more_vertSudden out-of-hospital cardiac arrest is the most time-critical medical emergency. In the second paper of this Series on out-of-hospital cardiac arrest, we considered important issues in the prehospital management of cardiac arrest. Successful resuscitation relies on a strong chain of survival with the community, dispatch centre, ambulance, and hospital working together. Early cardiopulmonary resuscitation and defibrillation has the greatest impact on survival. If the community response does not restart the heart, resuscitation is continued by emergency medical services’ staff.
Preference: Emergency Medicine
202
[Correspondence] Safe travels during hurricanes
On the evening of Sept 10, 2017, in Miami (FL, USA), at a time when Hurricane Irma had reached category 4 status, a 91-year-old woman had a stroke. As per local hurricane protocol, emergency medical services are halted when storm winds reach category 3 status or higher. With no viable alternative transportation to navigate through strong winds and the substantial storm surge (appendix), the patient was brought to the emergency room in the backseat of her granddaughter’s car.
The effect of provider affiliation with a primary care network on emergency department visits and hospital admissions [Research]
BACKGROUND:
Primary care networks are designed to facilitate access to inter-professional, team-based care. We compared health outcomes associated with primary care networks versus conventional primary care.
METHODS:
We obtained data on all adult residents of Alberta who visited a primary care physician during fiscal years 2008 and 2009 and classified them as affiliated with a primary care network or not, based on the physician most involved in their care. The primary outcome was an emergency department visit or nonelective hospital admission for a Patient Medical Home indicator condition (asthma, chronic obstructive pulmonary disease, heart failure, coronary disease, hypertension and diabetes) within 12 months.
RESULTS:
Adults receiving care within a primary care network (n = 1 502 916) were older and had higher comorbidity burdens than those receiving conventional primary care (n = 1 109 941). Patients in a primary care network were less likely to visit the emergency department for an indicator condition (1.4% v. 1.7%, mean 0.031 v. 0.035 per patient, adjusted risk ratio [RR] 0.98, 95% confidence interval [CI] 0.96–0.99) or for any cause (25.5% v. 30.5%, mean 0.55 v. 0.72 per patient, adjusted RR 0.93, 95% CI 0.93–0.94), but were more likely to be admitted to hospital for an indicator condition (0.6% v. 0.6%, mean 0.018 v. 0.017 per patient, adjusted RR 1.07, 95% CI 1.03–1.11) or all-cause (9.3% v. 9.1%, mean 0.25 v. 0.23 per patient, adjusted RR 1.08, 95% CI 1.07–1.09). Patients in a primary care network had 169 fewer all-cause emergency department visits and 86 fewer days in hospital (owing to shorter lengths of stay) per 1000 patient-years.
INTERPRETATION:
Care within a primary care network was associated with fewer emergency department visits and fewer hospital days.
Invitation for nominations for election to Federal Council
Australian Medical Association Limited ABN 37 008 426 793
Invitation for nominations for election to Federal Council
AREA NOMINEES
Invitation for nominations for election to Federal Council as Area Nominees
The Constitution of Australian Medical Association Limited (AMA) provides for the election, every two years, to the Federal Council of one Ordinary Member as a Nominee of each of the following Areas:
1. New South Wales and Australian Capital Territory Area 2. Queensland Area 3. South Australia and Northern Territory Area
4. Tasmania Area 5. Victoria Area 6. Western Australia Area
The current term of Area Nominee Councillors expires at the end of the AMA National Conference in May 2018.
Nominations are now invited for election as the Nominee for each of the Areas listed above.
1. Nominees elected to these positions will hold office until the conclusion of the May 2020 AMA National Conference. 2. The nominee must be an Ordinary Member of the AMA and a member in the relevant Area for which the nomination is made. 3. The nomination must include the name and address of the nominee and the date of nomination. It may also include details of academic qualifications, the nominee’s career and details of membership of other relevant organisations. 4. Each nomination must be signed by the Ordinary Member nominated AND must be signed by two other Ordinary Members of the AMA resident in the Area for which the nomination is made. 5. Nominations must be emailed to the Secretary General (atrimmer@ama.com.au). To be valid nominations must be received no later than 1.00pm (AEDT) Friday 2 March 2018. 6. A nomination may be accompanied by a statement by the nominee of not more than 250 words to be circulated to voters. 7. The ballot will be undertaken by electronic ballot.
The nomination form can be downloaded from ama.com.au/system/files/AreaNomineeForm.pdf
For enquiries please contact Lauren McDougall, Office of the Secretary General and President (email: lmcdougall@ama.com.au).
SPECIALTY GROUP NOMINEES
Invitation for nominations for election to Federal Council as Specialty Group Nominees
The Constitution of Australian Medical Association Limited (AMA) provides for the election, every two years, to the Federal Council of one Ordinary Member as a Nominee of each of the following Specialty Groups:
1. Anaesthetists 2. Dermatologists 3. Emergency Physicians 4. Obstetricians and Gynaecologists 5. Ophthalmologists
6. Orthopaedic Surgeons 7. Paediatricians 8. Pathologists 9. Physicians 10. Psychiatrists 11. Radiologists 12. Surgeons
Note that the General Practitioner Specialty Group is listed for nomination as a Practice Group as it has its own Council, in line with the other Practice Groups.
The current term of Specialty Group Councillors expires at the end of the AMA National Conference in May 2018.
Nominations are now invited for election as the Nominee for each of the Specialty Groups listed above.
1. Nominees elected to these positions will hold office until the conclusion of the May 2020 AMA National Conference. 2. The nominee must be an Ordinary Member of the AMA and a member of the relevant Specialty Group for which the nomination is made. 3. The nomination must include the name and address of the nominee and the date of nomination. It may also include details of academic qualifications, the nominee’s career and details of membership of other relevant organisations. 4. Each nomination must be signed by the Ordinary Member nominated AND must be signed by two other Ordinary Members of the AMA Specialty Group for which the nomination is made. 5. Nominations must be emailed to the Secretary General (atrimmer@ama.com.au). To be valid nominations must be received no later than 1.00pm (AEDT) Friday 2 March 2018. 6. A nomination may be accompanied by a statement by the nominee of not more than 250 words to be circulated to voters. 7. The ballot will be undertaken by electronic ballot.
The nomination form can be downloaded from ama.com.au/system/files/SpecialtyGroupForm.pdf
For enquiries please contact Lauren McDougall, Office of the Secretary General and President (email: lmcdougall@ama.com.au).
PRACTICE GROUP NOMINEES
Invitation for nominations for election to Federal Council as Practice Group Nominees
The Constitution of Australian Medical Association Limited (AMA) provides for the election, every two years, to the Federal Council of one Ordinary Member as a Nominee of each of the following Practice Groups:
1. General Practitioners 2. Public Hospital Doctors 3. Rural Doctors 4. Doctors in Training 5. Private Specialist Practice.
The term of Councillors expires at the end of the AMA National Conference in May 2018.
Nominations are now invited for election as the Nominee for each of the Practice Groups listed above.
1. Nominees elected to these positions will hold office until the conclusion of the May 2020 AMA National Conference. 2. The nominee must be an Ordinary Member of the AMA and a member of the relevant Practice Group for which the nomination is made. A member may nominate for, and vote in, as many Practice Groups as may be relevant to their practice. 3. The nomination must include the name and address of the nominee and the date of nomination. It may also include details of academic qualifications, the nominee’s career and details of membership of other relevant organisations. 4. Each nomination must be signed by the Ordinary Member nominated AND must be signed by two other Ordinary Members of the AMA Practice Group for which the nomination is made. 5. Nominations must be emailed to the Secretary General (atrimmer@ama.com.au). To be valid nominations must be received no later than 1.00pm (AEDT) Friday 2 March 2018. 6. A nomination may be accompanied by a statement by the nominee of not more than 250 words to be circulated to voters. 7. The ballot will be undertaken by electronic ballot.
The nomination form can be downloaded from ama.com.au/system/files/PracticeGroupForm.pdf
For enquiries please contact Lauren McDougall, Office of the Secretary General and President (email: lmcdougall@ama.com.au).
Anne Trimmer – Secretary General, 31 January 2018
Impact of frailty on outcomes after discharge in older surgical patients: a prospective cohort study [Research]
BACKGROUND:
Frailty is a state of vulnerability to diverse stressors. We assessed the impact of frailty on outcomes after discharge in older surgical patients.
METHODS:
We prospectively followed patients 65 years of age or older who underwent emergency abdominal surgery at either of 2 tertiary care centres and who needed assistance with fewer than 3 activities of daily living. Preadmission frailty was defined according to the Canadian Study of Health and Aging Clinical Frailty Scale as “well” (score 1 or 2), “vulnerable” (score 3 or 4) or “frail” (score 5 or 6). We assessed composite end points of 30-day and 6-month all-cause readmission or death by multivariable logistic regression.
RESULTS:
Of 308 patients (median age 75 [range 65–94] yr, median Clinical Frailty Score 3 [range 1–6]), 168 (54.5%) were classified as vulnerable and 68 (22.1%) as frail. Ten (4.2%) of those classified as vulnerable or frail received a geriatric consultation. At 30 days after discharge, the proportions of patients who were readmitted or had died were greater among vulnerable patients (n = 27 [16.1%]; adjusted odds ratio [OR] 4.60, 95% confidence interval [CI] 1.29–16.45) and frail patients (n = 12 [17.6%]; adjusted OR 4.51, 95% CI 1.13–17.94) than among patients who were well (n = 3 [4.2%]). By 6 months, the degree of frailty independently and dose-dependently predicted readmission or death: 56 (33.3%) of the vulnerable patients (adjusted OR 2.15, 95% CI 1.01–4.55) and 37 (54.4%) of the frail patients (adjusted OR 3.27, 95% CI 1.32–8.12) were readmitted or had died, compared with 11 (15.3%) of the patients who were well.
INTERPRETATION:
Vulnerability and frailty were prevalent in older patients undergoing surgery and unlikely to trigger specialized geriatric assessment, yet remained independently associated with greater risk of readmission for as long as 6 months after discharge. Therefore, the degree of frailty has important prognostic value for readmission.
Trial registration for primary study
ClinicalTrials.gov, no. NCT02233153
AMA shines in Australia Day Honours
Former Australian Medical Association President Dr Mukesh Haikerwal has been awarded the highest honour in this year’s Australia Day awards by being named a Companion of the Order of Australia (AC).
He is accompanied by the current Editor-in-Chief of the Medical Journal of Australia, Laureate Professor Nick Talley, as well as longstanding member Professor Jeffrey Rosenfeld – who both also received the AC.
The trio top a long and impressive list of AMA members to receive Australia Day Honours this year.
AMA Federal Councillor, Associate Professor Julian Rait, received the Medal of the Order (OAM).
A host of other members honoured in the awards are listed below.
AMA President Dr Michael Gannon said the accolades were all well-deserved and made he made special mention of those receiving the highest Australia Day Honours.
“They have dedicated their lives and careers to helping others through their various roles as clinicians, researchers, teachers, authors, administrators, or government advisers – and importantly as leaders in their local communities,” Dr Gannon said.
“On behalf of the AMA, I pay tribute to all the doctors and other health professionals who were honoured today for their passion for their profession and their dedication to their patients and their communities.
“The great thing about the Honours is that they acknowledge achievement at the international, national, and local level, and they recognise excellence across all avenues of human endeavour.
“Doctors from many diverse backgrounds have been recognised and honoured again this year.
“There are pioneering surgeons and researchers, legends across many specialties, public health advocates, researchers, administrators, teachers, and GPs and family doctors who have devoted their lives to serving their local communities.
“The AMA congratulates all the doctors and other health advocates whose work has been acknowledged.
“We are, of course, especially proud of AMA members who are among the 75 people honoured in the medicine category.”
Dr Haikerwal, who was awarded the Officer in the Order of Australia (AO) in 2011, said this further honour was “truly mind-blowing” and another life-changing moment.
“To be honoured on Australia Day at the highest level in the Order of Australia is beyond imagination, beyond my wildest dreams and extremely humbling,” Dr Haikerwal said.
“For me to be in a position in my life and career to receive such an honour has only been made possible due to the unflinching support and unremitting encouragement of my closest circle, the people who have been with me through every step of endeavour, adversity, achievement, and success.”
CHRIS JOHNSON
AMA MEMBERS IN RECEIPT OF HONOURS
COMPANION (AC) IN THE GENERAL DIVISION
Dr Mukesh Chandra HAIKERWAL AO
Altona North Vic 3025
For eminent service to medical governance, administration, and technology, and to medicine, through leadership roles with a range of organisations, to education and the not-for-profit sector, and to the community of western Melbourne.
Professor Jeffrey Victor ROSENFELD AM
Caulfield North, Vic
For eminent service to medicine, particularly to the discipline of neurosurgery, as an academic and clinician, to medical research and professional organisations, and to the health and welfare of current and former defence force members.
Professor Nicholas Joseph TALLEY
Black Hill, NSW
For eminent service to medical research, and to education in the field of gastroenterology and epidemiology, as an academic, author and administrator at the national and international level, and to health and scientific associations.
OFFICER (AO) IN THE GENERAL DIVISION
Emeritus Professor David John AMES
East Kew, Vic
For distinguished service to psychiatry, particularly in the area of dementia and the mental health of older persons, as an academic, author and practitioner, and as an adviser to professional bodies.
Dr Peggy BROWN
Sanctuary Cove, Qld
For distinguished service to medical administration in the area of mental health through leadership roles at the state and national level, to the discipline of psychiatry, to education, and to health care standards.
Professor Creswell John EASTMAN AM
St Leonards, NSW
For distinguished service to medicine, particularly to the discipline of pathology, through leadership roles, to medical education, and as a contributor to international public health projects.
Professor Suzanne Marie GARLAND
Docklands, Vic
For distinguished service to medicine in the field of clinical microbiology, particularly to infectious diseases in reproductive and neonatal health as a physician, administrator, researcher and author, and to professional medical organisations.
Dr Paul John HEMMING
Queenscliff, Vic
For distinguished service to higher education administration, to medicine through contributions to a range of professional medical associations, and to the community of central Victoria, particularly as a general practitioner.
Professor Anthony David HOLMES
Melbourne, Vic
For distinguished service to medicine, particularly to reconstructive and craniofacial surgery, as a leader, clinician and educator, and to professional medical associations.
Dr Diana Elaine O’HALLORAN
Glenorie, NSW
For distinguished service to medicine in the field of general practice through policy development, health system reform and the establishment of new models of service and care.
MEMBER (AM) IN THE GENERAL DIVISION
Dr Michael Charles BELLEMORE
Croydon, NSW
For significant service to medicine in the field of paediatric orthopaedics as a surgeon, to medical education, and to professional medical societies.
Dr Colin Ross CHILVERS
Launceston, Tas
For significant service to medicine in the field of anaesthesia as a clinician, to medical education in Tasmania, and to professional societies.
Associate Professor Peter HAERTSCH OAM
Breakfast Point, NSW
For significant service to medicine in the field of plastic and reconstructive surgery as a clinician and administrator, and to medical education.
Professor Ian Godfrey HAMMOND
Subiaco, WA
For significant service to medicine in the field of gynaecological oncology as a clinician, to cancer support and palliative care, and to professional groups.
Dr Philip Haywood HOUSE
WA
For significant service to medicine as an ophthalmologist, to eye surgery foundations, and to the international community of Timor Leste.
Adjunct Professor John William KELLY
Vic
For significant service to medicine through the management and treatment of melanoma, as a clinician and administrator, and to education.
Dr Marcus Welby SKINNER
West Hobart, Tas
For significant service to medicine in the field of anaesthesiology and perioperative medicine as a clinician, and to professional societies.
Professor Mark Peter UMSTAD
South Yarra, Vic
For significant service to medicine in the field of obstetrics, particularly complex pregnancies, as a clinician, consultant and academic.
Professor Barbara S WORKMAN
East Hawthorn, Vic
For significant service to geriatric and rehabilitation medicine, as a clinician and academic, and to the provision of aged care services.
MEDAL (OAM) IN THE GENERAL DIVISION
Professor William Robert ADAM PSM
Vic
For service to medical education, particularly to rural health.
Dr Marjorie Winifred CROSS
Bungendore, NSW
For service to medicine, particularly to doctors in rural areas.
Associate Professor Mark Andrew DAVIES
Maroubra, NSW
For service to medicine, particularly to neurosurgery.
Dr David William GREEN
Coombabah, Qld
For service to emergency medicine, and to professional organisations.
Dr Barry Peter HICKEY
Ascot, Qld
For service to thoracic medicine.
Dr Fred Nickolas NASSER
Strathfield, NSW
For service to medicine in the field of cardiology, and to the community.
Dr Ralph Leslie PETERS
New Norfolk, Tas
For service to medicine, and to the community of the Derwent Valley.
Associate Professor Julian Lockhart RAIT
Camberwell, Vic
For service to ophthalmology, and to the development of overseas aid.
Mr James Mohan SAVUNDRA
South Perth, WA
For service to medicine in the fields of plastic and reconstructive surgery.
Dr Chin Huat TAN
Glendalough, WA
For service to the Chinese community of Western Australia.
Dr Karen Susan WAYNE
Toorak, Vic
For service to the community of Victoria through a range of organisations.
Dr Anthony Paul WELDON
Melbourne, Vic
For service to the community, and to paediatric medicine.
PUBLIC SERVICE MEDAL (PSM)
Dr Sharon KELLY
Yeronga, Qld
For outstanding public service to the health sector in Queensland.
Professor Maria CROTTY
Kent Town, SA
For outstanding public service in the rehabilitation sector in South Australia.
How good are you at basic suturing?
Are you a junior medical officer looking for a refresher in basic suturing? Are you up to date with your basic surgical skills? Suturing is an essential skill in the everyday practice of medicine. Although suturing technique is important, as a junior doctor you’re also expected to have a thorough understanding of wound management in general to effectively care for a patient with a laceration.
Whether in primary health or in an emergency environment, junior doctors will encounter many types of wounds requiring closure. The decision to close a wound and the technique used are influenced by many factors, including location, depth and contamination of wound, age of patient and resources or time available.
Designed in response to feedback from junior doctors and accredited for CPD by ACRRM, ACEM, CICM and ANZCA, the Basic Suturing learning module will help doctors bolster their competence in the basic techniques of minor surgery. Doctorportal Learning, in partnership with Osler, have created an easy to understand, well-structured module with step-by-step instructions and streaming video demonstrations of basic knot tying and suturing techniques for beginners. The module covers:
- Wound assessment
- Wound cleaning
- Suturing technique
- Post suturing wound care
- Knowledge and assessment.
Click here for more information and add basic suturing to your skills.
[Editorial] Stroke—acting FAST at all ages
On Feb 1, Public Health England released new estimates for the incidence of first stroke in England and relaunched its Act FAST campaign. FAST is aimed at the public, encouraging them to call 999—the UK’s emergency number—if there are tell-tale signs of stroke in themselves or anyone they see. FAST stands for face, arms, speech, and time (to call). The new estimates showed that about 57 000 new strokes and 32 000 stroke-related deaths occur every year in England. Of those who have experienced a stroke, about a quarter leave hospital with moderate or severe disability.
[Comment] Amid US funding cuts, UNRWA appeals for health and dignity of Palestinian refugees
The United Nations Relief and Works Agency for Palestine Refugees in the Near East (UNRWA) faces a major challenge in upholding its mandate and preserving key services such as education and health care for Palestinian refugees. On Jan 16, 2018, the US Government announced a contribution of US$60 million for 2018 so far,1,2 in support of UNRWA’s efforts to keep our schools open, health clinics running, and emergency food and cash distribution systems functioning. Although important, this funding is dramatically below past levels.
National architecture needed for mental health
Almost one in two Australian adults will experience a mental health condition in their lifetime, yet mental health and psychiatric care are grossly underfunded when compared to physical health.
Those statistics were the stark reality AMA President Dr Michael Gannon laid out when releasing the AMA Position Statement on Mental Health 2018.
In doing so, he called for strategic leadership to integrate all components of mental health prevention and care.
The AMA is calling for a national, overarching mental health “architecture”, and proper investment in both prevention and treatment of mental illnesses.
“Many Australians will experience a mental illness at some time in their lives, and almost every Australian will experience the effects of mental illness in a family member, friend, or work colleague,” Dr Gannon said.
“For mental health consumers and their families, navigating the system and finding the right care at the right time can be difficult and frustrating.
“Australia lacks an overarching mental health architecture. There is no vision of what the mental health system will look like in the future, nor is there any agreed national design or structure that will facilitate prevention and proper care for people with mental illness.”
The AMA has called for the balance between funding acute care in public hospitals, primary care, and community-managed mental health to be correctly weighted.
Funding should be on the basis of need, demand, and disease burden, Dr Gannon said, not a competition between sectors and specific conditions.
“Policies that try to strip resources from one area of mental health to pay for another are disastrous,” he said.
“Poor access to acute beds for major illness leads to extended delays in emergency departments, poor access to community care leads to delayed or failed discharges from hospitals, and poor funding of community services makes it harder to access and coordinate prevention, support services, and early intervention.
“Significant investment is urgently needed to reduce the deficits in care, fragmentation, poor coordination, and access to effective care.
“As with physical health, prevention is just as important in mental health, and evidence-based prevention can be socially and economically superior to treatment.”
Dr Gannon said community-managed mental health services had not been appropriately structured or funded since the movement towards de-institutionalisation in the 1970s and 1980s, which shifted much of the care and treatment of people with a mental illness out of institutions and into the community.
The AMA Position Statement supports coordinated and properly funded community-managed mental health services for people with psychosocial disability, as this will reduce the need for costly hospital admissions.
The Position Statement calls for Governments to address underfunding in mental health services and programs for adolescents, refugees and migrants, Aboriginal and Torres Strait Islander people, and people in regional and remote areas.
It also calls for Government recognition and support for carers of people with mental illness.
“Caring for people with a mental illness is often the result of necessity, not choice, and can involve very intense demands on carers,” Dr Gannon said.
“Access to respite care is vital for many people with mental illness and their families, who bear the largest burden of care.”
The AMA Position Statement on Mental Health 2018 is available at position-statement/mental-health-2018
CHRIS JOHNSON