Western Nurse Magazine September October 2017 by ANF WESTERN NURSE MAGAZINE

September â&#x20AC;&#x201C; October 2017

incorporating western midwife

Reinvigorate your organs with litres of teen plasma

Genetic editing Hack your DNA code to prevent all the diseases you don't yet have

Bionic limbs

Robotic hearts

IMMORTALITY

Artificial exoskeletons

The Latest Obsession PAGE 6

western nurse is the official magazine for ANF members in WA

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Secretary's Report September-October 2017 on the

FEATURED

cover

4 Fremantle Hospital Ex Trainees Assoc celebrates 80th year 6 The immortality industry

sms of skeletal ontraction

cells scle ent ergy bre brils nts, pear tein tion for

State Secretary, Mark Olson

The immortality industry

10 ANF Humanitarian Fund: Helping our kids to hear 18 NEW: Mark’s Q & A is back!

FAVOURITES 8 Internet Watch

THICK FILAMENTS

20 Across the Nation

HOLIDAY ANF

Due to popular demand we’re bringing back Mark’s question and answer section as regular feature in western nurse. Tax deductions have been a common subject in many inquiries recently, so we’ll cover a repeatedly occurring question this edition.

Can we claim home internet costs as a tax deduction because we have to do CPD each year, much of which is online; and I also often need to access work emails and often I do most of my mandatory competencies at home because work is too busy?

Illustration 2. A:

It’s a very good question given the amount of online learning now being done. And the answer is yes, a claim can be made – as long as the education is related to current employment, such as either keeping up-to-date or enhancing earning capacity. The education cannot be for a different field outside the scope of current work e.g. a nurse studying to be a doctor.

River

You may also be able to claim for some home office expenditure:

Home office – You can claim the set rate of 45c per hour for heating, cooling, lighting;

Mobile phone – percentage of bill for work purposes. You need to keep records for a 4-week representative period in each income year to claim a deduction of more than $50; Internet – percentage for work purposes; Specific office equipment – percentage claim based on work/private usage i.e. computer;

Consumables – percentage based on work usage. i.e printer cartridges, paper, pens etc; You would need to ensure that any other people using the equipment, internet etc are factored into your calculations, so you only claim your own work-related usage as a deductible amount. 

NEW: Mark’s Q & A is back!

WIN! 31

Win four iconic 80s films in a special high definition blu-ray collection. Also up for grabs: The New Australian Garden: Landscapes for Living.

CLINICAL UPDATES 14 A drug update: Doxycycline

16 Mechanisms of skeletal muscle contraction

At recent meetings, the bureaucrats have visibly started acknowledging three facts – that existing national nurses’ board regulations and everyday hospital safety protocols already maintain standards and safety; that the appraisals are of no practical use when forced onto nurses and midwives; and that the Health Minister is committed to getting rid of them. I’ll keep you posted as more develops – with more meetings due in coming months, but I am confident that change will occur sooner rather than later. In the meantime, while we continue to fight behind the scenes for big picture items such as getting rid of appraisals, we are persisting with our goal to keep improving day-to-day services.

24 ANF Out ‘N’ About

Thick filaments are made up of myosin, a complex protein molecule that can be divided 26 Around the Globe into three regions: S1, S2 and the tail region. S1 30 forResearch Roundup is the globular head of myosin, responsible enzymatic and chemical activity and binding 31 ANF Contact Details ANF Humanitarian to actin within thin filamentsFund: (see Illustration our kids hear 1). S2Helping is the flexible necktothat connects S1 and the tail region. The tail region is long and straight. Myosin molecules are found in pairs. The tail and S2 regions are wrapped around each other, while the S1 heads sit next to one 15 ANF Super Deal Margaret Mark’s another. The molecules are highly organised within the thick filament. Myosin tails make 32 up the backbone of the filament, while theANF Super Deal Kalbarri heads extend outwards in both directions (see Illustration 2).

I’m pleased to report that since my last editorial in this publication, there has been positive movement on the performance appraisals front.

16 Mechanisms of skeletal muscle contraction

I have previously announced on these pages that an ANF App is on the cards, and adding to that good news, I’ll be personally revamping and relaunching our extremely popular computer classes that helped thousands of WA nurses and midwives become confident with the technology they were encountering both in and outside work – I still get letters of thanks from members for the lessons, years after they completed them. As always, we’ll be asking you what you want from the service as we re-develop it, through one of our comprehensive surveys – and whether it’s more knowledge about getting the best out of your laptop and its software, or traversing the features of the latest model of smartphone or other tech device, we want to know what you need. So keep an eye out for my email coming soon announcing that the computer classes survey has been uploaded on your iFolio. Meanwhile, I’ll inform you as usual about any significant developments affecting members on these pages, by email, and on iFolio.

22 Counting the numbers: Quantifying the burden of disease 29 Ketamine: A drug update

THIN FILAMENTS Thin filaments are made up of two strands of repeating protein molecules known as G-actin. The molecules rotate to form a helical structure called filamentous actin (F-actin), with a half turn every seven molecules. In the groove created by the rotation there sits another chain of protein molecules called tropomyosin. At the end of each tropomyosin is a protein complex called troponin. Together, tropomyosin and troponin regulate the interaction between actin and myosin to allow for controlled

September–October 2017 western nurse |

PITCHING IN TOGETHER OVER THE YEARS

As the number of nurses who mastered their craft in hospitals dwindles, groups like Fremantle Hospital Ex Trainees Association – celebrating its 80th anniversary this year – Rita Ilich, Associate Professor Ruth Letts keep the memories, camaraderie, and lessons of the past alive. and Annie Carswell

ver since its inception at the Florence Nightingale Club Rooms on April 2, 1937, the Fremantle Hospital Ex Trainees Association has provided friendship and fellowship for nurses who learned the ropes of their profession on the wards. The group reflects the spirit of cooperation and positivity that has always existed among Fremantle trainees, despite a learning regimen heavy on discipline, said long-time member and vice president, Annie Carswell. “We all enjoyed our time together, looking out and covering for each other, even sometimes to prevent a fellow traineenurse having a major anxiety attack – taking the blame for a situation one of your friends had been involved in,” said Annie, who started her training at the hospital 49 years ago, graduating in 1971 as a nurse. Annie said some protocols of the past might seem onerous for trainees of today – such as students having to present themselves to the sister-in-charge, in order to be “excused on for duty” and inspected, almost military style. “This was an opportunity for a casual inspection regarding your presentation and demeanour,” Annie said. “The reverse would happen at the end of your duty – there was an ‘excused off duty’ process, and nurses were often held back if things were deemed unsatisfactory. “At these times your mates came to the fore, with everybody pitching in to repeat or complete the tasks at hand. Sometimes we would go to a nearby ward, and assist the students there to gain ‘excused off’ status, then all head home to the quarters for a much needed rest, and the mandatory debriefing session about the day’s events.” Consultants’ morning rounds were when student nurses were expected to have a ward “ready-for-rounds, including some of the cleaning, all of the bed making and generally having the ward in tip top condition”.

western nurse September–October 2017

Original Fremantle Hospital still in use

Annie added: “Usually following the consultant visits, we had to put out the patient’s flowers before the arrival of Matron or senior administration sisters. Everyone was on their best presentation behaviour. If you were very lucky Matron might comment that you looked very smart, unlucky could be her saying ‘make sure your shoes are polished before tomorrow’s round’.” Night duty was tough: “We had only three students for each ward, a senior, a second year and a junior or ‘wet nurse’ doing pans, and early morning tea and not much else. The night supervisors travelled from ward to ward, and did rounds sometimes twice each night. Junior nurses were expected to conduct a round with the night super, having to have a comprehensive knowledge of the patient’s name, age, condition and any other significant relevant information – without the aid of a list.” Intensive and Coronary Care wards were quite new in the mid to late 1960s, and “it was a big deal” to be sent to these areas. “Bird machines, ventilators, central venous pressure lines, and cardiac monitors, made it all very scary for the novice nurse, not to mention the very strict protocols and nursing regimes needed for the life saving measures we were suddenly part of,” Annie said. “Operating theatres were almost ‘godlike’ tabernacles of worship. The surgeons were the staff members we worshiped, hanging on their every word – and sometimes dodging the instruments that on occasions were thrown around the room if you dared to pass the wrong item. However, it was a fascinating learning experience to have a one on one conversation on medical matters.”

Annie Carswell, Vice President Fremantle Hospital Ex Trainees Association, in her old uniform

Emergency, or casualty, as it was then known, was also intense: “From birth to death, all aspects of life in the Port City were demonstrated to us very young and inexperienced students, in a lot of different life event situations – from dealing with simple minor injuries to full blown resuscitation situations. This is where I found my niche. We gained much experience and knowledge from working in these times, and it probably made us more resilient and caring.”

“We all enjoyed our time together, looking out and covering for each other” Annie and many locals were saddened when Fremantle’s emergency department stopped operating, following Fiona Stanley Hospital’s opening a few years ago. “However, progress happens, and we must accept the changes,” she said. The association’s members hope the group has a long future, but tertiary education of nurses means it will inevitably end. “But in the coming few years, we can still enjoy days like our celebration lunches, and take pleasure in the memories of our long and colourful history,” Annie said.

Fremantle nurses in 1947

A few volunteer ex-nurses, including Annie and association secretary Rita Ilich, visit the hospital museum twice weekly to catalogue the many photographs, uniforms, nursing records and paraphernalia there, under the leadership of former Executive Director of Nursing, and Fremantle ex-trainee, Associate Professor Ruth Letts. 

The group is holding a special 80th anniversary celebration lunch on November 13, at Tompkins on Swan function centre Alfred Cove. Contact Rita on rita.ilich@gmail.com or phone Rita Ilich and Annie Carswell holding Fremantle Hospital's badge.

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September–October 2017 western nurse |

LIVE LIVE FOREVER FOREVER Whether it’s pumping the blood of teens into the veins of the rich to reinvigorate their organs, investigating ways to hack DNA to prevent diseases, or developing technology to freeze the brain so it can be revived at a later date – the quest for immortality is a growth industry. This special western nurse report examines what’s on offer and what researchers believe is possible in the future.

For a mere $8,000 U.S. you can now be infused with two-litres of “young blood” – a transfusion of plasma from 16 to 25-year-old donors, sourced from blood banks. This is just one of the many options available in an immortality industry that’s booming, with benefits claimed for the blood treatment ranging from hair colour reverting from grey to black, to gaining “pep”, and generally reversing ageing. Over 35s are eligible for the transfusions, which take about two hours. Jesse Karmazin, the 32-year-old Stanford managing director and founder of Ambrosia, the U.S. company behind the treatment, said in the UK’s The Times: “Our first clients were biotech chief executives. Now it’s broader. More men, mostly in their sixties, though it ranges from thirties to nineties.” He was inspired by parabiosis studies, involving “sewing together” blood vessels of two mice, which saw the organs of the older mouse reinvigorated, including the heart, brain and muscles – “even its coat became shinier”. Ambrosia’s own research of 70 customers, “found improvements in biomarkers related to cancer, heart disease and Alzheimer’s after one treatment”. Karmazin said: “I really believe it reverses ageing. There’s a statistically significant improvement in organ function after one month – and people do stand straighter and feel better.” But other researchers said Ambrosia’s findings “could largely be down to the placebo effect”. Meanwhile, in Boston, a drug “capable of reversing half a lifetime of ageing in mice” will be tested on humans in a medical trial monitored by

western nurse September–October 2017

NASA, according to the UK’s Evening Standard. NMN is a compound found naturally in broccoli which boosts levels of NAD, a protein involved in energy production that depletes as we get older. Professor David Sinclair, who led the initial research at the University of New South Wales, doses himself with 500mg daily. Blood tests analysing the 48-year-old’s cells before taking NMN indicated Sinclair had the physical condition of a 57-year-old – but now he’s as healthy as someone aged “31.4”. The Evening Standard also reported that at Newcastle University in the UK, Professor Mark Birch-Machin identified last February “the mitochondrial complex which depletes over time, causing skin to age”. Birch-Machin believes we will eventually have implants in our skin that “tell us the state of it – how well our batteries are doing, how many free radicals, and will inform us how we are doing with our lifestyle.” Such discoveries are being translated into treatment at an unprecedented rate, the Standard added. The day after the results of Birch-Machin’s study were published in The New York Times, his department was contacted by nine companies hoping to turn his research into pharmaceuticals. And in 2009, University of California biology and physiology Professor Elizabeth Blackburn won a Nobel Prize for work on telomeres, the protective tips on our chromosomes that break down with age, leaving us prone to agerelated diseases. Blackburn discovered an enzyme that stops shortening of telomeres by adding DNA – like a plastic tip fixing the end of a fraying shoelace. Today, rich Californians use telomeres therapy to prolong their pets’ lives.

Last year, at a London TEDx symposium, Harvard University post-doctoral scientist Daisy Robinton, proposed considering ageing “a disease in itself”, said the Standard. She described the medical community’s excitement about the discovery of CRISPR/Cas9, a protein that seemingly allow us to target and delete DNA genetic mutations. Robinton said: “Gene editing provides an opportunity to not only cure genetic disease, but also to prevent diseases from ever coming into being.” Silicon Valley, however, is where more radical advances seem likely, the Evening Standard added, such as the work of Dmitry Itskov, the Russian billionaire founder of the life-extension non-profit 2045 Initiative, who pays scientists to map the human brain “so our minds can be decanted into a

reported in July, adding that: “He intends to divert trillions of dollars into life-extending technologies – robotic hearts, artificial exoskeletons, genetic editing, bionic limbs and so on – in the hope that each Californian man, woman and AI (artificial intelligence) will eventually be able to upload their consciousness to the Cloud and experience digital eternity”. Finally, the best known element of the immortality industry is cryogenic freezing. Despite having a reputation “as the last resort of wealthy cranks”, cryogenic freezing remains in business, said The Evening Standard. At Alcor Life Extension Foundation’s Arizona facility, 149 corpses have already been preserved in liquid nitrogen at minus 196°C, since the company was founded in 1972. Worldwide, thousands of people have signed up for cryogenics

“If you actually exist as software you have a lot of options. I do enjoy having a physical body but why have just one when you could have lots of different ones?” computer and either downloaded to a robot body or synced with a hologram”. Then there is Joon Yun, a physician and hedge fund manager who in March proclaimed at an anti-ageing symposium of the California elite – including reportedly Google co-founder Sergey Brin and actor Goldie Hawn – that ageing is simply a programming error encoded in our DNA. He said: “If something is encoded, you can crack the code … we can end ageing forever”. The immortality quest has even entered politics. Californian entrepreneur Zoltan Istvan has launched his bid to become the 2018 Libertarian governor of California on a platform that includes “eliminating death”, The Times

services, including Alcor’s 28 UK clients. The service isn’t cheap – full-body freezing costs £165,000 ($282,345 AUD), while having just your head frozen is about £60,000 ($102,657 AUD). Dr Anders Sandberg, a researcher at Oxford University’s Future of Humanity Institute, who is one of Alcor’s clients, said: “It’s a gamble, but it’s still much better than being dead”. He envisages a world in which the brain is paramount, so when his is revived, it can be transformed into a sort of computer program containing all of his memories. Sandberg said: “If you actually exist as software you have a lot of options. I do enjoy having a physical body but why have just one when you could have lots of different ones?”  Staff writers with Emily Hill / Evening Standard; Richard Godwin / The Times; Mark Bridge / The Times; and The Interview People.

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September–October 2017 western nurse |

InternetWatch AMAZING APPS + ONLINE NEWS

Too Loud Do you ever struggle to keep a group of children silent for a while? Simple, make it competitive! While time passes the voice meter shows the noise level. Behind the meter there is an animal, when it is silent the animal looks happy and fun, but when the noise gets louder the animal keels over. Choose from a range of animals. Free

HuffPost HuffPost is a politically liberal news and opinion site that originated in the US but now has international editions including in Australia. The site offers news, satire, blogs, and original content and covers all aspects of the news. It also has a partnered website. Free

Hipages Here is an easy way to find quotes from a trades person, professional or home service. Select what you need, say a house painter. Registered businesses contact you directly and you choose the one that suits you best. The service is free and there is no obligation to hire any business that Hipages connects you with. Free

Fireballs If you’ve ever seen a meteor, or a bright fireball, then you’ve experienced one of nature’s true wonders. This app will turn your smartphone into a scientific instrument that can quickly and easily record all the relevant information from a fireball sighting. Also, you can see upcoming meteor showers and use your phone to find out where in the sky to look. Free

Black Cards You’ll love this if you’ve played Cards Against Humanity or Apples to Apples. There are heaps of new black cards to supplement the ones that come with the original games. You can also generate your own cards. Black Cards is an add-on and not affiliated with these games. Free

western nurse September–October 2017

MedicineWise Here’s a useful place to keep track of your medicines and access health information. Create a list of medicines by scanning your medicine barcodes or searching the database. Set reminders for when to take medicines and attend doctors’ appointments. Store, graph and share your test results. Free

YouTube Kids YouTube Kids is designed for curious little minds. This is a simple and safe version of YouTube where kids can discover videos, channels and playlists. To make navigation easy the videos are divided into four categories; shows, music, learning and explore. The functions are easy too; big buttons, easy scrolling, and instant full-screen. Free

Scoopon A Scoopon is a ticket to ride, eat, drink, watch and enjoy some of the coolest things around. Every day at midday, subscribers are delivered deals. Once you see a deal you like, press the ‘Buy’ button and the coupon is delivered to your device. Free

Echidna CSI Echidnas are curious beasts, hard to spot and difficult to find. You can help protect this iconic Australian animal by … wait for it … taking photos of their poo. Scientists gather lots of information about animal health and habits by examining poo. Help them out, no Bristol Stool Scale required! Free

Firefox Focus Browse like no one’s watching. Firefox Focus is a search engine that blocks online trackers, from the moment you launch it to the second you leave it. Easily erase your history, passwords and cookies so you won’t get followed by things like unwanted ads. Free

FIVESuperSites Improbable Research

Ig Nobel Prizes are light hearted awards handed out by Nobel Laureates to winners of trivial research. Their motto is “Research that makes people LAUGH and then THINK”.One of last year’s winners discovered that an itch on the left side of your body can be relieved by looking into a mirror and scratching the right side. http://www.improbable.com/

WA ScamNet

WA ScamNet profiles scams targeting Western Australians and provides information on the different types of scams, how to recognise them, and what to do if you have received one. Simply send in your suspect emails and letters and the folks at Consumer Protection will do the rest. http://www.commerce.wa.gov.au/ consumer-protection/wa-scamnet-0

Arcademic Skill Builders

Here’s an idea you might be interested in. This game site applies the persistence shown by kids playing video and computer games to their academic work. Access loads of fun education games that are designed to improve focus and fluency. http://www.arcademics.com/games?grade=1

Worldometers

Worldometers shows current populations based on statistics and projections from the most reputable groups including the World Health Organisation. The population of each country is updated in real time. Right now, there are around 7.5 billion people roaming this earth. http://www.worldometers.info/

Simon’s Cat

Simon’s Cat is an animated cartoon featuring a hungry cat who uses devious methods to get his owner to feed him. It’s super cute and chronicles the antics of these animals perfectly – especially cats and their cardboard boxes. https://simonscat.com/

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September–October 2017 western nurse |

ANF Humanitarian Aid

Helping our kids to hear so they can have a future Megan McDermott at Mt Margaret remote community indigenous school - Earbus visit with wall art painting by community members.

In this edition we continue reports of our members making a difference with the ANF’s humanitarian fund – in this project helping children in dire need in our own backyard. Otitis media is at least 10 times more common in Aboriginal children than others – and untreated can lead to deafness that affects learning and thus their future. Clinical nurse Megan McDermott decided to join the fight against this debilitating middle ear inflammation, by volunteering with the non-profit WA Earbus Foundation’s mobile ear health clinic team. The South West cancer services CN used an ANF Humanitarian Aid Volunteers Fund grant to assist her travel to WA’s remote and rural Pilbara and Eastern Goldfields Regions in December 2016 – covering more than 6,700 kms to help afflicted children. “Poor ear health is a leading cause of Aboriginal health disadvantage in our country with research reporting as the worst in the world,” she told western nurse. Megan McDermott with children at a remote area community giving out stickers to the kids before the Earbus clinic the next day.

10 |

western nurse September–October 2017

Volunteers Fund “Often unnoticed, OM is treatable and preventable – five in 10 children need medication, and one in four requires surgery. If children cannot hear they cannot learn.” Megan said Earbus aims to eradicate the impacts of hearing loss nationwide, and help “listening and learning for each young person to enable their full potential”. “The Foundation brings together experts from education, health, culture and community – employing general practitioners, nurse practitioners, audiologists, audiometrists, nurses and ear nose and throat (ENT) specialists who collectively enable an efficient and seamless service delivery, and complex and well-orchestrated succinct model of care,” she said. “They care deeply for the present and future of indigenous Australians, as our First Nations people. They are passionate and considerate about Aboriginal health improvement and input into their present and future well-being.”

Clinical nurse Megan McDermott mixing antibiotics at Yandeyarra Station Indigenous Remote Community Earbus visiting clinic December 2016.

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September–October 2017 western nurse |

ANF Humanitarian Aid

“If children cannot hear they cannot learn”

Megan McDermott washing those ears out with Betadine at South Hedland Community School Earbus Clinic December 2016.

12 |

western nurse September–October 2017

Volunteers Fund She said during her two-week trip: “We set up 17 clinics in Megan said experiencing indigenous home country was eight days across two regions. We serviced a secure care heart-warming, but also often heart-breaking. “The poverty Department of Child Protection linked facility, treated at eight in some places seemed immeasurable,” she said. “I quickly primary schools, three outback communities, recognised that in some areas local ear three child care centres, an indigenous health systems were either not efficient “This opportunity has medical centre and an Ed Support Centre. We or effective, but grossly underdeveloped traversed approximately 6,721 kms.” left me humbled, deeply or non-existent.” Megan said once children arrived at the clinic she enabled hand hygiene, cough etiquette, nose blowing, and checked for upper respiratory tract symptoms.

enriched, and extremely grateful to the Earbus Foundation of WA, and to the ANF, to have been an ANF Humanitarian Aid Volunteer.”

“We proceeded to aural health checks, views, testings, and screenings – if they were well, they were escorted back to class or their community, complete with fake tattoos, stickers, badges and pens. If ENT was symptomatic, we treated – ear washed, or bathed and soaked, then screened, ENT consulted, and referred for surgery and support, such as engaging transport and accommodation reimbursement.”

She said the Earbus team “fully and quietly embody the label of charity”. “To them, kids matter – and so the future and ability to have, understand and embrace change has begun,” she said. “Through their involvement, I saw children with hope and a better-than-chance opportunity to shape their future.

“This opportunity has left me humbled, deeply enriched, and extremely grateful to the Earbus Foundation of WA, and to the ANF, to have been an ANF Humanitarian Aid Volunteer.” 

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September–October 2017 western nurse |

update: A drug update: Doxycycline

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Generic Name: Doxycycline Trade Names: Doxy-50, Doxy-100, Doxylin, Frakas, Doxsig, Doryx Drug Class: Tetracyclines (antibiotic, antimalarial)

ADVERSE EFFECTS Table 1. Adverse effects associated with the use of doxycycline.1

Frequency

Adverse effects

Common

Gastrointestinal symptoms (epigastric burning, nausea, vomiting, diarrhoea) Teeth discolouration, enamel dysplasia Impaired bone growth Photosensitivity

INDICATIONS Doxycycline is an anti-infective agent indicated in a wide range of infections including communityacquired pneumonia, exacerbations of chronic bronchitis, acute bacterial sinusitis, non-gonococcal genital tract infections, pelvic inflammatory disease, chronic prostatitis, melioidosis, Rickettsial infections and Q fever.1 It may also be used for the treatment of rosacea and acne vulgaris.1 For example, along with topical agents, doxycycline is first-line treatment for moderate to severe inflammatory acne.1

Infrequent

Rash Fungal overgrowth Physical deformity

Rare

Oesophageal ulcers Photo-onycholysis, nail discolouration Clostridium difficile infections Liver impairment Benign intracranial hypertension Allergic reactions

Doxycycline is also an anti-malarial agent, used for prophylaxis and the treatment of uncomplicated P. falciparum malaria. In particular, it is useful for prophylaxis in those who cannot tolerate other agents and in areas of multi-drug resistance.1

ACTIONS Doxycycline is a broad spectrum antibiotic, created from organic tetracyclines produced by Streptomyces bacteria.2 It inhibits bacterial cell function by reversibly binding to ribosomes to prevent protein synthesis and bacterial growth.1

CONTRAINDICATIONS Doxycycline is contraindicated in individuals with serious allergic reactions or concurrent treatment with oral retinoids (according to some manufacturers). It should also not be used for women in the later stages of pregnancy (after 18 weeks) and in children under the age of eight, as it may cause teeth discolouration, enamel dysplasia, inhibition of bone growth and physical deformities.1 In cases of serious infections, short courses of doxycycline may be required despite contraindications.1

PRECAUTIONS Doxycycline should be used with caution in individuals with renal or hepatic impairment and dose adjustments may be required. Hepatotoxicity associated with doxycycline use is more common in those with underlying hepatic impairment and the concurrent use of hepatotoxic drugs.1 Doxycycline also has the potential to worsen cases of systemic lupus erythematosus, and should be used with caution in this patient population.1

14 |

western nurse Septemberâ&#x20AC;&#x201C;October 2017

be used once daily for up to eight weeks in order to assess for a response. If ineffective, the dose may be increased to 100mg per day, or treatment may be altered.1

ADMINISTRATION The standard adult dose of doxycycline is 200mg on the first day, followed by 100mg for all subsequent days of treatment. Oral treatment is generally taken once daily. In serious cases, 100mg twice daily may be required.1 Dosing for children (older than eight years of age) is calculated based on weight. 2mg/kg is given twice daily on the first day (to a maximum of 200mg per day), followed by 2mg/kg once daily for all subsequent days of treatment. Up to 4mg/kg may be used for more severe infections. Inflammatory acne is managed with long-term, low dose treatment. Initially, 50mg of doxycycline may

DOXYCYCLINE IN MALARIA Doxycycline kills malaria parasites in the red blood cells. Studies have demonstrated that it is effective for the treatment and prevention of P. falciparum malaria.2 Doxycycline for malaria prophylaxis must be commenced two days prior to entering an at-risk region, and maintained for four weeks following any potential exposure. In cases of prolonged or intense exposure, adjunct prophylactic agents may also be required.1

PREVENTING COMPLICATIONS It is recommended that once daily doses are taken in the morning, with food, to reduce gastrointestinal symptoms. Some sources suggest administration with milk, while others argue that milk reduces drug bioavailability.1,2 To date, there is insufficient evidence to support either argument. Despite potential epigastric burning, antacids should not be taken within two hours of medication administration as they may prevent gastrointestinal absorption. Given the associated risk of photosensitivity, individuals are encouraged to wear sun protection and prevent prolonged sun exposure while taking doxycycline.1

REFERENCES 1. Australian Medicines Handbook 2016 (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2016 July. 2. Tan KR, et al. Doxycyline for malaria chemoprophylaxis and treatment: Report from the CDC Expert Meeting on malaria chemoprophylaxis. Am J Trop Med Hyg. 2011 Apr 5;84(4):517-31.

Table 2. Doxycycline dosing for the prophylaxis and treatment of malaria.1

Indication

Patient population

Malaria prophylaxis (with protective barriers including repellents, protective clothing, and mosquito nets, with or without primaquine)

Adult

Treatment of uncomplicated P. falciparum malaria (with quinine)

Adult

Children (>8 years)

Dose 100mg once daily

2mg/kg (up to 100mg) once daily

100mg every 12 hours for 7 days 2mg/kg every 12 hours for 7 days

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Septemberâ&#x20AC;&#x201C;October 2017 western nurse |

update: Mechanisms of skeletal muscle contraction Read this article and complete the online quiz to earn 1 iFolio hour

Skeletal muscles are organs of the body that use energy to generate mechanical force and stimulate movement. They maintain essential body functions, such as breathing and swallowing, allow for voluntary motion, ensure stability and balance, control eye movement and generate heat. Illustration 1.

SKELETAL MUSCLE COMPOSITION Skeletal muscle is made up of muscle cells (myocytes) known as muscle fibres. Muscle fibres are multinucleate cells with sufficient mitochondria to supply the chemical energy required for contraction. Each muscle fibre contains hundreds to thousands of myofibrils composed of thick and thin protein filaments, organised in such a way that the tissues appear striated under a microscope. The protein filaments are essential for muscle contraction and the conversion of energy to allow for mechanical function (see Illustration 1).

THICK FILAMENTS

Thick filaments are made up of myosin, a complex protein molecule that can be divided into three regions: S1, S2 and the tail region. S1 is the globular head of myosin, responsible for enzymatic and chemical activity and binding to actin within thin filaments (see Illustration 1). S2 is the flexible neck that connects S1 and the tail region. The tail region is long and straight. Myosin molecules are found in pairs. The tail and S2 regions are wrapped around each other, while the S1 heads sit next to one another. The molecules are highly organised within the thick filament. Myosin tails make up the backbone of the filament, while the heads extend outwards in both directions (see Illustration 2). Illustration 2.

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Illustration 3.

Calcium ions from the sarcoplasmic reticulum are released only once. When they are no longer available, contraction ends and relaxation begins. The entire process of skeletal muscle contraction takes less than a few tenths of a millisecond. Therefore multiple cycles of contraction and relaxation can occur within a second. (see Illustration 4). Illustration 4.

Muscle relaxed

No Ca2+ for troponin

Contact between binding sites inhibited

Interaction inhibited Actin Tropomyosin

SARCOMERES: THE FUNCTIONAL UNIT OF A MUSCLE FIBRE A single muscle fibre can be divided into hundreds to thousands of myofibril bands and each myofibril can be further divided into sarcomeres. A sarcomere is the functional unit of a muscle fibre. It contains five anatomical regions essential for skeletal muscle function including the A band, H zone, M line, I band and Z line (see Table 1).

SKELETAL MUSCLE CONTRACTION Skeletal muscle contraction occurs as a result of external cellular excitation. Action potentials are passed down through somatic motor nerves in the central nervous system. The connection between motor neurons and muscle cells is known as the neuromuscular junction. When an action potential reaches this junction (known as a synapse), it stimulates the release of the neurotransmitter acetylcholine (ACh). ACh binds to specialised nicotinic receptors on the muscle cell and stimulates cellular depolarization. Adequate depolarization of the cell membrane results in the formation of an action potential, which leads to an increased intracellular calcium concentration, activation of the interaction between thick and thin filaments and muscle contraction. Action potentials are rapidly spread between myofibrils through the T-tubule (transverse tubule) system in the plasma membrane (sarcolemma) of the skeletal muscle.

To allow for muscle contraction, thick and thin filaments interact through a process known as the crossbridge cycle. Myosin heads in the thick filaments bind to G-actin in the thin filaments to cause sarcomere shortening. This is followed by detachment of the filaments and subsequent reattachment further along the thin filament. This movement causes the I-bands and H-zone to shorten and the Z lines to move closer together. The A band always remains the same length. It consistently measures 1.85 micrometres in the skeletal muscles of mammals.

Muscle Contracted Myosin

Ca2+ bound to troponin

Tropomyosin Interaction permitted

Actin Contact between binding sites permitted

(Crossbridge Formation)

At rest, actin and myosin are prevented from interacting by the troponin-tropomyosin complex of the thin filament. Calcium ions are stored in the sarcoplasmic reticulum of muscle cells (see Box 1). When a muscle action potential is reached, calcium ions are released from the sarcoplasmic reticulum into the region of the myofibrils. Calcium binds to the troponin-tropomyosin complex and changes its position to allow the crossbridge to form between actin and myosin. Box 1. Sarcoplasmic reticulum.

Sarcoplasmic reticulum is a smooth endoplasmic reticulum, responsible for storing calcium ions and releasing them into the cytoplasm of muscle fibres when stimulated.

Table 1. Description of the anatomical regions of the sarcomere. Anatomical region of the sarcomere

Description (describes appearance under light-microscope)

A band

The dark band of a myofibril that contains thick filaments (myosin) and the overlapping thin filaments (actin) from the I band.

H zone

The lighter area in the middle of the A band.

M line

Distinct line in the middle of the H zone

I band

Lighter area between the A bands Contains thin filaments (actin) that extend to the Z line and A band.

Z line (or disk)

Myosin

The three dimensional structure in the middle of the I band. Connected to thin filaments (actin) of the I band which extend to the A band.

THE ROLE OF ADENOSINE DIPHOSPHATE IN MUSCLE CONTRACTION

Adenosine diphosphate (ADP) also plays an important role in limiting the interaction between thick and thin filaments. At rest, ADP and inorganic phosphate are bound to the S1 region of the thick filament and keep myosin heads perpendicular to actin filaments. Once calcium manipulates the troponin-tropomyosin complex and thick and thin filaments bind, the affinity between myosin, ADP and inorganic phosphate is lost. At this point, the release of ADP and inorganic phosphate further contributes to muscle contraction by stimulating a stretch in the thick filament and a “power stroke” that pulls the thin filament past the thick filament. At the end of contraction, adenosine triphosphate (ATP) around the myofibril helps to ensure detachment of the filaments by binding to the myosin head. ATP hydrolysis restores ADP and inorganic phosphate and creates enough energy to stimulate myosin and actin to return to their resting state. In the event that ATP is no longer available, crossbridges cannot be detached and muscle stiffness occurs. In death, this process is known as rigor mortis.

REFERENCES 1. Rhoades, R.A. & Bell, D.R. (eds). (2013). Medical Physiology: Principles for Clinical Medicine (4th ed.). Baltimore, MD: Lippincott Williams & Wilkins.

September–October 2017 western nurse |

Mark’s

Due to popular demand we’re bringing back Mark’s question and answer section as a regular feature in western nurse. Tax deductions have been a common subject in many inquiries recently, so we’ll cover a repeatedly occurring question this edition.

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Q: Can we claim home internet costs as a tax deduction? I ask, because we have to do CPD each year, much of which is online; and I also often need to access work emails and often I do most of my mandatory competencies at home because work is too busy. It’s a very good question given the amount of online learning now being done. And the answer is yes, a claim can be made – as long as the education is related to current employment, such as either keeping up-to-date or enhancing earning capacity. The education cannot be for a different field outside the scope of current work e.g. a nurse studying to be a doctor.

western nurse September–October 2017

You may also be able to claim for some home office expenditure: Home office – you can claim the set rate of 45c per hour for heating, cooling, lighting; Mobile phone – percentage of bill for work purposes. You need to keep records for a 4-week representative period in each income year to claim a deduction of more than $50; Internet – percentage for work purposes; Specific office equipment – percentage claim based on work/private usage i.e. computer; Consumables – percentage based on work usage. i.e printer cartridges, paper, pens etc. You would need to ensure that any other people using the equipment, internet etc are factored into your calculations, so you only claim your own work-related usage as a deductible amount.  This information is general advice only. You should seek advice regarding your specific circumstances from an Accountant or Tax Advisor.

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For more information and to book: jamiesministryoffood.com.au Septemberâ&#x20AC;&#x201C;October 2017 western nurse |

AcrossTheNation NEWS, VIEWS AND GOSSIP FROM ALL OVER AUSTRALIA Minister Hunt said: “I will work with the medical authorities, health care workers and the aged care providers on how we can make it compulsory for those working in aged care facilities. “We cannot continue to have a situation where people, whose immunity is already low, are at risk from others who may be infected. Our job is to protect those who need our care.” Currently no legal requirement compels aged care workers to be vaccinated. “However, providers have a duty of care to provide the safest possible environment for their residents and carers,” the announcement added. improved surgical outcomes, and a lower likelihood of subsequent treatments.”

WA ROBOTIC SURGICAL SYSTEM FOR WA PUBLIC HOSPITAL A “state-of-the-art robotic system” will be used to treat prostate cancer at Fiona Stanley Hospital. In a first for WA public hospitals, “urological procedures, focused on robotic-assisted prostatectomies, partial nephrectomies and radical nephrectomies” will be provided by the $5 million State Governmentfunded “da Vinci system”. “It will also allow for 3D vision, magnification capabilities, and enhanced dexterity, so surgeons are able to manipulate and dissect areas where access is challenging or limited with the human hand,” said the Government, when announcing the system last month. “Compared to traditional techniques, the da Vinci system will result in patients having faster recovery, reduced length of stay in hospital, and faster return to normal day activities. “It is also expected to deliver greater efficiencies due to

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western nurse September–October 2017

The new robotic service will initially treat patients within the South Metropolitan Health Service area, but it is expected the technology will be available for others. Health Minister Roger Cook said FSH has already employed a urology specialist who has undertaken national and international training to lead the robotic program, ensuring patients receive the best possible care, and new surgeons learn the skills to master the new techniques. 

AUS COMPULSORY FLU VACCINATION FOR AGED CARE WORKERS All aged care workers will be forced to get a flu jab under moves by the Federal Government – following an increase in deaths and cases this winter. Federal Health Minister Greg Hunt announced recently he “has requested Australia’s Chief Medical Officer, Professor Brendan Murphy, investigate ways to ensure all aged care workers are properly vaccinated against flu”.

The investigation follows the deaths of seven residents at St John’s Retirement Village in Wangaratta, Victoria, and reports of flu fatalities at Tasmania’s Strathdevon Aged Care. Aged Care Minister Ken Wyatt has instructed the Australian Aged Care Quality Agency to conduct an urgent review into all aged care facilities. 90,000-plus cases of influenza have been reported this year – 2.5 times the amount in the same period last year. 

VIC PEANUT ALLERGY CURE? Hopes that the deadly peanut allergy is curable have been boosted because children who developed tolerance in a medical trial four years ago are still able to eat the legume. At the end of a 2013 probiotic and peanut oral immunotherapy trial in Victoria’s Murdoch Children’s Research Institute, 82 per cent of child participants were classified tolerant to peanuts. They went home able to eat the food that may once have made them

vulnerable to anaphylaxis, a lifethreatening allergic reaction. “Four years later, the majority of children who gained initial tolerance are still eating peanut as part of their normal diet (80 per cent) and have passed a further challenge test confirming long-term tolerance to peanut (70 per cent),” the institute announced on its website, after recent publication of the follow-up data in The Lancet, Child and Adolescent Health journal. Professor Mimi Tang, who pioneered the original treatment, and led the follow up research, said the findings suggest: “The exciting possibility that tolerance is a realistic target for treating food allergy. This is a major step forward in identifying an effective treatment to address the food allergy problem in Western societies.” 

AUS $3M FOR EATING DISORDERS Nearly $3 million will be allocated by the Federal Government for “more support and better treatment” for sufferers of eating disorders. The not-for-profit Butterfly Foundation that represents all affected by eating disorders and negative body image, including people with the illness, their family and their friends, will receive $1.7 million to expand its national counselling service, ED Hope. Federal Health Minister Greg Hunt, when making the announcement in September, said: “I am also pleased to launch the Butterfly Foundation’s new National Agenda for Eating Disorders, which aims to ensure we have a national approach to help people with eating disorders … a bank of information around what works, so people suffering from this disease can access the best treatment for their needs”. One of the first steps the Government will take towards a “nationally consistent approach” is funding a Workforce Capability Project to increase the skills of

health professionals to identify and respond to eating disorders. Butterfly will receive $1.2 million over the next two years to roll this project out nationally. The Minister said eating disorders “are among the most debilitating of mental health conditions and the impact on families is immense”, with thousands of sufferers in Australia yearly, but “with only 25 per cent of people thought to be diagnosed”. 

NSW MELANOMA STOPPED FROM SPREADING A combination of new treatments that stops melanoma from spreading or metastasising to distant organs has been successfully tested. “The trials, COMBI-AD and CheckMate 238, proved successful in preventing the spread of disease in Stage III melanoma patients whose tumours had been surgically removed,” said NSW’s Melanoma Institute Australia, which provided the investigators who conducted the trials. “Until now, these patients were at a high risk (40−70 per cent) of their disease progressing to advanced and fatal melanoma.” The research was published in the New England Journal of Medicine in September, and the study’s author Professor Georgina Long said: “These results will change the way we treat melanoma patients as well as their quality of life”. Professor Long, who is MIA’s Co-Medical Director, added that: “Until now, Stage III melanoma patients who have had their tumours surgically removed have simply had to play the waiting game, to see if their melanoma would metastasise or spread. Living with such fear severely affected them and their loved ones. “Results from these clinical trials suggest we can stop the disease in its tracks – effectively preventing it from spreading and saving lives. Our ultimate goal of making melanoma

a chronic rather than a terminal illness is now so much closer to being achieved.” 

WA $1 METH ADDICTION CURE A potential cure for methamphetamine addiction will be trialled in Perth. The treatment using a pill containing muscle relaxant Baclofen, has been found to act as an anticraving agent for treating alcoholism and cocaine addiction in overseas human and animal trials, The Sunday Times reported in September. WA Health emergency medicine specialist Dr Amanda Stafford, who is leading the study, said doctors in Australia and Europe informed her of cases where Baclofen had been effective in treating methamphetamine addiction – helping patients “stay on the straight and narrow”. She had successfully treated dozens of alcoholic patients with the prescription pill that costs as little as $1 a day, so she “was hopeful it could revolutionise treatment for meth addiction which had turned some of the State’s hospital emergency departments into ‘meth city’”. “Anecdotal evidence suggests that Baclofen in higher doses can be helpful for meth addiction,” Dr Stafford told The Sunday Times. She said alcohol and cocaine cravings were known to stop quickly, sometimes taking as little as a week. But some patients would need longer time to reach an effective dose and others would still require rehabilitation because they had “spiralled down too far”. Dr Stafford said a year-long trial, funded by the WA Health Department, with full ethical approval, would start in November, with 18 addicted patients, and involving physicians and researchers from various Perth medical facilities.  September–October 2017 western nurse |

update: Counting the numbers: Quantifying the burden of disease Read this article and complete the online quiz to earn 1 iFolio hour

It is now possible to measure the overall health of our populations by formally quantifying the burden of disease. This technique is helping governments and healthcare providers make informed, data-driven decisions about healthcare policy and cost-effective care. Governments around the world have begun using a new measurement to calculate the cost we pay for illness: time. According to the most recent Australian Institute of Health and Welfare (AIHW) Burden of Disease Study released in 2016, 4.5 million years of life were lost across Australia in 2011 due to premature death from disease, or the impact of living with ill health. This amounts to 201 years for every 1,000 Australians and represents the quantitative burden of disease on our healthy population over the course of the year. Since 2003, the Australian Government has been helping to lead a global movement towards the consistent quantification of the impact of fatal and non-fatal illness. The purpose is to ensure that monitoring of the health of our population, as well as policy and service planning and assessment of the costeffectiveness of care, can be conducted based on informed statistics and reliable data that can be easily compared between nations.

WHAT IS THE BURDEN OF DISEASE? The “Burden of Disease” is a calculation of the cost that ill health has on our population, measured in time. It is a data-driven translation of the total fatal and non-fatal health losses that occur from disease and injury in a population. Healthcare practitioners and policy makers can use it to assess the different conditions or risk factors that affect the health of a population, and the effectiveness of our attempts to influence them.

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HOW DOES IT WORK? Burden of disease studies measure the ‘ideal expected healthy lifespan’ of a population, and then subtract from it the time that is lost to disease and disability, in years. For fatal diseases, this is done by removing the number of years that are lost to premature death from the expected lifespan. These are known as Years of Life Lost, or YLL (see Box 1). Box 1: Years of Life Lost (YLL)

YLL = N x L, where N is the number of deaths in a population L is the standard life expectancy minus the age at death For non-fatal diseases, the number of years the population suffers from the disease is multiplied by a statistically-derived calculation of the severity of its symptoms. These years are known as Years Lived in Disability, or YLD (see Box 2).

Box 2: Years Lived in Disability (YLD)

YLD = I x DW x L, where I is the number of incident cases (non-fatal disease cases) DW is the disability weight (severity of symptoms) L is average duration of symptoms until remission or death The difference between the ideal and actual level of health for an entire population is known as the burden of disease, and it is measured in “Disability-Adjusted Life Years” or DALYs (see Box 3). Box 3. Disability-Adjusted Life Years (DALYs)

A disability-adjusted life year is one lost year of “healthy” life. DALY = YLL + YLD.

AUSTRALIA’S BURDEN OF DISEASE IN 2011 Findings of the 2011 AIHW Burden of Disease Study suggest that Australia’s greatest burden of disease is related to the impact of five chronic disease groups: cancer, cardiovascular disease, mental and substance use disorders, musculoskeletal conditions and injuries. Together, these groups represent 66% of the overall burden of disease. While the burden of cancer and cardiovascular disease was predominantly fatal, the burden of mental and substance abuse disorders was predominantly non-fatal. Yet both managed to have a significant impact on population health. At least 31% of the total DALYs lost were deemed preventable. Modifiable risk factors that have the greatest impact on Australian health include tobacco use, high body mass, alcohol use, physical inactivity and high blood pressure. This suggests a great potential for health improvement by reducing exposure to these factors and emphasizes the need for enhanced health prevention measures moving forward. Australian men suffer from 30% higher rates of disease burden than women. Significant differences between the sexes were noted in disease groups including injuries (where men had 2.7 times the burden), cardiovascular disease (1.8 times) and cancer (1.4 times). While there were many individual conditions where women experienced higher rates of burden, these were generally responsible for a

limited number of DALYs and therefore had a minimal impact on overall burden of disease. When comparing states and territories, the Northern Territory experienced the highest rates of disease burden. Regional and remote areas also experienced higher burden rates than metropolitan areas. Overall, the most dramatic difference could be identified across socioeconomic groups, where a full 21% of the burden could be reduced if all of the socioeconomic groups in Australia experienced the same disease burden as its most prosperous people.

IMPROVEMENTS SINCE 2003 The 2011 findings represent a significant improvement from those generated by the first Australian Burden of Disease study in 2003. Overall, the rate of burden decreased by 10%, and there was a 15% reduction in the burden of fatal disease, from 110.7 to 93.9 YLL per 1,000 Australians. This was coupled with a 3.9% reduction in the burden of non-fatal disease, from 99.8 to 96 YLD per 1,000, which suggests that treatment and prevention has reduced premature deaths from disease and improved the overall quality of life for Australians. Between the two studies, the total burden of disease dropped from 210.5 to 189.9 DALYs per 1,000 people, after adjustments for population growth and ageing. While there was a reduction in the populations’ exposure to some risk factors that cause disease and burden resulting from them, there was also an increase in others.

For example, there was a significant reduction in the burden attributable to high cholesterol (-29%), and an increase in the burden due to high body mass (+23%) and drug use (+22%).

CONCLUSION In recent years, measuring the burden of disease has been of great importance to global and population health. In Australia, findings have been used to monitor population health, plan health services, and evaluate the costeffectiveness of interventions. Perhaps the greatest advantage of the Burden of Disease study is that it is translatable, allowing for comparisons to be made across diseases, and across communities, states, and nations. Rather than merely considering fatalities or expenses, it allows us to measure health in a unit that is valuable to us all: time.

REFERENCES 1. Australian Institute of Health and Welfare 2016. Australian Burden of Disease Study: Impact and causes of illness and death in Australia 2011. Australian Burden of Disease Study series no. 3. BOD 4. Canberra: AIHW. 2. World Health Organization. Metrics: DisabilityAdjusted Life Year (DALY) [Internet]. Geneva: WHO; 2016 [cited 2016 Sep]. Available from: h t t p : / / w w w. w h o. i n t / h e a l t h i n fo / g l o b a l _ burden_disease/metrics_daly/en/. 3. Australian Institute of Health and Welfare. Burden of disease [Internet]. Canberra: AIHW; 2016 [cited 2016 Sep]. Available from: http:// www.aihw.gov.au/burden-of-disease/.

September–October 2017 western nurse |

ANF Out ‘N’ About

This edition's happy snaps of our members are taken at Geraldton Regional Hospital, Sir Charles Gairdner Hospital, and Fiona Stanley Hospital during lunch time visits, and other sessions. One more edition and we'll close our competition for the best workplace photo/s for this year – so get in it to win it! See you at your workplace soon!

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A. GERALDTON REGIONAL HOSPITAL A1. Geraldton Regional Hospital Group A2. Steve Williams, Leisha Oliveri, Natalie Gray and Anthony Bii A3. Kahla Dumbris, Kathryn Welch

C. FIONA STANLEY HOSPITAL C1. Ancy Georgekutty and Karen Mattioli C2. Fiona Stanley Hospital Group

B. SIR CHARLES GAIRDNER HOSPITAL Lisa Edmonds, Aissa Aspuria, Claudia Hahn

September–October 2017 western nurse |

AroundtheGlobe WORLD NEWS

TOXIC TATTOOS? Getting body art could spread toxic particles around your body. German and French scientists said last month there is “strong evidence for both migration and long-term deposition of toxic elements and tattoo pigments”. The researchers also said in their report published in the journal Scientific Reports, there is also evidence for “conformational alterations of biomolecules that likely contribute to cutaneous inflammation and other adversities upon tattooing”. They analysed tattooed human skin and lymph nodes from four donor corpses.

SPIN CLASSES BLAMED FOR RARE ILLNESS A severe pathologic condition that kills muscle fibres – causing “leakage of muscle cell contents” into the blood is resulting from spin classes, U.S. researchers say. “Spin class-induced rhabdomyolysis” was so severe in one patient studied by the researchers that “acute kidney injury” requiring dialysis occurred after just one class. “Our nephrology practices have diagnosed a number of cases of symptomatic patients presenting to our emergency departments following their first spin classes, with histories and creatinine phosphokinase levels diagnostic of exertional rhabdomyolysis,” wrote the New York researchers in The American Journal of Medicine this year. Rhabdomyolysis occurs “when muscle injury leads to leakage of

PUPPIES GIVE PET SHOP PATRONS THE POOPS A gut infection that struck 39 people across seven states of the U.S.A has been linked to puppies in a national pet shop chain, according to the Centers for Disease Control and Prevention. The CDC said last month that it, the Ohio Department of Health, several other states, and the United States Department of Agriculture Animal and Plant Health Inspection Service USDA-APHIS were “investigating a multistate outbreak of human Campylobacter infections linked to puppies sold through Petland stores”. The infection is caused by Campylobacter bacteria, which can be ingested after handling young pets, other animals, raw meat and pet meat.

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“Tissue samples of four individuals tattooed with orange, red, green or black and two non-tattooed control donors were analyzed for the presence of organic pigments,” they said. “Detection of the same pigment species in both skin and regional lymph nodes revealed the drainage of tattoo particles in two out of four tattooed donors.” The researchers said their future experiments will examine “the pigment and heavy metal burden” of other internal organs and tissues “in order to track any possible biodistribution of tattoo ink ingredients throughout the body”. This will help assess health risks associated with tattooing, and also other exposures such as the entrance of titanium dioxide nanoparticles in cosmetics into the damaged skin. 

muscle cell contents, including electrolytes, myoglobin, and other sarcoplasmic proteins … into the circulation and extracellular fluid”, which can result in kidney failure. In spin classes participants exert themselves using stationary exercise bicycles in different positions, with varied resistance, to simulate hill climbing, flat road cycling, and sprinting. The researchers from Westchester Medical Center presented three cases of exertional rhabdomyolysis occurring after a first spin class, including one where “the patient developed biopsy-proved acute kidney injury secondary to exertional rhabdomyolysis and required hemodialysis”. They concluded: “The high-intensity exercise associated with ‘spin class’ comes with significant risks to newcomers”. University of Queensland’s Academic Research Manager Dr Rob Eley told The Times of London this year he has “observed the rise in rhabdo with concern” and added for some “it has become a status symbol”. 

Diarrhoea which can contain mucus and blood, stomach cramps which can be similar to appendicitis pain, nausea, vomiting, and fever can be among symptoms. Cases in Florida, Kansas, Missouri, Ohio, Pennsylvania, Tennessee, and Wisconsin saw illnesses begin on dates ranging from September 15, 2016 to August 12, 2017, with a case as recently as September 1, 2017. The CDC said among the ill, 12 were Petland employees and “27 either recently purchased a puppy at Petland, visited a Petland, or visited or live in a home with a puppy sold through Petland”. Nine people have been hospitalised, but no deaths reported. 

GETTING YOUR DIMPLES DONE – IT’S THE LATEST THING Millennials in the U.S. are flocking to have plastic surgery that gives them dimples, according to “beauty tips, trends and product reviews” Web bible Allure.

depending on anatomy, and involving an incision inside the patient's mouth, "where a defect is created in the cheek muscle, known as the buccinator”.

Allure online informs us that dimpleplasty, mainly in the cheeks, has become “a common request – almost tripling among millennial-aged patients”, in the past few years.

The muscle is then attached to the undersurface of the skin, and patients have semi-permanent dimples for up to two months, as well as mild swelling and soreness, but eventually indentions can only be seen when smiling.

Wright Jones, a double-board-certified Atlanta-based plastic surgeon, said this demand is due to the procedure’s “little downtime, enhancement of facial aesthetics, and lack of need for general anesthesia”. He added the dimpling treatment is "a finesse technique that requires a clear understanding of aesthetic goals between the patient and an experienced board-certified plastic surgeon," taking about 30 minutes,

But the surgeon warned while the procedure “has little downtime” there are still risks which could “lead to deformities that are incredibly difficult to correct”. “Dimples could be overly dramatic, appear underwhelming, look unnatural, disappear with time, or even be located in the wrong place," he said. 

CONTAGIOUS KILLER KITTY A woman who died from a tick-borne disease may have been infected by a bite from a stray cat she was trying to help. As if the tale of infectious puppies also on these pages isn’t horrifying enough – Japan's health ministry has confirmed the death occurred last year after “what could be the first such mammalto-human transmission”, reported the BBC. Ten days after the woman – who was in her 50s – was helping the apparently sick feline, she died of Severe Fever with Thrombocytopenia Syndrome (SFTS), which is carried by ticks.

Doctors assumed the illness came from the kitty because no tick bite was found. A Japanese health ministry official told the AFP news agency: “It's still not confirmed the virus came from the cat, but it's possible that it is the first (animal-to-human transmission) case”. The BBC said SFTS is relatively new in China, Korea and Japan, and that the virus is said to have fatality rates of up to 30 per cent, with more severe cases in people over 50. Japan's health ministry said the death was still a rare case, but warned people to be careful when dealing with ill animals. 

SELENA GETS KIDNEY TRANSPLANT FROM PAL The debilitating autoimmune disease Lupus has forced U.S. popstar Selena Gomez to have a kidney transplant. Gomez, who became famous playing Alex Russo in the Disney Channel series Wizards of Waverly Place, and who has since sold 7 million albums and 22 million singles worldwide from songs including this year’s release Bad Liar, made the transplant announcement on social media site Instagram in September. “I’m very aware some of my fans had noticed I was laying low for part of the summer and questioning why I wasn’t promoting my new music, which I was extremely proud of,” she said. “So I found out I needed to get a kidney transplant due to my Lupus and was recovering. It was what I needed to do for my overall health. I honestly look forward to sharing with you, soon my journey through these past several months as I have always wanted to do with you. “Until then I want to publicly thank my family and incredible team of doctors for everything they have done for me prior to and post-surgery. And finally, there aren’t words to describe how I can possibly thank my beautiful friend (actor) Francia Raisa. “She gave me the ultimate gift and sacrifice by donating her kidney to me.” Lupus can affect the joints, skin, kidneys, heart, lungs, blood vessels, and brain, with symptoms including extreme fatigue, painful and swollen joints, fever, skin rashes, and kidney problems. 

Francia Raisa and Selena Gomez lie side-by-side after the transplant.

September–October 2017 western nurse |

Are you an ANF member who does humanitarian volunteer work?

VOLUNTEER FUNDING

ANFIUWP Humanitarian Aid Volunteers Fund provides financial help to ANF members who are undertaking humanitarian volunteer work in Australia or overseas. The closing date for applications is the 15th December 2017. The fund may be used for planned or completed volunteer work.

For more information about the fund or to get a copy of the application form and selection guidelines, call the ANF office on 6218 9444, email anf@anfiuwp.org.au or log on to iFolio.

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western nurse Septemberâ&#x20AC;&#x201C;October 2017

update: Ketamine: A drug update CONTRAINDICATIONS

Read this article and complete the online quiz to earn 0.5 iFolio hour

Generic name: Ketamine, 2-(2 chlorophenyl)2-(methylamino) cyclohexanone Trade name: Ketalar Routes of administration: Oral, sublingual, intranasal, intravenous, subcutaneous injection, intramuscular injection, per rectal or spinal Drug class: General anaesthetic

INDICATIONS Ketamine is an anaesthetic agent that may be used for conscious sedation or sedation during ventilation.1 It may also be indicated for the treatment of chronic or persistent pain, unresponsive to other agents, including severe post-operative, neuropathic, inflammatory, and cancer or procedure-related pain.1,2 More recently, ketamine has also been used to treat psychiatric conditions including depression, obsessive compulsive disorder and posttraumatic stress disorder.3 Although it has been demonstrated to be an effective rapid antidepressant, there are concerns regarding safety with long term use. At present, accepted indications for ketamine are restricted to procedural sedation and analgesia.1 Illicit, recreational use of ketamine (referred to as “special K”) does occur.1,2

METHOD OF ACTION Ketamine is a potent N-methyl-D-aspartate (NMDA)-receptor antagonist. NMDA receptorchannel complexes are found in nerve cells.1,2 At rest, magnesium blocks the receptors’ activity. Once excited, the channel opens and allows for calcium to move into the cell. Excess calcium causes neuronal hyperexcitability, pain sensitivity, and a reduced response to opioids.1,2 By inhibiting NMDA receptor channels, ketamine prevents the transmission of pain signals.1,2 It also interacts with a variety of other physiological processes including calcium and sodium channels, dopamine receptors, cholinergic transmission, noradrenergic and serotoninergic reuptake, and inflammation.2 These additional interactions cause therapeutic effects including enhanced analgesia and reduced inflammation, and may also be responsible for some side effects and adverse outcomes.2

Ketamine should be used with caution in individuals with conditions that may be affected by an increase in heart rate or blood pressure. Cardiac monitoring is often required. Special consideration should also be taken when using ketamine with elderly patients and pregnant women (category B3).1

ADVERSE EFFECTS Psychological reactions often occur with ketamine. Individuals may experience feelings of dissociation with their environment, delusional symptoms, hallucinations, memory impairment and irrational behaviour.1,3 The onset of acute hallucinations following the administration of ketamine is known as an emergence reaction. It may be pleasant or unpleasant. Treatment, if required, includes minimal stimulation and premedication with a benzodiazepine.1 The majority of psychiatric symptoms resolve with cessation of use.3 Although there is no definite link between ketamine abuse and psychosis, neuropsychiatric toxicity may occur in the long term.2 Additional adverse effects associated with ketamine include abnormal vital signs (hyper or hypotension and tachy or bradycardia), mild transient apnoea, increased muscle tone, gastrointestinal upset, raised intracranial pressure, irritation of the urinary tract and hepatobiliary toxicity.1 Urinary symptoms such

as dysuria, frequency, pain and haematuria, have been reported by chronic users and misusers of ketamine.1,2 Increasing awareness of the potential toxicities associated with ketamine may ultimately result in limited long-term therapeutic usage.2

DOSE AND DURATION OF ACTION The dose of ketamine is calculated in milligrams per kilogram for both adults and children (see Table 1).1 Depending on the indication, doses are titrated to achieve the desired response (i.e. sedation or analgesia). The time required for complete recovery may be several hours, depending on the dose administered. Individuals who are given ketamine in outpatient settings should be aware not to drive, operate machinery or participate in risky behaviour for at least 24 hours.1

REFERENCES 1. Australian Medicines Handbook 2015 (computer program). Adelaide: Australian Medicines Handbook Pty Ltd; 2015 July. 2. Quibell R, Fallon M, Mihalyo M, Twycross R, Wilcock A. Ketamine. Journal of Pain and Symptom Management. 2015 Aug;50(2):268-78. 3. Rasmussen KG. Has psychiatry tamed the “ketamine tiger?” Considerations on its use for depression and anxiety. Progress in NeuroPsychopharmacology and Biological Psychiatry. 2016 Jan;64:218-224.

Table 1. Ketamine dosages (adapted from the Australian Medicines Handbook July 2015) Onset, duration, frequency

Indication

Route

Dosages

Induction of anaesthesia*

Intravenous injection

2mg/kg over 60 seconds

Onset: within 30 seconds Duration: 5-10min

Intramuscular injection

6.5-13mg/kg

Onset: 3-4min Duration: 12-25min

Intravenous infusion

Initial: 0.5-2mg/kg Maintenance: 1045mcg/kg/min

Titrate as required

Intravenous

1-1.5mg/kg over 2-5min

Repeat half dose after 10min if required

Intramuscular injection

3-4mg/kg

Repeat half dose after 10min if required

Intravenous

0.5mg/kg

Duration: 40min

Intranasal

50mg

Single dose

Sedation/analgesia for a painful procedure*

Major depressive disorder and Bipolar depressive disorder**

* Response to IV anaesthetics varies between patients. Alternative doses may be required. ** Ketamine dosing and administration patterns for psychiatric disorders are based on randomised controlled trials performed between 2000-2014. Further research is required before routine use in clinical practice.

September–October 2017 western nurse |

ResearchRoundup LATEST AND GREATEST FROM SCIENCE “This association was robust to adjustment for other health, sociodemographic and work variables,” according to the study. Of the increased risk, one of the study’s co-authors, Peter Smith, from the University of Toronto, said on the ABC’s The Conversation website: “That’s because standing too long can result in blood pooling in the legs, increased pressure in the veins and increased oxidative stress, all of which can contribute to an increased risk”. The study added: “Cardiovascular risk associated with occupations that involve combinations of sitting, standing and walking differed for men and women, with these occupations associated with lower cardiovascular risk estimates among men, but elevated risk estimates among women”. 

PATIENTS DON’T HAVE TO FINISH ANTIBIOTICS COURSES – EXPERTS SAY Illustration: Demin Liu

MICROSCOPIC DNA ROBOTS CREATED A “robot” made of a single strand of DNA that can autonomously walk around and pick up molecules and drop them off in specific locations is now reality. California Institute of Technology announced last month its scientists had built “three basic building blocks that could be used to assemble a DNA robot”, which had a leg with two feet for walking, an arm and hand for picking up and dropping off “cargo”.

Stopping antibiotic treatment when you feel well rather than when the course finishes likely does not encourage antibiotic resistance, medical experts have stated. “With little evidence that failing to complete a prescribed antibiotic course contributes to antibiotic resistance, it’s time for policy makers, educators, and doctors to drop this message,” Martin Llewelyn, a professor in infectious diseases at Brighton and Sussex medical school, and other academics said in the British Medical Journal recently. Their BMJ analysis said antibiotic resistance is a “global, urgent threat to human health”, and therefore “reducing unnecessary antibiotic use” is “essential to mitigate antibiotic resistance”.

“Just like electromechanical robots are sent off to faraway places, like Mars, we would like to send molecular robots to minuscule places where humans can’t go, such as the bloodstream,” said Lulu Qian, Caltech assistant professor of bioengineering.

Yet, in materials supporting Antibiotic Awareness Week 2016, the World Health Organization advised patients to “always complete the full prescription, even if you feel better, because stopping treatment early promotes the growth of drug-resistant bacteria”.

“Our goal was to design and build a molecular robot that could perform a sophisticated nanomechanical task: cargo sorting.”

And similar advice is in national campaigns in Australia, Canada, the U.S., and Europe, and is in the UK secondary school curriculum.

She added about the research that was published in the journal Science: “… it is my hope that other researchers could use these principles for exciting applications, such as using a DNA robot for synthesizing a therapeutic chemical from its constituent parts in an artificial molecular factory, delivering a drug only when a specific signal is given in bloodstreams or cells, or sorting molecular components in trash for recycling”.

But the researchers said “the idea that stopping antibiotic treatment early encourages antibiotic resistance is not supported by evidence, while taking antibiotics for longer than necessary increases the risk of resistance”.

STANDING AT WORK MAY GIVE YOU A BAD HEART

They added: “We explore the evidence for antibiotic duration, clinical effectiveness, and resistance, and encourage policy makers, educators, and doctors to stop advocating “complete the course”. 

Standing work stations have become popular – but new research strongly connects being upright all day with heart disease. Subjects within a group of 7320 Ontario workers who did their job standing had an “approximately two-fold risk of heart disease compared to occupations involving predominantly sitting”, according to research published recently in the American Journal of Epidemiology. The male and female workers studied from 2003-2015 worked 15 hours or more weekly, and were “free of heart disease at baseline”.

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western nurse September–October 2017

They pointed out that the US Centers for Disease Control and Prevention and Public Health England have replaced “complete the course” messages, with “messages advocating taking antibiotics ‘exactly as prescribed’”.

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It’s your magazine. We want your feedback and story ideas! Editor Mark Olson Phone 08 6218 9444 Freecall 1800 199 145 Fax 08 9218 9455 Email anf@anfiuwp.org.au Web www.anfiuwp.org.au Australian Nursing Federation 260 Pier Street Perth WA 6000 Use the QR code reader on your smartphone to quickly save all of the ANF’s contact details. Get QR code readers on iTunes or Google Play

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FIVE COPIES ARE UP FOR GRABS OF A BOOK THAT DEFINES A “NEW MOVEMENT IN AUSTRALIAN LANDSCAPE DESIGN”. The New Australian Garden: Landscapes for Living is described as an insider's account of the journey to design, construct and plant 18 landmark gardens that represent a new movement in Australian landscape design – one where the relationship between architecture and garden is paramount. Traditional lawns are reimagined as contoured sculptural forms, and water and fire pits inject life and energy into open spaces. The resulting gardens are destination spaces, sanctuaries and breathtaking backdrops for everyday life.

WIN FOUR ICONIC 80S FILMS IN A SPECIAL HIGH DEFINITION BLU-RAY COLLECTION! The ANF continues its series of prizes showcasing top movies of the past five decades – with this set taking you back to the time when perms, Bon Jovi and shoulder pads were the way of the land! Ferris Bueller’s Day Off (1986) tells the tale of the film’s namesake, Ferris, played by Matthew Broderick, who decides one particular spring day, near the end of his senior year in high school, to cut classes and head to downtown Chicago with his girlfriend and his best friend to experience a day of freedom that may never come again – but using his buddy’s dad’s 1961 Ferrari 250 GT SWB California Spider! The Blues Brothers (1980) 80s comedic superstars Dan Aykroyd and John Belushi star in the tale of newly released jailbird Jake Blues (Belushi) and his brother Elwood (Aykroyd), who decide to reunite their blues band for a big gig, in order to raise money to save the old home where they were raised by nuns – which sets them off on their "mission from God".

Reserve a rainy Sunday afternoon for Back To The Future (1985), where Michael J. Fox as Marty McFly and Christopher Lloyd as Doc Brown, take off for the ultimate feel-good time traveling romp, 80s style, in their DeLorean sports car/time machine. Often listed among the best high school films ever, The Breakfast Club (1985), from legend 80s director and writer John Hughes, tears open the wounds of adolescence and the need for belonging within a group of high school students brought together for Saturday school detention – but with a tonne of comedic moments and a top foot-tapping soundtrack.

You can enter both competitions on iFolio – with winners drawn at the end of the month.

September–October 2017 western nurse |

FORGET RAINY DAYS-

KALBARRI IS PERFECT RIGHT NOW. Kalbarri offers beach weather all year round right here in WA.

From less than $50 a night.*

Book an ANF holiday unit on your iFolio.

BOOKINGS AND INFORMATION ON YOUR IFOLIO

ifolio.anfiuwp.org.au

* Rates are higher for Easter, the two weeks prior to school holidays and during school holidays. Please see terms and conditions for full pricing list.