Research news in brief

Australian Doctors Federation awards Bruce Shepherd Medals

The Australian Doctors Federation (ADF) has awarded the Bruce Shepherd Medals to 16 doctors and one medical administrator for excellence in independent medicine at a ceremony in Sydney. The late Dr Bruce Shepherd AM instigated these awards in 2008. The 2019 honorees are: Mr Paul Boyatzis, former WA Australian Medical Association (AMA) executive director for over 30 years; Dr John Buntine, plastic surgeon and service to the Australian Association of Surgeons, the AMA and the Australian Hand Surgery Society; Dr Rosanna Capolingua, GP and former Federal President of the AMA; Dr Bill Coote, GP and former CEO of the Federal AMA; Dr Merv Cross OAM, orthopaedic surgeon and Director of Orthopaedics for the Sydney 2000 Olympics; Dr John Dixon Hughes OAM, former Chair and Administrator of the Medical Services Committee of NSW, and surgeon; Dr John Dowden, editor-in-chief of Australian Prescriber, GP, National Health and Medical Research Council Expert Advisory Group on ADHD; Dr Mukesh Haikerwal AC, former Federal President of the AMA, Melbourne GP; Prof John Murtagh AM, wrote General practice, considered the “bible” for GPs; Dr Charles New OAM, Sydney orthopaedic spinal surgeon, surgeon in the Royal Australian Army Medical Corps; Dr Jim O’Brien, orthopaedic surgeon, member of the ADF Management Committee; Professor Julie Quinlivan, Foundation Dean of Health and Head of the School of Medicine at Notre Dame University Sydney, and Director of the Professional Services Review; Dr Shaun Rudd, Queensland GP, former President of the Queensland AMA, member and Director of the ADF; Dr Adrian Sheen, GP, trombone player, magician, founder of Vatu Health, delivering quality primary care in Fiji; Dr Gary Speck AM, Melbourne orthopaedic spinal surgeon, former Federal Vice-President of the AMA, Director of the MJA’s parent company Australian Medical Publishing Company; Dr Michael Steiner, Sydney ophthalmologist, former President of the NSW branch of the AMA, former President of the Australian Society of Ophthalmologists; Laurate Professor Nicholas Talley AC, international authority in gastroenterology, editor-in-chief of the MJA, former Chair of the Council of Presidents of Medical Colleges.

Improvement needed for care of children with acute gastroenteritis

Treatment for children with acute gastroenteritis follows clinical practice guidelines 90% of the time but drops to around 50% adherence for best practice diagnosis and ongoing management of the condition, according to research from the Australian Institute of Health Innovation at Macquarie University, published in PLoS One. The study evaluated the documented care in 2012 and 2013 of 669 children across 75 GPs, 34 emergency departments (EDs) and 26 inpatient hospital services in New South Wales, Queensland and South Australia. The authors wrote that while clinicians and particularly GPs were adhering to clinical practice guidelines for treating children with acute gastroenteritis, improvements could be made in the areas of documenting diagnosis and ongoing management of the condition. An important aspect of care is in the taking of routine observations for a child presenting with vomiting or diarrhoea, or both, that has been going on for days and may be accompanied by a high temperature, reduced fluid intake and lack of appetite. Overall, only 16.8% of children had their observations recorded, which can include details about the duration of the illness plus the child’s temperature, heart rate, blood pressure and weight. Across all settings, general practice, ED and in hospital, only 27.4% of babies aged under 1 year presenting with symptoms of acute gastroenteritis had their fontanelles assessed and recorded — depression of the anterior fontanelle is a clinical sign of dehydration in infants. Also, when presenting to GPs, only 14.2% of children had their urine output recorded (an indicator for dehydration) and less than a quarter had their weight recorded.

Improved support after self-harm needed to reduce suicide risk

The risk of suicide following hospital presentation for self-harm is very high immediately after hospital discharge, emphasising the need for provision of early follow-up care and attention to risk reduction strategies. To reduce the high risk of suicide after hospital attendance for self-harm, improved clinical management is needed for all patients – including comprehensive assessment of the patients’ mental state, needs, and risks, as well as implementation of risk reduction strategies, including safety planning, according to an observational study spanning 16 years and including 49 783 people aged over 15 years who presented to hospital after non-fatal self-harm a total of 90 614 times between 2000 and 2013. Published in The Lancet Psychiatry, the study compared the risk of suicide following hospital presentation for self-harm according to patient characteristics, method of self-harm, and socio-economic deprivation. It also estimated the incidence of suicide by time after hospital attendance, adjusting for gender, age, previous self-harm, and psychiatric treatment. The authors followed these patients for 16 years (until the end of 2015), and the study included five UK hospitals (one in Oxford, three in Manchester and one in Derby). Within the 16-year follow-up, 703 out of 49 783 people died by suicide – with the incidence of suicide being 163 per 100 000 people per year. Around a third of these deaths occurred within a year of the patient attending hospital for non-fatal self-harm (36%, 252/703 deaths), and the study confirmed the high risk of suicide in the first year after presentation to hospital for self-harm (the incidence of suicide in the year following discharge from hospital was 511 suicides per 100 000 people per year – 55.5 times higher than that of the general population). The authors found that risk was particularly elevated in the first month (the incidence of suicide in the month after discharge from hospital was 1787 per 100 000 people per year – close to 200 times higher than in the general population) – with 74 out of 703 people in the study dying by suicide within a month. Men were more likely to die by suicide following hospital presentation of self-harm than women, people who attended hospital more than once for non-fatal self-harm were more likely to die by suicide than those with a single presentation, and age was associated with risk (with risk increasing 3% with each year of age).

What’s new online at the MJA

Research: Is the risk of cancer in Australia overstated? The importance of competing mortality for estimating lifetime risk
Bach et al; doi: 10.5694/mja2.50376
The current method for calculating lifetime risks overestimates these risks, especially for men … OPEN ACCESS permanently