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"The important thing is not to stop questioning. Curiosity has its own reason for existence"
Albert Einstein

 

Medical overuse

Medical overuse is associated with patient harm and increased healthcare costs. Research indicates clinicians have a tendency to overestimate the benefit of treatments and underestimate its harms. In this annual update, authors identified the following trends:

  • unnecessary ECGs are common and can lead to a cascade of services
  • lipid monitoring rarely affects care
  • patients overdiagnosed with cancer experienced anxiety and criticism about not seeking treatment
  • calcium and vitamin D supplementation does not reduce hip fracture
  • pregabalin does not improve symptoms of sciatica but frequently has adverse effects
  • robotic-assisted radical nephrectomy was without benefits by being slower and more costly than laparoscopic surgery
  • high-sensitivity troponin testing often yielded false-positive results
  • one-third of patients who received a diagnosis of asthma had no evidence of asthma
  • restructuring the electronic health record was able to reduce unnecessary testing

Source: JAMA Internal Medicine 2019; 179(2): 240-246

Further reading
Curbing unnecessary and wasted diagnostic imaging
"Radiographic incidentalomas, defined as abnormalities that did not serve as the native reason for the performance of the test, are very common".
Source: Journal of the American Medical Association 2019; 321(3): 245-246

 

Predicting delirium - older patients

This study examined whether preoperative anaemia or intra-operative blood transfusions were predictors of postoperative delirium in older adults. From a cohort of 461 patients aged 60 years and over, 8% developed post-operative delirium. Those with anaemia who also received intra-operative transfusions were at the greatest risk.  

Source: International Journal of Geriatric Psychiatry 2019; online first: 13 February

 

Person-centered care & eMR

This Australian study asks whether nursing models of person-centered care (PCC) in subacute settings is compatible with the standardised approach of electronic medical record (eMR) models. The experiences of rehabilitation nurses were collated into themes highlighting the pressures that occur between PCC and use of eMRs. Authors provide key practice points and encourage nurses to "innovate in partnership with organisational champions and those who develop eMR technology".

Source: Rehabilitation Nursing 2019; online first: 18 January

 

Lactation & postpartum BP

Preeclampsia affects 3%-8% of all pregnancies and is associated with increased risk of cardiovascular events postpartum. Women with preeclampsia face barriers to breastfeeding due to challenges encountered during labour, birth and postpartum. However, research shows "increased duration of lifetime lactation seems to be correlated with a greater reduction in cardiovascular risk". This study examined blood pressure at postpartum visits for women diagnosed with preeclampsia who were lactating, compared to those who were not. Authors stress the importance of encouraging women with preeclampsia to breastfeed so they can benefit from its cardioprotective effect.

Source: MCN: the American Journal of Maternal Child Nursing 2019; online first: 24 January

 

Thromboembolism - new guideline

Venous thromboembolism (VTE) is the third most common cardiovascular disease affecting an estimated 10 million people annually. VTE is a chronic and frequently recurrent disease which can be fatal if untreated. Recommendations for the diagnosis and management of VTE are outlined in a new guideline from the Thrombosis and Haemostasis Society of Australia and New Zealand.

Guideline summary: MJA 2019; online first: 11 February

Full guideline: THANZ 2019

 

Did you know: Healthcare-associated MRSA stats

A web update for the MyHospitals site presents information on healthcare-associated Staphylococcus aureus bloodstream infections for 677 public hospitals and 157 private hospitals in Australia in 2017-18.

Most public hospitals reported a SAB rate below the national benchmark of 2.0 cases per 10,000 days of care. See how Austin Health compares against other similar hospitals.

Australia's Health 2014(Click for larger image)

Source: AIHW, 20 February 2019

 

Austin Health Research Online - recent submissions

Rapid response team review of hemodynamically unstable ward patients: the accuracy of cardiac index assessment
Eyeington CT, Lloyd-Donald P, Chan MJ, et al. Journal of Critical Care 2019; 49: 187-192

Unintended consequences of a cautious approach to e-cigarette laws
Catalano C, Cranswick NE, Robinson J, et al. The Medical Journal of Australia 2019; 210(3) 143-143.e1

Genetic imbalance is associated with functional outcome after ischemic stroke
Pfeiffer D, Chen B, Schlicht K, et al. Stroke 2019; 50(2): 298-304

Bilateral versus single internal-thoracic-artery grafts at 10 years
Taggart DP, Benedetto U, Gerry S, et al. The New England Journal of Medicine 2019; 380(5): 437-446

Looking beyond lesions for causes of neuropsychological impairment in epilepsy
Rayner G, Tailby C, Jackson GD, et al. Neurology 2019; 92(7): e680-e689

See more at AHRO, Austin Health Research Online

 

eBooks Spotlight

Field guide to wilderness medicine / Paul S Auerbach, Benjamin B Constance and Luanne Freer, 5th ed., 2019
A practical guide to preventing and treating medical issues that occur in a wilderness setting. Although some sections are written with a North American readership in mind, most topics covered are relevant to practicing medicine in the Australian outdoors. With chapters focusing on common injuries and illnesses, as well as advice on survival in extreme environments.

Pocket Guide to POCUS: point-of-care tips for point-of-care ultrasound / Cameron M Baston, Christy Moore, Elizabeth A Krebs et al, 2019
A point-of-care reference which supports clinicians in using ultrasound imaging for diagnosis at the bedside. Extensive video content demonstrates technique and provides reference images of pathologic and normal conditions. The book includes a question and answer chapter for testing understanding.

Nolte's the human brain in photographs and diagrams / Todd W Vanderah, 5th ed., 2019
This extensively illustrated textbook aids students or clinicians in improving their understanding of the central nervous system. Functional anatomy is represented using a combination of diagrams, photographs and three-dimensional reconstructions based on specimens from the Warren Anatomical Museum at Harvard Medical School. 

 

Journals Spotlight

Each bulletin we highlight a selection of journals from our collection
Links provide access to the current table of contents:

Australian Psychologist

British Journal of Radiology

International Journal of Urological Nursing

Journal of 3D Printing in Medicine

Journal of Neonatal Nursing

Lancet

Maternal & Child Nutrition

NEJM

Neuro-Oncology Practice

Postgraduate Medicine

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