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"There's a way to do it better-find it"
Thomas Edison


Tackling wasteful spending on health

The report's foreword notes that "it is alarming that around one-fifth of health expenditure makes no or minimal contribution to good health outcomes. Put in other words, governments could spend significantly less on health care and still improve patients' health. Efforts to improve the efficiency of health spending at the margin are no longer good enough." The topics of appropriateness, overuse/underuse, value and waste can be considered to have some degree of overlap. This is reflected in, among other things, this new report from the OECD.

Source: Tackling Wasteful Spending on Health OECD Publishing; 2017

Further reading:

Austin Health Choosing Wisely (available via Austin Hub)

Choosing Wisely Australia


Wrong guidelines: how to detect them

There are currently no evaluation instruments for assessing the trustworthiness of guideline content and no single distinguishing feature of a trustworthy guideline. The authors suggest using a seven-point 'safety bundle' to confidently recognize wrong guidelines by assessing content as well as methodological aspects. The authors contend that better care pathways and health policy decisions can be made by adopting a critical analysis approach to guidelines.

Source: Evidence Based Medicine 2017; 22: 4-8

Further reading:
Wrong guidelines: why and how often they occur
"Evidence-based guidelines are considered an essential tool in assisting physicians, policymakers and patients when choosing among alternative care options and are considered unbiased standards of care. Unfortunately, depending on how their reliability is measured, up to 50% of guidelines can be considered untrustworthy. This carries serious consequences for patients' safety, resource use and health economics burden."
Source: Evidence Based Medicine 2017; 22: 1-3


Patients' experience of thirst in ICU

Increasingly, patients in ICU requiring mechanical ventilation are not sedated. Research indicates that critically ill patients often associate feelings of desperation, anxiety and powerlessness with the experience of thirst. Study authors suggest a need for ICU nurses to increase their focus on issues of thirst and dry mouth to improve patient experience and psychological well-being.

Source: Nursing in Critical Care 2017; online first: 25 January


Benefits and management of breastfeeding

"Prenatal education that includes both informational materials and interpersonal support is positively associated with breastfeeding initiation, duration, and exclusivity. Breastfeeding support delivered in a variety of formats, including home visits and individual or group sessions at prenatal clinics, is associated with improved breastfeeding outcomes."

Source: Journal of Human Lactation 2017; 33 (1): 50-82


Anxiety disorders and risk of stroke

Anxiety disorders represent the most common mental health problem globally. A systematic review and meta-analysis which critically appraised studies involving 950,759 patients indicated a significantly increased risk of stroke for those with anxiety disorders.

Source: European Psychiatry 2017; 41: 102-108
Link to full text is available with ClinicalKey remote access when you are offsite


Updating systematic reviews

Systematic reviews aim to summarise and appraise all available evidence on a research question, therefore it is imperative that reviews are kept up to date. "It is known that half of all systematic reviews are out of date after 5.5 years, but this result is most probably dependent on the research activity within a given field." Authors reveal a dilemma (post investigating 250 journals) as there seems to be a lack of guidance on how to report updates of systematic reviews!

Source: Evidence-Based Medicine 2017; online first: 30 January

Further reading: 
When and how to update systematic reviews: consensus and checklist 
Source: BMJ 2016; 354: i3507


Did you know?

The latest Future Leaders Communiqué, from the Victorian Institute of Forensic Medicine, presents a case study of missed diagnosis in a patient whose care was delivered by numerous clinicians from various specialities. Expert commentary by Professor Daniel O'Connor, the Victorian Deputy Chief Psychiatrist, Aged Persons Mental Health provides insights into the management of vulnerable patients.

DynaMed Plus is a point-of-care resource that provides evidence-based information to support clinical care. Mobile access is available with the DynaMed Plus app if downloaded using Austin WiFi. Please consider using your User Preferences in Cerner to put this link into a quick link tab.

This trial runs until 28 February 2017 - after reviewing DynaMed Plus please complete our survey to provide your input.


Austin Health Research Online - recent submissions

Development and validation of a 21-item challenges to stopping smoking (CSS-21) scale
Thomas D, Mackinnon AJ, Bonevski B, et al. BMJ Open 2016; 6(3): e011265

Poor agreement in significant findings between meta-analyses and subsequent large randomized trials in perioperative medicine
Sivakumar H, Peyton PJ. British Journal of Anaesthesia 2016; 117(4): 431-441

Physician performed chest ultrasound: progress and future directions
Denton EJ, Hannan LM, Hew M, Internal Medicine Journal 2016; online first: 16 November

Histopathology and florbetaben PET in patients incorrectly diagnosed with Alzheimer's disease
Sabbagh MN, Schäuble B, Anand K, et al. Journal of Alzheimer's Disease 2017; 56(2): 441-446
Full text available for Austin & MHW Heidelberg staff via document delivery

"Plug and Play": a novel technique utilising existing technology to get the most out of the robot
Manning TG, Christidis D, Coles-Black J, et al. Journal of Robotic Surgery 2017; online first: 2 January

See more at AHRO, Austin Health Research Online


New books on display

Using patient reported outcomes to improve health care / John Appleby, Nancy Devlin, David Parkin – Wiley Blackwell, 2016. 
With real life examples and case studies, this is the only resource to introduce and show how patient reported outcomes can be best used to improve healthcare and patient outcomes. 

Protocols for high-risk pregnancies : an evidence-based approach / edited by john T. Queenan, Catherine Y. Spong, Charles J. Lockwood – 6th ed., Wiley Blackwell, 2015. 
Designed for clinical practice, the book presents life threatening challenges for the mother and her foetus with guidelines and protocols for understanding the patients conditions with optimum management strategies.

Pelvic pain management / edited by Assia T. Valovska – Oxford University Press, 2016.  
Addresses all aspects of pelvic pain management and deals with all populations on how to perform a proper physical examination, diagnosing the origins of pain and developing a treatment plan.


Journals spotlight

These links provide access to the current table of contents:

Australian Occupational Therapy Journal


Evidence-Based Mental Health

Intensive and Critical Care Nursing


New England Journal of Medicine

Nursing for Women's Health

Pain Medicine

Transfusion and Apheresis Science


Looking for the latest journal issues?
All our journal titles with electronic access are available via the Journal List
(outside the Austin Health network use your Library barcode no. & PIN for access)

If you require an article from a journal that is not in the Journal List, please use our online document delivery form.


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The Austin Health Sciences Library accepts no liability for the information or advice provided by external links. Links are provided on the basis that readers make their own decisions about the accuracy, currency and reliability of the information contained therein. Any opinions expressed are not necessarily those of Austin Health.