08 October 2015

What really matters at the end of life - B.J. Miller

BJ Miller is a palliative care physician at Zen Hospice Project in San Francisco, and he presented this very moving TED talk earlier this year. Miller tries to create a dignified, graceful end of life for his patients, asking what do they really want?  Miller, who suffered a horrific accident as a young man and was close to death himself, says, "Let's begin at the end.  For most people it's not death that they fear - it's dying".   

Watch the TED talk, and/or read the transcript of What really matters at the end of life.  

Improving length of stay - what can hospitals do?

The Nuffield Trust in the UK has published a report, Improving length of stay: what can hospitals do?.  The authors point out that improvements in internal processes could reduce the variations in stay for patients with similar conditions.  Some of the principles of good practice that emerged from their study of the literature and insights from clinicians include:  a focus on flow, getting the basics right and ensuring active support for discharge seven days a week.

Codeine-related deaths

Almost half of codeine-related deaths in Australia from 2000 to 2013 are attributable to accidental overdose, say researchers. Deaths related to codeine, which soon could be available only on prescription, more than doubled in Australia between 2000 and 2009.

There was a jump from 3.5 to 8.7 per million population, with a 9.3 per cent rise each year, say researchers who found the increase mainly driven by accidental deaths. Almost half were attributed to accidental overdose and a third to intentional self-harm, with education about the dangers of taking too much codeine needed. The study was published in the Medical Journal of Australia in early October.

Trends and characteristics of accidental and intentional codeine overdose deaths in Australia; Amanda Roxburgh, Wayne D Hall, Lucinda Burns, Jennifer Pilgrim, Eva Saar, Suzanne Nielsen and Louisa Degenhardt. Med J Aust 2015; 203 (7): 299

Cancers in Australia in 2010. Attributable to modifiable factors

Many cancers are caused by exposure to environmental and lifestyle factors, offering opportunities to diminish the burden of cancer if these exposures can be minimised.  Cancer is now the leading cause of death in Australia. In 2014, it is estimated that more than 45,500 people died from cancer in Australia and more than 123,500 new cancers were diagnosed, with the number of new cases expected to rise to 150,000 by 2020. In addition, about 374,000 Australians each year are estimated to develop BCC or SCC of the skin, and the costs of treating these cancers are higher than for any other cancer in Australia.
This series of reports was commissioned by Cancer Council Australia with the aim of estimating the burden of cancer arising in Australia that may be preventable.  Numbers and population attributable fractions of cancer are presented in accompanying papers, published as open access in the Australian and New Zealand Journal of Public Health.

Australian and New Zealand Journal of Public HealthVolume 39, Issue 5,  October 2015

Leading cause of premature mortality in Australia fact sheets

This product (a combination of a web report and fact sheets) from AIHW focuses on the major causes of premature deaths—both overall, and among certain age groups. The leading cause of premature death in 2010–12 was coronary heart disease, accounting for 10% of all deaths in people aged under 75. Lung cancer accounted for almost 9% of premature deaths, and was the second leading cause. More than half of all deaths due to lung cancer were among people younger than 75.
Suicide was the third leading cause of premature mortality in 2010–2012, accounting for 4.5% of premature deaths, with 92% of suicide deaths occurring among people younger than 75.
The web pages are accompanied by 15 fact sheets and 15 General Record of Incidence of Mortality (GRIM) books, looking in greater depth at a range of causes of premature mortality, including diabetes, cardiovascular disease, breast cancer, colorectal cancer, accidental poisoning, assault and chronic obstructive pulmonary disease.

AIHW 2015. Leading cause of premature mortality in Australia fact sheets. Cat. no. PHE 191-205. Canberra: AIHW.

01 October 2015

Models of health service delivery for people with intellectual disability

The Social Policy Research Centre at the University of NSW has recently published Current models of health service delivery for people with intellectual disability: Literature review, by Gianfranco Giuntoli, B. J. Newton and Karen R. Fisher. 

The review focused on publications from January 2011 to January 2015 and identified nine models of health service delivery for people with intellectual disability, seven from the UK and two from Australia. All the models identified stressed the need for interagency collaboration as a way of delivering services based on co-operation and integration between generic and specialist teams. 

eBooks not yet taking over from print

Photo by Abhi Sharma 
The Plot Twist: E-Book Sales Slip, and Print Is Far From Dead is an article recently published in the New York Times by Alexander Alter.  E-book sales increased by 1,260% between 2008 and 2010 according to Alter and "the book world was seized by collective panic over the uncertain future of print."  Analysts predicted that e-books would overtake print sales by 2015. 

Now, there are signs that many people are becoming hybrid readers, using both e-reading devices and paper. E-book sales fell by 10 % in the first five months of this year, according to the Association of American Publishers, and digital books accounted last year for around 20 percent of the market, which has been steady for a few years.

Reduction in Radiation Exposure to Children and Young People from CT Scans

The Australian Commission on Safety and Quality in Health Care has published a range of resources aimed at reducing unnecessary radiation exposure to children and young people from CT scans. They estimate that over 80,000 CT scans are performed on children and young people in Australia each year, and although they are a valuable diagnostic tool, they use a higher level of ionising radiation than other types of imaging. 

The resources include brochures for parents and carers outlining the benefits and risks of CT scans - available at, a fact sheet for referring doctors to provide information on the typical radiation doses and the key questions to consider when deciding whether to refer a child for a CT scan, and an online training module from the Australian Institute of Radiography to support radiographers who undertake CT scans for children and young people. 

More information can be found on the dedicated ACSQHC pages, as well as at Healthdirect, which has partnered with the Commission to develop these resources and others. See

Acute kidney injury in Australia

Acute kidney injury (AKI) is increasing in incidence globally. This report, Acute Kidney Injury in Australia: a first national snapshot, is a first look at the statistical impact of AKI in Australia, using hospital and mortality data.

In 2012-13, there were around 131,780 hospitalisations for AKI (as the principal and/or an additional diagnosis). The average length of stay for AKI hospitalisations was 11.4 days, which was twice as long as the average length of stay for hospitalisations overall (5.6 days).  In addition, in 2012 there were around 5,160 deaths where AKI was recorded as the underlying or an associated cause of death.

AKI hospitalisations (as a principal diagnosis) more than doubled between 2000-01 and 2012-13. Hospitalisation and death rates for AKI increase rapidly with age, with the majority occurring in those aged 65 and over. Males had at least 40% higher rate of AKI hospitalisations than females when it presents as an additional diagnosis.  People living in remote areas, socioeconomically disadvantaged areas and those with Aboriginal and Torres Strait Islander status also had higher hospitalisation and death rates.

NICE Guidelines on diabetes

The UK’s National Institute for Health and Care Excellence (NICE) has published some new (or updated) guidelines around diabetes:

NICE Guideline NG19 Diabetic foot problems: prevention and management

In addition, there's a new guideline about Coeliac disease: NICE Guideline NG20 Coeliac disease: recognition, assessment and management

Antimicrobial use in Australian hospitals

This report, covering antimicrobial use during 2014, was released last month by the Australian Commission on Safety and Quality in Health Care.  The results from 129 adult acute hospitals showed that Australian usage rates continue to be greater than in the Netherlands and Sweden, and on par with Denmark. There is a wide variance in average antimicrobial usage rates between hospitals, but a slight decline generally in usage rates since they peaked in 2010.  

Six antibacterials represented more than 50% of all those used, and these were:  Amoxicillin with clavulanic acid, Flucloxacillin, Cephazolin, Amoxicillin, Doxycycline and Cephalexin.  This NAUSP Report includes historical comparisons over five and ten-year periods for selected antimicrobials, giving valuable information about trends and patterns of use.

30 September 2015

Life satisfaction across life course transitions

This paper looks at how life satisfaction changes as we pass through various life transitions on the pathway from adolescence through young adulthood, middle age and into old age. It explores how leaving home, commencing a relationship, having children, separating, entering the “empty nest” phase, retirement and widowhood affect life satisfaction.

We all experience ups and downs at various points throughout life. Do these transitions effect our life satisfaction and is it greater for me or for women? Some people bounce back and some never do, and how long does it take?

This report from the Australian Institute of Family Studies is free to download.
Life Satisfaction Across Life Course Transitions  Lixia Qu, David de Vaus, Australian Family Trends No. 8, September 2015.   

Health expenditure Australia 2013-14

A new report from the Australian Institute of Health and Welfare (AIHW) shows that spending on health rose in 2013–14, after record low growth in the previous year. The report, Health expenditure Australia 201314, shows that $154.6 billion was spent on health goods and services in 2013–14. This was up by 3.1% in real terms from the previous year and despite this relatively slow growth, total expenditure was 9.8% of GDP in 2013-14, up from 9.7% in 2012-13.

Download the full report for free online.  
ISSN 1323-5850; ISBN 978-1-74249-812-6; Cat. no. HWE 63; 141pp.

Special Supplement on Health Equity

Evidence shows that those with greater (economic and social) resources are more likely to have better health outcomes than those with lesser resources. Whilst health inequalities include differences in health outcomes that include those caused by natural biological variation, health inequities are health differences that are socially produced.
In 2005, The World Health Organisation (WHO) reiterated the urgent need to address the social causes of poor health and health inequities and established the Commission on Social Determinants of Health to provide guidance on how to tackle health inequities globally. VicHealth released Fair Foundations: the VicHealth framework for health equity in 2013 and has now commissioned eight rapid evidence reviews to investigate best and promising policy and practice to reduce health inequities within healthy eating, tobacco, physical activity, alcohol, mental well-being, settings for health promotion, early childhood development and social innovation investments.

Health Promotion International: Special Supplement on Health Equity, Volume 30 suppl 2 September 2015  

Unnecessary and Harmful Tests

Internationally, there is a groundswell of activity seeking to identify and reduce the use of health care interventions that deliver marginal benefit, be it through overuse, misuse or waste. A special ABC Four Corners investigation reveals many of the treatments and tests we get are unnecessary, sometimes harmful and needlessly expensive, costing the health system billions of dollars every year.
Figures from the Australian Institute of Health and Welfare show Australia spends just under $155 billion on health each year, and it is estimated that one-third of that amount — about $46 billion — is being squandered. This is total spending by federal and state governments, private health insurance and in hard cash from patients in gap fees.

"Adam Elshaug, Associate Professor of Healthcare Policy at Sydney University, is an authority on what is called low-value care and has identified at least 150 unsafe, inappropriate or ineffective medical services that receive Medicare and health insurance rebates." You can read more on this story by  from ABC Radio.

Click here to read the full ABC story. You can also read the recent article in the Medical Journal of Australia on the same topic: 
Adam G Elshaug, Amber M Watt, Linda Mundy and Cameron D Willis. (2015), Over 150 potentially low-value health care practices: an Australian studyMed J Aust, 197(10), 556-560.