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"A good physician treats the disease, the great physician treats the patient who has the disease."
Sir William Osler (1849-1919)


Are you "Choosing Wisely”?

Overdiagnosis provides no benefits to patients, may expose them to harm and is a challenge to the sustainability of modern healthcare systems. McCaffery and colleagues contend that communication based strategies could help reduce overdiagnosis and its negative impact on individuals and health systems.
Effective strategies include: shared decision making and the use of patient decision aids; community campaigns and initiatives such as “Choosing Wisely”; and changing medical terminology and labels.
A careful, evidence-based approach is advocated so that the potential harms of communicating overdiagnosis, such as adversely affecting patients already diagnosed and treated, are considered.

Source: BMJ 2016; 352: i348

Further reading

Choosing Wisely: a parody of the Pharrell Williams song Happy: YouTube

Ten clinician-driven strategies for maximising value of Australian health care (featured at Austin Grand Round)
There is scant literature that translates the concept of high value care into actionable enhancement strategies for clinicians in everyday practice settings. This article provides 10 strategies with supporting studies in an attempt to fill this gap.
Source: Australian Health Review 2014; 38(2): 125-133

Are you choosing wisely in your professional practice?
The Oncology Nursing Society has contributed a list of "Ten Things Nurses and Patients should Question" to the Choosing Wisely initiative. This list provides cancer nurses the chance to review the rationale behind particular recommendations and understand when a service is appropriate for their patient cohort.
Source: Clinical Journal of Oncology Nursing 2016; 20(2): 211-212

Shared decision making
The Australian Commission on Safety and Quality in Health Care is working on shared decision making as part of its commitment to support patient-centred care and to ensure suitability of care.
Source: ACSQHC


Blood transfusion: patient identification and empowerment

If patient misidentification occurs during the transfusion process it can have potentially fatal consequences. This article "explores the aspects of patient contribution to patient safety relating to positive patient identification in transfusion." The authors suggest clinician’s attitudes to patient involvement are key to successful cultural change.

Source: British Journal of Nursing 2016; 25(3): 138-43

Why patient matching is a challenge: Research on Master Patient Index (MPI) data discrepancies in key identifying fields.
Within electronic health records, problems associated with matching patient identification information or duplicate records can contribute to poor care coordination and serious medical errors. Research indicates a significant area of data discrepancy involved a patient’s middle name, accounting for 58.3% of mismatches. The authors recommend establishing standard naming convention policies to improve overall data integrity.
Source: Perspectives in Health Information Management 2016; 13: 1e

NSQHS Standards fact sheet – Standard 5: Patient identification and procedure matching
NSQHS Standards fact sheet – Standard 6: Clinical handover

Hub page: Standard of the Month


Medication-related problems post discharge

This Australian study surveyed the perspectives and experiences of more than 500 patients regarding medication related problems (MRPs) following discharge from hospital. The four main risk factors for MRPs which emerged were: health literacy; health status; consumer engagement; and medication costs. The results demonstrate the importance of consumer engagement in the area of medication safety and discharge.

Source: International Journal for Quality in Health Care. 2016; online first 26 April

Further reading

Medical error—the third leading cause of death in the US
This paper discusses the need for national statistics in the US to include deaths due to medical care. Currently US death certificates, which form part of the national vital statistics, have no mechanism to acknowledge medical error as the cause of death. The authors note that if medical error was viewed as a disease, it would be the third leading cause of death.
Source: BMJ 2016; 353: i2139

Medical errors: Disclosure styles, interpersonal forgiveness, and outcomes
"This study investigates the intrapersonal and interpersonal factors and processes that are associated with patient forgiveness of a provider in the aftermath of a harmful medical error." The study discusses different forgiveness models and concludes that healthy, reconciliatory outcomes are more likely when physicians display nonverbal involvement during medical error disclosures.
Source: Social Science & Medicine 2016;156: 29-38
Full text available for Austin & MHW Heidelberg staff via document delivery


AIHW spotlight

The Australian Institute of Health and Welfare have released several new web updates and reports which are of relevance to Austin Health and the Mercy Hospital for Women.

Key data and trends for 13 key cancers, plus all cancers combined, and cancer affecting Indigenous Australians, is now available online. These latest statistics indicate in 2008–2012 individuals diagnosed with cancer had a 67% chance of surviving for 5 years compared to their counterparts in the general Australian population. Between 1983–1987 and 2008–2012, 5-year relative survival from cancer improved from 47% to 67%.
View web report: All cancers in Australia

Musculoskeletal - Indigenous data
AIHW have updated their web content for osteoporosis and rheumatoid arthritis to incorporate prevalence rates among Aboriginal and Torres Strait Islander Australians.
View web reports: Who gets osteoporosis? and Who gets rheumatoid arthritis?

Chronic respiratory conditions
The chronic respiratory conditions webpage provides high-level information on the prevalence of various chronic respiratory conditions including asthma, chronic obstructive pulmonary disease (COPD), hay fever and bronchiectasis. COPD is a leading cause of death in Australia and internationally, and asthma death rates in Australia are high in comparison with many other countries. In 2013, there were 12,465 deaths where the underlying cause was an acute or chronic respiratory condition.
View web report: Chronic respiratory conditions

Cervical cancer screening
This report indicates more than 3.8 million women aged 20 to 69 took part in the National Cervical Screening Program in 2013-2014, a participation rate of 57%. According to this report, cervical cancer cases and deaths in Australia are low compared to rates internationally.
View report: Cervical screening in Australia 2013–2014


Austin Health Research Online - recent submissions

Intestinal failure and transplant: The Australian experience (2009 to 2014). Chapman B, De Cruz P, Jones R, Hardikar W, Testro A. Transplantation Proceedings 2016; 48(2): 463-467

Resting state functional connectivity in anorexia nervosa. Phillipou A, Abel LA, Castle DJ, Hughes ME, Nibbs RG, Gurvich C, Rossell SL. Psychiatry Research 2016; online first: 19 April

Use of video to facilitate sideline concussion diagnosis and management decision-making. Davis G, Makdissi M. Journal of Science and Medicine in Sport 2016; online first: 22 February

Preparing patients at high risk of falls for discharge home after rehabilitation: Do we meet the guidelines?. Said C, Batchelor F, Shaw K, Blennerhassett J. Geriatrics & Gerontology International 2016; 16(5): 570-576

Emerging trends in prostate cancer literature: medical progress or marketing hype?. Lo J, Papa N, Bolton D, Murphy D, Lawrentschuk N. BJU International 2016; 117(1): 14-19

See more at AHRO, Austin Health Research Online


eBooks spotlight

Introduction to public health / Mary Louise Fleming and Elizabeth Parker - 3rd ed. - Elsevier Australia, 2015.
This text addresses topical issues, including epidemiology, ethics and evidence-based practice. It includes a new focus on infectious diseases and disease presence and a new chapter on public health and social policy.

Principles and practice of sleep medicine / edited by Meir Kryger, Thomas Roth – 6th ed. – Elsevier, 2017.
This edition assists in guidance for effective diagnosis and management of the most challenging sleep disorders. Updates are provided for genetics and circadian rhythms, occupational health, sleep in older people, memory and sleep, physical examination of the patient, and comorbid insomnias. There is new content on legal aspects of sleep medicine and dental sleep medicine.


Are workarounds ethical? : managing moral problems in health care systems / Nancy Berlinger - Oxford University Press, 2016.
By framing moral problems facing people in health care systems, the author offers ways to think critically about the challenges of health care work and promoting social change.


Journals spotlight

These links provide access to the current table of contents:

Blood Reviews

BMJ Quality & Safety

Clinical Nurse Specialist

COPD: Journal of Chronic Obstructive Pulmonary Disease

International Journal of Gynecological Cancer

Journal of Clinical Psychopharmacology

Journal of Patient Safety

Journal of the American Medical Informatics Association

MCN: The American Journal of Maternal Child Nursing

The New England Journal of Medicine

Obesity Research & Clinical Practice

Primary Care Diabetes

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