 60% of inpatients with these disorders also have cardiometabolic comorbidities, and that increased comorbidity burden was associated with greater likelihood of readmission.

Christoph U. Correll, Daisy S. Ng-MakDana Stafkey-Mailey, Eileen Farrelly, Krithika Rajagopalan and Antony Loebel. (2017). Cardiometabolic comorbidities, readmission, and costs in schizophrenia and bipolar disorder: a real-world analysis. Annals of General Psychiatry, 16(9)   
 

Hospital care for patients aged 85 years and over 2014-15

AIHW has published Hospital care for patients aged 85 years and over 2014-15 which expands the 85 years and over age-group into four 5 year age-groups up to ages 100+ and reports on aspects of admitted patient care provided to these very old patients.
It looks at the admitted patient care provided for the oldest of patients in Australian hospitals in 2014–15 and presents information on the amount of activity there was for patients aged 85 years and over and how this has changed over time. It includes information on who used the hospital services, the length of stay in hospital, the overall type of care provided, the types of conditions patients received care for, the type of procedures undergone by the patients, and who funded the hospital stay.

Monday, March 13, 2017

Can Australia cope with a growing life expectancy?

This is the title of an ABC report on PM recently, looking at a global study of life expectancy of people in the developed world, which is continuing to rise. Australians, for example, will have a life expectancy of 84 years by 2030. This has obvious implications for social and health structures in the years ahead, and planning needs to be in place for the needs of the ageing population. 

The study referred to here is from the Imperial College London and is available freely for download:  Projections of life expectancy in 35 industrialised countries: Projections with a Bayesian model ensemble. People in South Korea are projected to have the highest life expectancy, most likely being over 90 for women by 2030.

Parents' attitudes to vaccination

Very topical yet again is the question of vaccination in Australia. Here are three recent publications discussing parental attitudes and practices in this area:

Child Vaccination: perspectives of Australian parents gives the results of the Australian Child Health Poll from the Royal Children's Hospital in Melbourne.  This is the source of the media reports about unvaccinated children being refused treatment by health care providers. See the comments at the end of the landing page for discussion about this.  The report of the 2000 families surveyed also showed that 95% of them kept their children's vaccines up to date.

Parental attitudes, beliefs, behaviours and concerns towards childhood vaccinations in Australia: a national online survey reports on a study of 452 parents who responded to a survey in 2012. 92% reported they had kept their children's vaccines up to date, but 52% had concerns. The authors of the paper concluded that GPs need to communicate better with parents to improved their knowledge and trust in vaccination.
Maria Yui Kwan Chow et al, Australian Family Physician 46 (3) : 145-51, March 2017.

And in The Conversation, three public health academics emphasise that Australians' attitudes to vaccination are more complex than a simple 'pro' or 'anti' label.  It cites their own research, plus others (including the two surveys reported above) indicating that parents want more detailed information about vaccination safety. The authors are developing a package of support and information for parents called SKAI: Sharing Knowledge About Immunisation. They have already prepared some factsheets for the Australian Department of Health.

Monday, March 06, 2017

Experiences of maternity care in NSW public hospitals

Experiences of maternity care in NSW public hospitals: January to December 2015 has been released by the Bureau of Health Information this month.

It shows that most women giving birth in 2015 in a NSW public hospital had a good experience, with 79% saying they would speak highly about the hospital where they had their baby. 80% of these women felt that their length of stay was about right, but 13% felt it was "too short". Most felt that they had received adequate information and were engaged in decisions about their care. There was variation across LHDs about time waiting to be seen at antenatal appointments and cleanliness of toilets and bathrooms (MNCLHD scored highly on cleanliness and hygiene).

ADHD brains are different

A recent study published in The Lancet Psychiatry involved a mega-analysis of the neuroimaging of several regions of the brains of people with and without ADHD. It showed that the brains of people diagnosed with attention-deficit hyperactivity disorder tended to be smaller overall, and slightly smaller in some specific regions.

A clear explanation of the article by the University of Sydney's Alison Poulton was published in The Conversaton, Imaging study confirms differences in ADHD brains.

Martine Hoogman, et al. Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet Psychiatry. Published online 15 February 2017. http://dx.doi.org/10.1016/S2215-0366(17)30049-4.

Access via CIAP, or contact your health librarian.

Effect of walking on days spent in hospital

A study recently published in the Medical Journal of Australia has shown that "more active people require less hospital care, and an achievable extra 4300 steps per day would result in an average of one less day in hospital for each 3 years of life".

The authors of the study, Daily step count and the need for hospital care in subsequent years in a community-based sample of older Australians, measured the step counts of over 3000 residents of Newcastle, who were over 55 years of age.  They wore pedometers for a week during 2005-2007 and their hospital data was analysed approximately eight years later. There was a statistically significant reduction in the number of hospital bed days associated with higher step counts.

Ben Ewald, one of the authors of the study from the University of Newcastle, summarised the results in The Conversation, New study shows more time walking means less time in hospital, and it was also reported by the ABC, Increasing daily step count reduces days in hospital, study shows 

Ben D Ewald, Christopher Oldmeadow and John R Attia. Med J Aust 2017; 206 (3): 126-130

Hospitalisation for intentional self-harm 2014-2015

Hospitalisations for mental health conditions and intentional self-harm in 2014-15 has been updated by the Australian Institute of Health and Welfare. It provides data for the 31 Primary Health Network areas, as well as over 300 smaller local areas across Australia. The site also includes some downloadable PDF resource pages and infographics.

This update shows that in 2014-2015, there were 223,882 overnight hospitalisations in Australia for mental health conditions. The rate in the North Cosat PHN area was particularly high.  There were 36,696 hospital admissions for intentional self-harm in that year.