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"Best clinical decisions are at the heart of appropriate care, the goal to which our system should aspire"
Dr. Anna Reid 


Deprescribing proton pump inhibitors

Proton pump inhibitors (PPI) are one of the most commonly prescribed drugs in Australia, with over 19 million prescriptions dispensed in 2013-14. Usage of PPIs is disproportionately higher in older adults and this age group is at higher risk of adverse drug events. PPIs "have been recognised on a national and international level as a priority for deprescribing" due to the high prevalence of inappropriate use. This paper discusses barriers to deprescribing; highlights the scarcity of evidence in this area; and compares strategies for deprescribing including pharmacy-led interventions and education of hospital clinicians.

Source: Drugs & Aging 2017; online first: 21 February

Further reading
GORD guidelines from the UK National Institute for Health and Care Excellence recommend either “stepping down” treatment to the minimum effective dose or cessation of PPIs in selected populations.
Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management
Source: NICE Clinical Guideline CG184 2014


Patient reported outcomes – measuring what matters

Health ministers from OECD countries have announced a strong commitment to reorienting health systems towards person-centered care. "If we are to focus on what matters to patients then patients must be involved in determining which health outcomes to measure, yet this is surprisingly rare. A recent review of studies describing the development of 193 different PROMs (patient reported outcome measures) found that only 21 (10.9%) of these had actually asked patients which outcomes were worth measuring".

Source: BMJ 2017; 356: j816

Further reading
The next generation of health reforms: ministerial statement
Source: OECD Health Ministers 2017


A path to patient-centeredness - interprofessional rounding

"As healthcare moves toward a value-based system, the importance of collaboration, patient-centeredness, and shared decision is of utmost importance". Interprofessional daily rounds are a means to promote collaboration and information sharing among team members. This study explored including patients (n=63) as part of the rounding process to increase their engagement in, and overall satisfaction with, their care. "Although interprofessional rounds in itself may help contribute to better overall communication among team members, deliberate interaction with the patient as a team may be necessary to achieve the ultimate goal of patient-centeredness".

Source: Journal for Healthcare Quality 2017; 39(2): 95-106
Full text available for Austin & MHW Heidelberg staff via document delivery

Further reading
All together now: Impact of a regionalization and bedside rounding initiative on the efficiency and inclusiveness of clinical rounds
"Creating regionalized care teams and encouraging interdisciplinary bedside rounds increased the proportion of bedside rounding time and the presence of nurses on rounds while decreasing total rounding time".
Source: Journal of Hospital Medicine 2017; 12(3): 150-156
Full text available for Austin & MHW Heidelberg staff via 
document delivery


Clinical trials & informed consent

"This multipart review provides an overview of innovative approaches to improving and expanding the informed consent process for researchers and participants". Authors discuss the impact of big data; electronic informed consent; internet-based trials and app-based trials; and video informed consent.

Source: New England Journal of Medicine 2017; 376: 856-867

Further reading
Why clinical trial outcomes fail to translate into benefits for patients
"Clinical research should ultimately improve patient care. For this to be possible, trials must evaluate outcomes that genuinely reflect real-world settings and concerns. However, many trials continue to measure and report outcomes that fall short of this clear requirement. We highlight problems with trial outcomes that make evidence difficult or impossible to interpret and that undermine the translation of research into practice and policy".
Source: Trials 2017; 18:122


Practicing psychiatry in the digital age

"With the increasing availability of technology to support the delivery of mental health care, it is anticipated that we will see a transformation in our ability to deliver efficient and optimized care for our patients" - John Docherty
Digital technologies provide the potential to develop innovative diagnostics and psychosocial interventions, along with clinical decision-making algorithms, advanced data analytic insights, and context-aware programs to deliver more effective care and improve clinical outcomes.

Source: Practicing Psychiatry in the Digital Age - website developed by Healthcare Global Village, Inc. Financial support for content preparation and dissemination was provided by ODH, Inc (Healthcare consultants)


Thyroid treatment in pregnancy

Studies have shown that poor neurodevelopmental outcomes in children may be associated with subclinical thyroid disease during pregnancy. New trials investigated levothyroxine treatment for pregnant mothers with subclinical hypothyroidism or hypothyroxinemia. Authors concluded that thyroxine treatment for mothers did not result in significantly better developmental or behavioural outcomes in children.

Source: New England Journal of Medicine 2017; 376: 815-825


Did you know?

Transfusion Evidence Library is a database of systematic reviews and RCTs relevant to transfusion medicine. It is fully searchable, updated monthly and aims to be a key resource for medical practitioners, policy makers and researchers. The Cochrane Collaboration has officially endorsed the database, recognising it as a "unique, evidence-based resource for the transfusion medicine community".


Austin Health Research Online - recent submissions

Improving communication of medication changes using a pharmacist-prepared discharge medication management summary
Ooi CE, Rofe O, Vienet M, et al. International Journal of Clinical Pharmacy 2017; online first: 11 March

Advance care planning in chronic kidney disease: a survey of current practice in Australia
Luckett T, Spencer L, Morton RL, et al. Nephrology 2017; 22(2): 139-149

Validation of the Dutch clinical prediction rule for ambulation outcomes in an inpatient setting following traumatic spinal cord injury
van Silfhout L, Peters AE, Graco M, et al. Spinal Cord 2016; 54(8): 614-618

Higher maternal serum prolactin levels are associated with reduced glucose tolerance during pregnancy
Ekinci EI, Torkamani N, Ramchand SK, et al. Journal of Diabetes Investigation 2017; online first: 27 January

Clinicians' adherence to international guidelines in the clinical care of adults with inflammatory bowel disease
Jackson BD, Con D, Liew D, et al. Scandinavian Journal of Gastroenterology 2017; 52(5): 536-542

See more at AHRO, Austin Health Research Online


eBooks spotlight

Roberts and Hedges’ clinical procedures in emergency medicine / editor in chief, James R. Roberts – 6th ed. Elsevier, 2014.
This electronic book, which includes procedural videos demonstrating key techniques, explains not only how to perform each procedure but why and when you should. Covers a new chapter on chemical and physical restraints to facilitate management of violent or aggressive patients.

Williams obstetrics / edited by: F Gary Cunningham … [et al.] – 24th ed. McGraw Hill Education, 2014.
Summarises important new data that influences evidence-based management to improve pregnancy outcomes and patient management. Data is distilled into newly created tables and diagnostic and treatment algorithms. Images and procedural videos complement the text, providing clinicians with what they need to know about the practice of obstetrics with a level of authority and high quality of presentation.

Treat as one : bridging the gap between mental and physical healthcare in general hospitals / a report by the National Confidential Enquiry into Patient Outcome and Death / compiled by S. Cross – NCEPOD, 2017.
Looks at patients presented to hospital with physical health issues who also had significant mental health problems. This study did not aim to look at the care given for the mental health condition, but sought to identify the common themes that emerged in the general hospital setting.


Journals spotlight

These links provide access to the current table of contents:

Acta Obstetricia et gynecologica Scandinavica

American Journal of Hypertension

Age and Aging

BJU International

International Journal of Clinical Pharmacy

International Wound Journal


Journal of Pain and Symptom Management

Journal of Palliative Medicine


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