Cubism – Cube Blog

Recently, the British Medical Journal launched an iPad app – the first general medical journal to do so! This is truly a sign that the health world is embracing medical information ‘on the move’. The app ‘combines the weekly BMJ print journal selection of research, comment, and interactive education, along with live feeds of the latest news, blogs, podcasts, and videos’.

The launch will be welcomed by doctors and nurses armed with tablets and smart phones, who are now more mobile than ever before – particularly those in remote and rural areas.

This mobile medical education, however, is about podcasting as much as it is about apps.

Mainstream sources of medical- and health-related podcasts include key international medical journals, such as the New England Journal of Medicine and the Lancet, as well as the World Health Organisation and the Cochrane Library.

Podcasts are also increasingly being used in medical schools, including for downloadable libraries of high resolution heart and respiratory sounds.

Interestingly, a recent survey of student nurses found podcasts allowed greater control over their learning, helping them gauge their individual learning needs and build their understanding of complex topics.

Here are five top audio resources specifically relevant to clinical practice in Australia (although there are surely many more worthwhile resources!):

1.       ABC’s The Health Report – Jargon-free, easy-to-understand information and analysis on health and medical matters, considered within social, scientific and political contexts – presented by Dr Norman Swan.

2.       ABC’s Health Minutes – 60 seconds of straight talk covering the latest in medical research.

3.       Australian Family Physician – Interviews with authors from the official peer-reviewed journal of the RACGP

4.       Australian Government National Health and Medical Research Council – Updates on Australia’s major health and medical research issues from the people who shape them.

The rise in popularity of audiovisual media in medical education will likely continue as society moves to using more audio and video and physicians strive to keep current in an era of evidence-based practice. Some futurists believe that we are entering a post-textual period of the Web and that there will be an even greater demand for audio and video content in the future.

Dean Giustini, UBC Biomedical Branch Library, Canada

This week marks a landmark moment in Australia’s healthcare system when a key item in the Government’s health reform plans is fully realised.  In a major change that will affect nurses – but also GPs, patients and the pharmaceutical industry – nurse practitioners and midwives will now have the power to access specific Medicare Benefits Schedule (MBS) items and prescribe certain medicines subsidised on the Pharmaceutical Benefits Scheme (PBS).

The change in legislation recognises the highly-skilled and capable Australian nursing and midwifery workforce, providing a new framework to enhance and expand their role in providing quality healthcare.

Nurse prescribing is common practice overseas. The UK has seen a significant shift in the last two decades in nurse prescribing – which started in the 1990s when community based nurses were able to prescribe independently from a limited formulary. Since May 2006 independent nurse prescribers have been given the ability to “prescribe any licensed medicine for any medical condition within their competence.”

With this local shift in prescribing power now happening in Australia’s healthcare system, divisions in opinion and the murmur of a ‘turf war’ were always going to be inevitable. Great effort has been made to ensure the change in legislation preserved the requirement for nurse practitioners and midwives to work in collaboration with medical practitioners to access the MBS and PBS – essentially ensuring GPs are ‘kept in the loop’.  The AMA has gone to considerable lengths to help GPs prepare for the changes asking them to ‘embrace the changes’ or risk the possibility of jeopardising the mandated collaborative arrangements.

Importantly everyday Aussies are reportedly supportive of the Government’s move. Research just released by the Australian Primary Health Care Research Institute (APHCRI) has shown Australians know the difference between being sick and needing a doctor and those “everyday health concerns” when a nurse practitioner would suffice.

Responses to the ongoing APHCRI survey has stated nurses are “good listeners” and could cater for “everyday health concerns, such as repeat prescriptions and minor illnesses, to free up GPs to manage more complex conditions.”  Shorter waiting times and better access to primary care has been identified as important advantages.

There is no doubt this represents a major milestone in Australia’s healthcare system. Ensuring this significant move enhances the delivery of best possible healthcare to Australians will be critical.  Time will tell whether or not we can indeed reach the levels of contribution nurse practitioners are making in the UK.

Let me introduce you to Gerald, a 12 year old living in the small outback NSW town of Bourke – population 1,800. Gerald loves fishing, Rugby League (he barracks for the Penrith Panthers) and lives with his Mum, Dad, Nan, brothers – Steven (14) and Adrian (5), and sisters – Becky (3), Isabel (1 ½) and Ruthie (two weeks old).

Gerald is an Indigenous Australian. As we are unfortunately aware, Australia continues to retain developing world standards when it comes to the health of Aboriginal and Torres Strait  Islander people. In fact, Aboriginal Australians rank 103^rd on the United Nations Index of Human Development (which considers life expectancy, literacy, and standard of living) compared to all Australians, who come in 4^th.

Gerald’s Dad, Shaun, is 45 years old and suffers from diabetes and kidney disease. Last week, Gerald travelled 300km to the ‘big metropolis’ of Cobar (population 5,200) for his first-ever visit to the dentist (two adult teeth were removed and three fillings added). Little Ruthie was born with a low birth weight and has an 80 percent chance of developing hearing problems before her 5^th birthday. And Nan (60), who has been suffering dementia for six years, was admitted to the local hospital two weeks ago where she will spend the rest of her days.

It’s time we balanced the ledger when it comes to Aboriginal health

Indigenous health is an issue high on the agenda of the Public Health Association of Australia’s annual conference, which kicked off last week in Adelaide.

According to the Australian Bureau of Statistics (ABS), the health of Indigenous Australians is inequitable when compared to the rest of the Australian population. The rate of suicide in the Indigenous population is more than three times the non-Indigenous population. The burden of disease and injury for Aboriginal people is 2.5 times the level for non-Indigenous Australians, and dementia rates for older Aboriginal people are five times more than that of non-Indigenous Australians.

What’s more, Indigenous children born in Australia are three times more likely to die before the age of five than non-Indigenous children – survival rates similar to that of Cambodia. Indigenous men and women can expect to live 11.5 years and 10 years respectively, less than their non-Indigenous neighbours.

A harsh outlook this may seem – but it is the reality for 562,681 Indigenous people living in Australia.  So how and when will we Close the Gap?  

Last week, the previous Indigenous health minister – Warren Snowdon – was reinstated along with the Indigenous health portfolio as a result of public backlash.

One way to tackle the appalling statistics is to produce more Indigenous doctors. 150 Indigenous Australians are studying medicine in universities across the country – a move in the right direction. And 420km up the road from Bourke, the small rural town of Wilcannia has struck a pioneering agreement with the federal and NSW governments to set-up Indigenous-run small businesses, in addition to improving health services by establishing nurses in schools and setting up better healthcare for pregnant women. Gerald and his family have fingers and toes crossed that Bourke will soon follow suit.

We need to see proactive strategies based at ground level and focused on the premise of community education if we are to see any genuine improvements in the state of Australia’s Indigenous health.

When the health of some Australians is comparable to that of people living in third world countries we must commit to real change to close the gap and dissolve all inequities.

THE ELECTION – it’s THE ‘hot topic’ dominating news headlines, coffee shop banter and online forums. Australia’s mental health has emerged as an issue with potential to derail the major parties. So are the parties bringing enough reform to the table to swing votes their way? 

 Mental health is Australia’s third largest health issue behind cancer and cardiovascular disease. Mental illness is the leading cause of death for all Australians under 45, more than road trauma and binge drinking. It affects 1 in 5 Aussies and is predicted to be one of the world’s largest health problems by 2020. Such statistics can be overwhelming, however, let’s not dwell on why mental health has been relegated to the health backburner; let’s focus on escalating discussion, taking action and moving forward!

Currently, just 6 per cent of the health budget is devoted to mental health and only a third of those suffering will receive access to mental health care. Australian of the Year, Patrick McGorry has used his notoriety to give a voice to those shouting for change, particularly as 2,500 Australians die each year due to mental illness.

McGorry states that the best way to show the Australian community that mental health really is a priority for the Government is to invest in mental health reform and provide Australians with access to genuine 21^st century mental health care. 

Recently the Western Australia state government appointed the first ever Mental Health Commissioner and Melbourne played host to the world’s inaugural International Youth Mental Health Conference – both small steps in the right direction.

An analysis of the major political parties’ election promises on mental health, conducted by national charity SANE Australia, has found that both policies lack vision and take a narrow and superficial view  of the complexities of mental health. SANE Australia has challenged the major parties to commit to ‘real action’ and ‘move forward’ promptly if elected.

Everyone who needs help for mental illness should get treatment and support as early as possible, for as long as needed, and in the community where they live.

In Australia, this is far from the reality of people with mental illness – says the Executive Director of SANE Australia, Barbara Hocking.

2010 is a pivotal year for mental health in Australia. Just last week, two dozen organisations have written to both main party leaders demanding for true leadership on mental health. The announcement of an election has propelled mental health out of the policy shadows and into the election spotlight. However, sustained effort and investment will be required to keep people with a mental illness living well in the community. Hopefully this August we will finally be able to give Australia’s mental health the help it deserves.

Australian Doctor reported on some pioneering research this week – researchers in the US have successfully transplanted lab-grown lung tissue into rats that works like the real thing. The pipe dream of organically grown organs has long been discussed in medical circles, but this breakthrough led us to consider whether the future might be closer than we think?

For years, transplant surgery has been the primary way of replacing severely damaged organs. Yet transplantation is one of the most challenging and complex areas of modern medicine – doctors must battle with organ rejections and transplant failure, as well as a major shortage of organs.

In June 2008, the world’s first whole tissue-engineered organ – the windpipe – was successfully transplanted into a 31 year old lady in Spain. 18 months on, she is leading a near-normal life without the need for immunosuppressants.

In cosmetics, ‘Reconstituted Human Epidermis’ (aka lab-grown skin) is already a reality – made from discarded skin during surgery, synthetic skin is being used to test the irritancy of chemicals as an alternative to animal and human testing. The technique has taken 30 years to perfect.

In the last few months, research teams have successfully created biologic blood vessels, corneal tissue and intervertebral discs. Next will be the development of a full-sized, functional organs. Moving one step further into the future, new research is investigating ways to use this technology to repair tissues and might one day prevent organ failure altogether.

However this area is surrounded by controversy. Whilst the development of lab-grown organs may benefit medicine, the use of stem cells continues to influence public opinion on whether or not research should continue. What do you think?

Following the combined efforts of six different cancer organisations (Bowel Cancer Australia, the Gut Foundation, the GI Cancer Institute, the Bowel Cancer Foundation, the National Bowel Cancer Coalition and the Cancer Council Australia) last week in raising awareness of Australia’s second largest cancer killer, bowel cancer, it prompted us to ask: what makes a ‘healthy’ health awareness campaign?

Poignant call to action

If we take a look at Bowel Cancer Awareness Week as the most recent example, the issue dominated health news headlines all week, generating some 200 media impressions each day.

While there were varying messages from all of the organisations vying for a voice, the most common and resounding messages were: this is a cancer beginning to hit younger people (emotional), screening is critical (call-to-action) and society needs to put ‘social awkwardness’ aside when it comes to talking about bowel cancer (quirkiness).

Some organisations harnessed the power of celebrity to get their message across including Lara Bingle, George Calombaris and John Singleton, while others embraced research, personal stories and a touch of humour to spread the word.

With over 160 local, national and international health awareness days, weeks and months formally recognised by the Australian Department of Health & Ageing each year, why is it that some stand out from the crowd and demand such public and media attention, like Bowel Cancer Awareness Week, while others remain almost unheard of?

We know that not all health awareness campaigns are created equal and when embarking on a health awareness campaign, whether it’s an NGO, charity or pharmaceutical company, there needs to be a number of critical ingredients in place for a level of noise to be achieved. A host of important decisions must be made and depending on the topic/issue in question, one may find they have to work that little bit harder than their counterparts to pique the interest of media and ultimately get their target audience to act.

Working in the area of health and having played a part in many a health awareness campaign over the years, we’ve put together our top tips (with a couple of examples showing these in action) for what can help make a ‘healthy’ health awareness campaign:

1. Compelling, new research & statistics

2. Clear call-to-action that can be measured

3. Celebrity/high profile personality including MPs

4. Appeals to wider community – not just those that are affected

5. Real life stories

6. Specialists, key opinion leaders, clinical spokespeople

7. Original, creative or quirky take on getting the message across

8. Finding a journalist/media outlet with a personal connection

9. Ways to extend the campaign beyond the ‘day’, ‘week’ or ‘month’

10. Strong online presence

This week has seen a resurgence in discussion about the effect mobile phones are having on our health, with a large international study receiving widespread media coverage. Suggestions about the health impact of our mobile phone habits are a popular topic, so it may be worthwhile considering the impact the so-called ‘digital age’ and the resulting constant connectivity has on our health.

Our very smart phones allow us to stay connected, longer. But next time you are getting through the flurry of work emails on your Blackberry/iPhone while in traffic or on the bus, or even at home in front of the telly, consider this: a recent study has linked working overtime to an increased risk of heart disease.

This is worrying, considering a survey found nearly one third of Americans feel they need to stay connected to work 24/7, even during weekends and holidays. With Australians working the longest hours of any other country, we must be batting a similar average.

And with almost a third of us now using our mobiles to tweet and update our Facebook accounts, is it any wonder there are suggestions some are becoming addicted? In light of this, Facebook apps like this are eerily ironic.

Cube attended a post-budget discussion yesterday led by Chris Caton, Chief Economist at BT Financial Group, dissecting the 2010 Federal budget announcement. Contrary to 2009 forecasts – made during the height of the global economic crisis – the Government is aiming to drive the budget back into surplus within just three years.

As predicted, health is high on the priority list in this year’s budget. A total new investment of $7.3 billion in the National Health and Hospitals Network over five years hit the headlines yesterday, funded by major reforms and tax increases across three economic sectors.

Where have the savings been made?

The 2010 Federal budget – a healthy balance?

Increases in tax revenue across three core sectors will be used to fund the pledged health reform. As pre-announced in the media two weeks ago, taxes on tobacco have increased by 25%; a $9 billion Resource Super Profit Tax on the mineral industry was announced last week; and significant reforms within healthcare through the Pharmaceutical Benefits Scheme (PBS) and a new Community Pharmacy Agreement are predicted to deliver a total $2.5 billion in net savings over five years from 2010-11.

PBS reform plans began back in 2007 and are expected to generate about $6 billion in savings. Designed to take advantage of patent expiry, cuts to the price of prescription medicines are expected to generate $2 billion savings to the Government and about $300 million to patients over four years. Economic experts at the post-budget discussion suggested that leaning against the steady growth in PBS spending seen in recent years was an appropriate measure.

Where is the money going to be spent?

Whilst tax increases are not always popular and reforms can take time, the cuts will help fund the Government’s new health commitment. These savings will provide an additional $2.2 billion to meet the needs of Australia’s healthcare system, including:

1. $355 million for almost 450 GP ‘Super Clinics’
2. $417 million to enhance after-hours services, making them more streamlined
3. $523 million to provide practice nurses in all GP surgeries  
4. $467 million to rollout the national e-Health strategy, introducing individual electronic health records

Distilling the debate down to a grassroots level, patients may receive cheaper scripts, better access to GPs and practice nurses, shorter waiting lists for elective surgery and emergency department care, and better chronic disease management.

The current Government has placed a major focus in the national health system in an election year and time will quickly show the outcome of its decisions.

On a dreary day like today, there is nothing worse than travelling in cramped public transport with someone sneezing, wheezing and coughing all over you. As the chilliness approaches, the cold and flu bug is literally ‘breathing down our backs’.

With swine flu making headlines last year, what lessons did we learn? And at a time of significant discussion about vaccinations, how will we combat the inevitable germs we will be exposed to this winter?

Our own mini poll conducted almost two weeks ago provides a snapshot of 100 Australians’ experience with the winter woes last year – 80% were hit with a cold, almost half took time off work and one-in-five saw a GP as a result.

Of those that visited their GP, the most common diagnosis was a viral infection – very few were diagnosed with influenza.

The poll offers clues to our likely behaviour this year. We asked all participants if they expected to catch a cold this winter and only 21% feel that they won’t get struck down. So what will the rest of us do to fight the dreaded lurgy?

We discovered almost one-third is planning to have a flu vaccination, which is similar to the number of survey respondents who had the jab a year ago.

When asked about cold treatment strategies, short of packing up and moving to a tropical island, heading to a pharmacy for cold and flu medication was the number one remedy by far, followed by resting and taking it easy. Only a small number feel they will need to trouble their GP.

With Australians now urged more than ever to take greater responsibility for managing their own health, these results are encouraging to see. We must be listening. Well at least Cube’s friends and colleagues are! Thank you to everyone who participated in our poll.

So what will you do to contest the cold and flu crusade this year?

If someone asked you to drive a rusty old car worth less than your TV set, don an Akubra and drive 3,500kms through the 45®C unforgiving Australian outback on just $500 worth of petrol, would you say yes? Well someone from Cube did, and for a good reason – to raise funds for Cancer Council NSW.

People from around the world are coming together to take part in the inaugural Sh*tbox Rally this month to raise funds for Cancer Council NSW. On 20 March, 17 teams will each drive an old car of less than $1,000 value – in other words, a sh*tbox – 3,500 kms from Sydney to Alice Springs. The challenge is to get there in one piece – both the cars and the participants!

The 2010 Shitbox Rally Route

From the gateway of the outback at Nyngan, to Broken Hill, up the Oodnadatta Track, onto Uluru/Ayres Rock and finishing in Alice Springs, the Rally will incorporate some of the most challenging roads in Australia. Participants range from their early 20’s to late 30’s and herald from the UK, Hong Kong as well as various states across Australia including VIC, QLD, NSW and SA.

One of Cube’s very own employees, Polly Lutter, is taking part: “The challenge will be to ensure our old car reaches the destination in one piece whilst raising as much money as possible. Sadly, we all know someone who has been affected by cancer and I wanted to raise awareness of the wonderful work done by the Cancer Council of NSW. It’s also a great way to see some of this amazing country whilst ‘roughing it’ a little along the way!”

Organiser and founder of the Sh*tbox Rally, James Freeman, who recently lost both his parents as well as his brother (five years ago) to cancer, hopes not only to raise funds for Cancer Council NSW, but also help support the greater community of people the disease affects. “Like me, the type of people that are doing the Rally want to make a bigger and more meaningful contribution to the fight against cancer.” 

Cancer Council NSW funds vital cancer research, prevention, information and support services like the Cancer Council Helpline. Help the team reach their fundraising goal by donating online at Everyday Hero.