26 August 2015

Avoiding ineffective treatment - Grattan report

Questionable care: avoiding ineffective treatment is a report from Stephen Duckett and Peter Breadon at the Grattan Institute. They argue that some Australian hospitals are still providing treatments that are unnecessary or ineffective and that Australia needs a system to identify these outlier hospitals.

The report looks at five treatments which should not be used on some patients, such as treating osteoarthritis of the knee with an arthroscope, filling a vertebrae with cement to treat fractures and putting patients in pressurised oxygen chambers.  "Expert guidance labels most of these five treatments do-not-do, yet in 2010-11 nearly 6000 people – or 16 people a day – received them."

The authors argue that the these treatments are not managed well by the health system, which often offers incentives for extra, ineffective care.  They call for more awareness and policies to prevent this happening.

Music and communication in the operating theatre

412145284 03f93ec4d9
A UK study has looked at the possible disruptive effect of playing music in the operating theatre. According to sources cited here, background music is quite common, being played during 53-72% of surgical operations. Video recordings over six months examined 20 operations in two different theatres and the authors reported that “repeated requests were five times more likely to occur in cases that played music than those that did not. A repeated request can add 4-68 seconds each to operation time and increased tensions due to frustration at ineffective communication.”  They concluded that music played in operating theatres is underrecognised as a potential safety hazard. 

Music and communication in the operating theatre.  Weldon S-M, Korkiakangas T, Bezemer J, Kneebone R. Journal of Advanced Nursing. 2015. [epub].

Population statistics - Australia and world

Two population data reports have been released recently:

Population by Age and Sex, Regions of Australia, 2014 from the Australian Bureau of Statistics contains the latest available estimates by age and gender of the resident populations of areas of Australia as at 30 June.  In June 2014 there were 23.5 million people living in Australia, with two thirds of them living in capital cities. 11.7 million were males and 11.8 million were females. 7.5 million people lived in New South Wales, including 4.8 million in Greater Sydney.

2015 Revision of World Population Prospects is the official United Nations population estimates and projections. The main results give key demographic indicators for each development group, income group, major area, region and country for selected periods or dates within 1950-2100. According to this report, the world population reached 7.3 billion as of mid-2015 - an increase of approximately one billion people in the the last twelve years. 60% of the global population lives in Asia, 16% in Africa and 10% in Europe. China and India are the largest countries, having 19% and 18% of the world's total population.

25 August 2015

Negotiating the maze of dietary cures for cancer

This sympathetic article in a recent issue of the Medical Journal of Australia looks at how practitioners can help their patients make sensible decisions? In the age of the internet and Doctor Google patients are looking for dietary options online and doctors continually see  patients who choose extreme dietary and alternative treatments for potentially curable cancers and don’t turn to the medical profession until they are quite ill and their cancer has spread and become incurable. "As an example, a woman claimed to have cured herself of thyroid cancer by eating pineapples."

 Haines. Ian E. (2015). Negotiating the complex maze of claims of dietary cures for cancer.  Medical Journal of Australia, 203 (4): 196-197.

Type 2 Diabetes; a long road to go

The journal Clinical Pharmacology & Therapeutics has recently published a virtual themed issue on diabetes. Most of the articles in this issued dated August 2015 are free to access. Included are articles on anti-inflammatory strategies, bringing the protocol to the patient, cardiovascular risk and the current drug treatment landscape. 

Facing Tough Time

This booklet produced by the Australian Child & Adolescent Trauma, Loss & Grief Network discusses the impact of family adversities on children, what helps children to get through adversities and how important it is for families to seek help and support when it is needed. 
The booklet isn't designed to take the place of advice from a health professional, rather it is designed to share information about how experiences of trauma and adversity can impact on your child. 
Facing Tough Time: Supporting your family through life's tough times

How well do health professionals interpret diagnostic information?

The most important finding of this systematic review is the lack of understanding of test accuracy measures by health professionals. Published in BMJ  Open, the results of the systematic review of the evidence on test interpretation found that, across multiple studies, clinicians do not accurately interpret common measures of test accuracy such as likelihood ratios.
Whiting PF, Davenport C, Jameson C, Burke M, Sterne JAC, Hyde C, et al
BMJ Open. 2015 [epub]. 

Australia's welfare 2015

Overall, Australians are better educated and living longer than a decade ago according to the latest 2-yearly national publication "Australia's Welfare 2015" from the Australian Institute of Health and Welfare (AIHW). The report covers: Understanding welfare; Australia's welfare spending and workforce; Child wellbeing; Young people; Working age; Growing older; Diversity and disadvantage in Australia; Indicators of Australia's welfare.

Acting AIHW Director Ms Kerry Flanagan said, 'Our report shows that most children are doing well and that most young people are studying or working. Adult participation in the labour force is higher than 20 years ago, and while some people are staying at work longer, after retirement, the majority of older Australians are not using aged care services. On the other hand, we see that 1 in 37 children are receiving child protection services, around 2 million Australians, mostly women, have experienced partner violence since the age of 15, youth unemployment exceeds 13%, and there's been little improvement in the proportion of young people who are not fully engaged in employment, education or training.'

Australia's welfare 2015 | online HTML report
Australia's welfare 2015-in brief

13 August 2015

GP understanding of hospital discharge abbreviations

A study recently published in the Medical Journal of Australia revealed that abbreviations in hospital discharge letters are not well understood by the receiving GPs. General practitioner understanding of abbreviations used in hospital discharge letters describes an audit which was made of abbreviations used at Nepean Hospital in Sydney in December 2012.  Twenty common and clinically important abbreviations were identified and sent in a questionnaire to 240 GPs from the local area.  The abbreviations were used in context, but still no individual abbreviation was correctly interpreted by all GPs.  Six of the abbreviations were misinterpreted by over 25% of the GPs.
The authors of the study concluded that these results have potential to adversely affect patient care in the transition from hospital to community care. 

Mark Chemali, Emily J Hibbert, Adrian Sheen, Mark Chemali, Emily J Hibbert and Adrian Sheen  Med J Aust 2015; 203 (3): 147.  doi: 10.5694/mja15.00224

The mental health of children and adolescents

The Department of Health (Australia) has just released The mental health of children and adolescents: report on the second Australian child and adolescent survey of mental health and wellbeing. The survey referred to was conducted in the homes of more than 6,300 families with children or adolescents between the ages of four and seventeen. Children over the age of eleven completed their own survey.

The report presents a comprehensive picture of the mental health of young Australians, documenting the prevalence and type of mental health problems, the impact of those problems on families and young people themselves and the role of health and education services in providing assistance.    

Nursing and midwifery workforce 2014

The total number of all nurses and midwives registered in Australia increased from 330,680 in 2011 to 352,838 in 2014 (6.7%) according to this recently published web report on the nursing and midwifery workforce, from the AIHW.

In 2014 the overall supply of employed nurses and midwives was 1,134 FTEs for every 100,000 people, slightly higher than the last report in 2011. There were more employed nurses and midwives in the 50-54 year age group than any other age group, and the proportion aged 50 and over grew from 38.3% to 39.4% over the past three years. 

Fighting Cancer - TED Radio Hour

Human melanoma cell dividing
TED is a non-profit organisation which aims to spread ideas by way of short, powerful talks given all over the world.  The TED Radio Hour is a collection of excerpts from the talks and interviews with the speakers who have presented on similar topics.  You can listen to the programs or download a podcast.

Recently the topic was Fighting Cancer and some wonderful speakers talked about emerging technologies and scientific discoveries surrounding the early detection of cancer cells and fighting specific cancer cells.  Other talks were about non-medical interventions, how to live with cancer and what it really means to be a cancer survivor.  Well worth listening to for any health professional.

Too much medicine - Big Ideas

A recent lecture in the Sydney Ideas series was entitled Highlights of too much medicine: exploiting fear for the pursuit of profit.  Retired GP Iona Heath is concerned that, despite the best of intentions, modern medicine may be doing more harm than good. She examined and critiqued the health system and argued that greed and profit are at the centre of a self perpetuating cycle of fear, over diagnosis and over servicing.
ABC's Big Ideas recorded highlights of the talk and you can listen to it or download it at their website here.  You can also read an essay by Heath published in the BMJ late last year, entitled Role of fear in overdiagnosis and overtreatment—an essay by Iona Heath

Iona Heath's talk was presented by the School of Public Health, University of Sydney, Sydney Ideas and the Centre for Research in Evidence Based Practice - Bond University on 5th Aug 2015.

04 August 2015

Lithium therapy in bipolar disorder: a balancing act?

This recent article in The Lancet concedes that Lithium is without doubt the best treatment for many patients with bipolar disorder because it confers long-term mood stability and prophylaxis. "Lithium also reduces the risk of suicide and is possibly neuroprotective. The dilemma of lithium therapy arises because, if poorly managed, lithium can compromise renal function, sometimes irreversibly, and severely disrupt endocrine homoeostasis—ultimately limiting its usefulness. Therefore, lithium therapy remains a challenge that will benefit from a better understanding of its therapeutic properties."
You can read the full text for free in this open access article from the Lancet.

Malhi, GS. (2015) Lithium therapy in bipolar disorder: a balancing act? The Lancet,  386(9992), 415-416   

Movement Disorders - Pick your avatar.

Software that generates animated characters with strikingly realistic movement have been part of the entertainment world for some time. But now scientists have taken this one step further to create models that can help kids with cerebral palsy walk better or delay the onset of osteoarthritis.
The researchers behind this video—an entrant in the NIH Common Fund’s recent video competition—have developed OpenSim: a free software tool that combines state-of-the-art musculoskeletal modeling and dynamic computer simulations to produce highly accurate representations of the underlying biomechanics of motion. OpenSim was designed at the NIH-supported center for physics-based Simulation of Biological Structures (Simbios) at Stanford University, Palo Alto, CA. And now, researchers around the world are using OpenSim to find more effective interventions for a variety of movement disorders.
We can link you to the page, however you may need to use your home computer to further access OpenSim as the videos are on YouTube.