17 April 2014

Evolution of nursing in general practice

"The evolution of nursing in general practice: a comparative analysis of workforce surveys ten years on" is an article recently published in BMC Family Practice by Elizabeth Halcomb et al.  It describes the current demographic and employment characteristics of Australian nurses working in general practice, and trends over time.

Government initiatives to strengthen primary care has seen an expansion of the role of nurses in general practice over the last decade, but this study identified continuing barriers that impact practice nurse role development. "Understanding and addressing these issues is vital to optimise the effectiveness of the primary care nursing workforce."

BMC Family Practice, 2014, 15:52 http://www.biomedcentral.com/1471-2296/15/52 (open access).

Unlocking Skills in Hospitals - report from the Grattan Institute

The Grattan Institute - an Australian public policy think tank - has just released a report, "Unlocking Skills in Hospitals: better jobs more care" by Stephen Duckett and Peter Breadon.  The authors argue that enabling less highly-trained hospital workers to play a bigger role could improve jobs for doctors and nurses, save public hospitals nearly $430 million a year and fund treatment for more than 85,000 extra people.

The report suggests ways that hospitals can get a better match between workers and their work.  For example, AINs could free up nurses’ time by providing basic care to patients, specialist nurses could free up doctors’ time by doing common, low-risk procedures now done by doctors and more assistants could be employed to support physiotherapists and occupational therapists. The authors suggest that barriers of culture, tradition, industrial relations and vested interest stand in the way of change and current  workforce roles are outdated.

Peter Breadon wrote a commentary piece in The Conversation earlier this week which summarises the report's findings, Hospital Work Reform, which was answered in the same publication today by Rhian Parker from the University of Canberra who in, Leave Prescribing to Doctors and Nurse Practitioners, urges caution in adopting the recommendations from the Grattan report.

Global guideline for Type 2 diabetes in older people

The International Diabetes Federation as published its Global Guideline for Managing Older People with Type 2 Diabetes.  The guideline has been developed to provide clinicians with recommendations that assist in clinical management of older adults who are both relatively well and active and those who are functionally dependent.  Topics covered include assessment measures, cardiovascular risk, education, renal impairment, diabetic foot disease and sexual health. Also included is a section of 'special consideration' where areas such as pain and end of life care are addressed.

11 April 2014

Alzheimer's Australia reports on incidence and medication

Alzhiemer's Australia publishes regular reports and discussion papers on this disease.  The most recent are:

Paper 39 - Is the Incidence of Dementia Declining?  - a joint report from Alzheimer's Australia and the Centre for Healthy Brain Ageing, suggesting that action on preventative health could lower the risk of dementia for future generations.  If Australians change the way they think about dementia, the growth of the disease could be reduced.

Paper 38 - The Use of Restraint and Psychotropic Medication in People with Dementia - describes how up to 80% of people with dementia and nearly half of people in residential aged care facilities are receiving psychotropic medications that in some cases are inappropriately prescribed.

National Aged Care Data Clearinghouse

The new National Aged Care Data Clearinghouse, at the Australian Institute of Health and Welfare, is an useful repository of national aged care data. It is a component of the Australian Government’s package of aged care reform measures and was developed to provide aged care data to policy makers, researchers, service providers and consumers. It provides statistical information on clients and services within a range of national programs and services, including residential aged care, aged care packages provided in the community, the Transition Care Program, the National Respite for Carers Program and the Aged Care Assessment Program.

Rare Cancers report

Rare Cancers Baseline Report: 2014from Rare Cancers Australia, calls on the Australian government to take action to improve research, diagnostics and access to medicines for rare and less common cancer patients. 
‘Rare cancers’ are defined as those with an incidence of less than 6 per 100,000 Australians per annum and ‘less common’cancers as those with an incidence of between 6 and 12 per 100,000 Australians per annum.
This accounts for over 42,000 diagnoses of rare and less common (RLC) cancers and around 22,000 deaths in Australia.

The report describes a failing in research funding and support for patients with RLC cancers and their families.  The survival rates are very low compared to rates for the more common cancers. 

09 April 2014

NHMRC homeopathy review

The National Health and Medical Research Council has today released its draft information paper, Evidence on the effectiveness of homeopathy for treating health conditions.  It summarises the findings of an assessment of homeopathy which included an overview of published systematic reviews, evaluation of information provided by homeopathy interest groups and the public, and consideration of clinical practice guidelines and government reports on homeopathy published in other countries. Their overall finding was "NHMRC concludes that the assessment of the evidence from research in humans does not show that homeopathy is effective for treating the range of health conditions considered."

An assessment of the paper and discussion of the issues can be found in an article by Ian Musgrave from the University of Adelaide in The Conversation.  No evidence homeopathy is effective.

Breast cancer screening debate

The ABC Health and Wellbeing website has included a precis of the current debate from researchers about whether or when to screen for breast cancer.  Breast cancer: to screen or not to screen gives a good summary of the prevalence of the disease, the problems of over-diagnosis and the importance of early diagnosis.  It seems the research is mixed, and a recent Canadian study published in the BMJ concluded that annual mammography in women aged 40-59 did not reduce mortality from breast cancer and 22% (106/484) of screen detected invasive breast cancers were over-diagnosed.

Quality of allied health - evidence based framework

In this research paper the Australian-based authors propose a framework for measuring the quality of allied health (AH). A systematic review of the literature since 1980 led to the development of a “realist synthesis framework" to describe what AH does, how it does it, and what is achieved. The literature review identified 24 measures of quality which can be used to address the complexity of AH therapies. This reveiw should assist in better evaluation of AH processes and outcomes, costs, and evidence-based engagement of AH providers in healthcare teams.  The article is available freely on open access.

An evidence-based framework to measure quality of allied healthcare  Grimmer K, Lizarondo L, Kumar S, Bell E, Buist M, Weinstein P. Health Research Policy and Systems 2014;12(1):10.

04 April 2014

Indigenous health check data tool

This innovative tool from the Australian Institute of Health and Welfare, draws together MBS billing data and Indigenous population data to produce readily-accessible information about use of MBS-rebated regular health checks for Aboriginal and Torres Strait Islander people. It shows quarterly and financial year data on numbers of health checks and usage rates (the proportion of Indigenous people who have had a health check) across Medicare Locals. It also links data to map displays and shows trends over time. Policy makers, program officers, researchers and Aboriginal and Torres Strait Islander consumers can now easily track progress and identify priority areas for action.   

Immunisation rates for children 2012-13

The National Health Performance Authority has released the second in a new series of reports, Healthy Communities: Immunisation rates for children in 2012–13.  The number of children in Australia not fully immunised in 2012-13 was 75,002, a reduction of almost 2,000 compared to the previous year.  While this is good news, the new report highlights areas in Australia where rates are low and examines immunisation rates across three geographic levels – 61 Medicare Local catchment areas, 333 Australian Bureau of Statistics Statistical Areas Level 3 (SA3) and 1,500 postcode areas across Australia.

World Autism Day - article

2 April was World Autism Day, and Jodie van de Wetering reminds us in her article on the ABC's Ramp Up site that one in a hundred Australians are on the autism spectrum, all with complex and varied needs and from all walks of life and ages.  "World Autism Day: we're all in this together" is an attempt to redress what the author sees as a media bias towards children and parents in recognising and servicing autism sufferers.  As an adult with Asperger's syndrome, she makes some interesting points and concludes that "services that help today's adults with autism will help the current generation of kids on the spectrum when they, in turn, become adults".

31 March 2014

Climate change and health - IPCC Report

The Intergovernmental Panel on Climate Change brought out its Fifth Assessment Report today.  The IPCC is the international body for assessing the science related to climate change and was set up in 1988 by the World Meteorological Organization (WMO) and United Nations Environment Program (UNEP) to provide policymakers with regular assessments of the scientific basis of climate change, its impacts and future risks.

The human health chapter in the second (“Impacts”) volume of the IPCC’s Fifth Assessment Report concludes that the impact of climate change on our health is increasing significantly.  In the next few decades, the largest impacts will occur in poorer and vulnerable populations and communities where illnesses such as under-nutrition and diarrhoeal disease are already high – thus widening further the world’s health disparities.  A good summary of the health impacts described by the report can be found in The Conversation today, Climate change and health:  IPCC reports emerging risks, emerging consensus.

Elder abuse - current Australian legal situation

Australia’s ageing population is growing and so too is the number of older persons who experience abuse.  A recent article in the Sydney Law Review, Neglectful to the point of cruelty? Elder abuse and the rights of older persons in Australia, outlines the factors that can heighten a person’s vulnerability to abuse and describes the complexity of addressing elder abuse from a legal and policy perspective.  Case examples are provided, and the author examines the current legal situation in Australia.  Recognising that elder abuse involves the denial of a person’s basic human rights, this article calls for a national inquiry into elder abuse by the Australian Human Rights Commission.

Lacey W. (2014). Sydney Law Review, 36(1), 99-130

27 March 2014

The Essential Role of the Rehabilitation Nurse in Facilitating Care Transitions

Rehabilitation NursingFacilitating effective care transitions is incredibly important given the longevity of people today, and the increasing prevalence of chronic illnesses. "There is a need for clinicians with the necessary knowledge and skills to advocate and facilitate transitions that result in the greatest value to the patients, their families, and the healthcare delivery system. A review of the literature reveals significant problems with transitions to postacute care (PAC) settings. Care is fragmented, disorganized, and guided by factors unrelated to the quality of care or patient outcomes. Studies have demonstrated that the selection of a PAC setting for patients is influenced by multiple factors". Although the article is American, it still may be applicable to the rehabilitation nurse in Australia.
  In the January-February issue of Rehabilitation Nursing  you can read the article, “The Essential Role of the Rehabilitation Nurse in Facilitating Care Transitions: A White Paper by the Association of Rehabilitation Nurses”.   There is free access to this paper throughout 2014.