Kidney Donation Doesn't Complicate Later Health

Kidney donors' long-term health is, on the whole, similar to that of the general population, a New England Journal of Medicine study concludes.
Researchers followed up on some 3700 kidney donors whose nephrectomies were done at the University Minnesota between 1963 and 2007. The donors' mortality rates matched those of the general population, and their rate of end-stage renal disease was lower.
An editorial points out the dangers of extrapolating the results from this nearly all-white sample to other ethnic groups. It concludes that the results "could encourage the expansion of the donor pool."

Citation:NEJM 2009, 360(5)459-69

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Clinical Information Technologies Associated with Lower Hospital Mortality

Use of information technology may lower inpatient mortality, complications, and costs, according to a study in Archives of Internal Medicine.
Researchers measured information technology use in some 40 urban Texas hospitals, and then compared usage levels with hospital costs, patient length of stay, and patient outcomes. (An assessment tool gauged hospitals' actual use of automated notes and records, order entry, decision support, and test results.) The study encompassed nearly 170,000 patients older than age 50 over a 6-month period.
Among the findings:
Higher scores (and thus higher levels of automation) on notes and records favored lower rates of overall inpatient mortality.
Higher order-entry scores were associated with lower mortality from MI and CABG.
Higher decision-support scores were associated with lower mortality from pneumonia.
An editorialist finds some flaws, but calls the study a "landmark" nonetheless. He concludes: "For large- and medium-sized hospitals, it appears that the time is now" to adopt these technologies.

Citation: Arch Intern Med. 2009;169(2):108-114

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Intimate Partner Violence and Maternal Maltreatment

Women who are victims of intimate partner violence often turn on their young children.
In 2005, the U.S. had 900,000 substantiated cases of child maltreatment, with the highest rates in children aged 3 years and younger. Intimate partner violence (IPV) has historically been linked to child abuse and neglect by the perpetrator, often assumed to be the father or other male figure in the home. To learn the extent to which IPV coincides with maternal child abuse and neglect, researchers focused on a subgroup from a longitudinal prospective study that had oversampled high-risk families (i.e., births were nonmarital).
There were 2508 mothers with 3-year-old children and current partners (the child’s biological father in 76% of the families). The mothers reported committing an average of 25 acts of psychological aggression and 17 acts of physical aggression in the previous year; 11% reported some neglect in the previous year; and 55% reported spanking their children in the previous month. About 40% of the women suffered violence by their current partners; they reported significantly higher rates of parental stress, and 26% were assessed with major depression (compared with 15% of those who did not suffer IPV). IPV was significantly associated with perpetrating child abuse and neglect. Ratings of IPV, maternal stress, and maternal maltreatment were highly correlated.
Comment: Missing from this study is information about whether the mothers reciprocated the violence from their partners, whether the fathers also abused and neglected the children, and the role of alcohol or substance abuse. Clearly, though, women who are victims of IPV are at high risk for maltreating their small children. Clinicians should attend not only to the impact of these traumatic situations on the women but also to the possibility that they, in turn, might put their children at risk.
— Joel Yager, MD
Published in Journal Watch Psychiatry January 26, 2009

Citation(s):
Taylor CA et al. Intimate partner violence, maternal stress, nativity, and risk for maternal maltreatment of young children. Am J Public Health 2009 Jan; 99:175.

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Simple surgical checklist during major operations lowers deaths and complications

A collection of hospitals in eight cities around the globe has successfully demonstrated that the use of a simple surgical checklist during major operations can lower the incidence of deaths and complications by more than one third. The year-long study was led by researchers from the Harvard School of Public Health (HSPH) in collaboration with the World Health Organization, and the results are published Online First on Wednesday, January 14, 2009 on the website of the New England Journal of Medicine. The study will appear in the January 29, 2009 printed issue of NEJM.

The rate of major complications in the study operating rooms fell from 11% in the baseline period to 7% after introduction of the checklist, a reduction of more than one third. Even more dramatically, inpatient deaths following major operations fell by more than 40% (from 1.5% to 0.8%) with implementation of the checklist. The reductions were of equal magnitude in high income and lower income sites in the study.

The pilot hospitals used a checklist developed by an expert panel convened by the World Health Organization as part of its "Safe Surgery Saves Lives" Initiative, led by Atul Gawande, Associate Professor of Health Policy and Management at HSPH and a surgeon at Brigham and Women's Hospital, Boston. The checklist is a single page that requires only a few minutes to complete at three critical junctures of operative care: before anesthesia is administered, before skin incision, and before the patient is removed from the operating room. Items on the checklist are intended to ensure safe delivery of anesthesia, appropriate preventive measures against infection, effective teamwork and other essential practices in operative care.

Links to the article, plus a range of videos and manuals on use of the Checklist.

Economic crisis linked to suicide rate rises (rural focus)

SUICIDE rates in the bush are predicted to rise significantly as the credit crunch combines with the ongoing drought to create financial difficulties.

A recent study from Flinders University concluded that the suicide rate amongst farmers was around 50 per cent higher than the rest of the population.

NHMRC Clinical practice guidelines for the management of melanoma in Australia and New Zealand

The Clinical Practice Guidelines for the Management of Melanoma in Australia and New Zealand (2008) have been developed by an expert team to provide the evidence for optimal care and will assist GP's, dermatologists , surgeons and others in clinical decision making when managing patients with melanoma.
For hard copies email

Will more medical places result in more rural GPs? (Rural Health Workforce Australia)

Australia is investing very large sums of money in expanding both the number of medical places available at university and the number of medical schools around the country. By 2012 there will be almost 3000 graduates a year : up from just over 1300 in 2005. The expectation is that this increase in domestic medical graduates will solve our medical workforce issues. However, there is little evidence to suggest that this will result in more doctors for rural and remote areas of Australia, according to Dr Kim Webber, CEO of Rural Health Workforce Australia (RHWA).

Press release

Discussion paper

Climate will hit indigenous Australians hardest: report

Indigenous Australians in remote areas will be hardest hit by climate change because of their poorer health and access to services, a team of environment and indigenous health experts has warned.

Article

Country Careers : know your part of GWAHS

The GWAHS Country Careers program has recently created a website to allow staff to access information about the towns in the GWAHS region and find out what it is like to live in the region.Of interest to new staff, convenors of interview panels, potential staff, students and anyone else new to GWAHS. A series of very detailed booklets on the various regions of GWAHS are available.

The website is now live and a link can be found on the GWAHS Internet site or follow the link below:

http://www.gwahs.nsw.gov.au/CountryCareers

Garling Report : opportunity for comment

To support wider consultation on the Final Report of the Special Commission of Inquiry into Acute Care Services in NSW Public Hospitals (the Garling Report) a website has been developed that allows interested community members and the health workforce to provide their comments on each recommendation. The site is available at www.healthactionplan.nsw.gov.au with a link from the NSW Health site on www.health.nsw.gov.au . The Ministerial Forum was filmed and footage is also available on this site together with an outcome statement from the day. The full text of the report and recommendations is also available.
The Government response to the Garling Report is due no later than March 2009.