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Welcome to our Winter issue
The World Health Organization (WHO) recently issued a warning about the increase in identification of multidrug-resistant, hypervirulent Klebsiella pneumoniae (hvKp).
The warning follows the Global Antimicrobial Resistance and Surveillance System on Emerging Antimicrobial Resistance Reporting (GLASS-EAR) indicating the presence of hvKp sequence type (ST) 23 carrying resistant genes to the carbapenem antibiotics in at least one country in all six WHO Regions. While traditionally hvKp infections have occurred in community settings, there has been a rise in transmission in healthcare settings. The WHO has recommended countries strengthen awareness and laboratory capacity, enhance data collection, develop a surveillance system and enhance infection prevention and control measures.
Bacterial AMR led to 1.27 million global deaths in 2019 and contributed to 4.95 million deaths1, according to the WHO.
Efforts are being made to tackle inappropriate prescribing but we still have a long way to go — among the people who received antimicrobials in Australia, there were 2.30 antimicrobial prescriptions per person in 2022, as against 2.35 in 2021.
In this issue’s lead article, Dr Susan Jain, Principal Advisor and COVID-19 Response Lead at the Clinical Excellence Commission (CEC), provides insights on CEC’s approach and how health leaders can use it in their own personal combat with AMR.
Dr David Hansen, CEO of CSIRO’s Australian e-health research centre (AEHRC) is the guest for this issue’s ‘In Conversation’ feature. Hansen reflects on the role of data
and AI in improving care outcomes and reducing burnout.
With the rise in startup activity in the healthcare sector, we’re pleased to introduce a new feature: ‘Startup Corner’, with the inaugural article contributed by digital health commercialisation advocate Chief Executive and Managing Director of ANDHealth Bronwyn Le Grice. In her article, she reflects on the need for significant reform, and a shift in incentives and rewards to drive change and secure healthcare systems for the future.
Speaking of reform, Grace Larson, co-founder of The Sisterhood Project, who is transforming access to first aid training, particularly for rural families, was recently recognised with the 2024 Victorian Rural Woman of the Year Award. This issue’s ‘Day in the Life’ feature provides a glimpse into her daily routine, but also highlights her passion, dedication and hard work to improve outcomes for rural children, families and caregivers.
Other topics covered in the issue include: wound healing and management, mental health care, hearing loss, psychotropic medicines, childbirth coping strategies, holograms to connect with patients, heavy menstrual bleeding, pharmacy and more.
We welcome articles and research reports from health professionals across Australia for review for the quarterly print publication and our daily web page. If you have a story you think would be of interest, please send an email to hh@wfmedia.com.au
Keep nurses hands-on
Clinically proven to improve skin hydration with repeated use 1
Introducing TGA registered Aqium Moisturising
Antibacterial Hand Gel. Proven to increase skin hydration by 14% in settings that mimic hospital sta use – sanitising hands 20+ times per day over a two week period 1 .
Benefits include:
• TGA Registered (Aust R 410937)
• Enriched with 4 moisturisers
• Quick drying
• 70% w/w ethanol – absolute
Found to have no impact to skin pH even with frequent and extended use 1 .
Scan to try for yourself
1. Ego Pharmaceuticals commissioned external dermal tolerability study. Average increase in skin hydration (corneometer), average change in pH (skin pH meter). Participant assessments. n=33.
Fighting antimicrobial resistance
What can health leaders learn from the CEC?
Amy Sarcevic
In the war against antimicrobial resistance (AMR), there is one line of defence which stands out to public health expert Dr Susan Jain — and, contrary to expectation, it does not come from a pharmacy.
It is the same tool that was used to curb COVID-19 outbreaks and will be used as an armour against avian influenza — a virus beginning to alarm health authorities around the world.
So what exactly is it, and how can health leaders use it in their own personal combat with AMR?
“Communication,” said Jain, who is the Principal Advisor and COVID-19 Response Lead at the Clinical Excellence Commission.
“Disseminating information is a vital tool in curbing the AMR epidemic. That’s why we are always meeting with local health districts and putting out resources, like public-facing videos and professional documents.”
Staying abreast
However, much like pharmaceuticals, the communication guidelines CEC publish are also continually being tested by changing microbes — a challenge shared by health authorities in the management of COVID-19.
Throughout the pandemic, public health advice changed to mirror the evolution of the virus. This included variations to advice around public movement, personal protection advice including use of masks and handwashing.
In a broader AMR context, health guidelines also shift, as bacteria, viruses, fungi and parasites learn to outsmart the drugs designed to kill them.
Jain says it is crucial to understand the role of infection prevention and control plays in addressing AMR and to be up to date with AMR research.
“Clinicians know they can trust our guidance, because we continuously monitor and verify evidence and disseminate it in a standardised way.
“There is a lot of noise out there in terms of infection prevention and control, so it is important we distil the very best evidence and make it known to colleagues.
“Being one source of truth for clinicians on how to protect their patients (and themselves) from AMR is central to our mission.”
Advice for hospitals
For hospital leaders, communication is also an effective tool when it comes to reducing the impact of AMR. So what can healthcare leaders learn from the CEC’s approach?
Collaborate
When updating its neonatal guidelines for infection prevention and control, the CEC consulted with an NICU specialist group and asked, “Is there anything else we should be doing to make your life easier; and do you agree with the advice we offer clinicians?”
“At the end of the day, they are the ones at the bedside and the ones who need to implement what we write. So, health worker input is vital to all our guidelines,” Jain said.
Having a two-way channel of communication also helps combat dis- and misinformation.
“If a clinician looks at any of our documents and wants to know more, it’s easy for them to approach us. That’s important, because we can confront any concerns people have head on.”
Be approachable
In a similar vein, Jain said it is important for leaders to remain approachable.
“We meet regularly with local health districts, so they know who to contact if they need advice at any time.
“Yes, you need to be a high-level authority, but people also need to feel comfortable dealing with you.”
Be direct
Conveying public health knowledge in a concise and easy-to-understand way helps clinicians stay abreast with continually changing advice.
“Having a clear governance structure can help distil highlevel research into actionable clinical insights and ensure information being pushed out to clinicians is accurate.”
“It’s important to keep in mind that (a) it’s hard to stay across all the research; and (b) clinicians are busy, so communicating with brevity is crucial.”
Develop a clear governance structure
Having a clear governance structure can help distil high-level research into actionable clinical insights and ensure information being pushed out to clinicians is accurate.
“For us, a clearly defined governance structure has been pivotal in our infection
prevention and control programs. It is definitely not something to be overlooked.”
Lifelong learning
While documents and resources can be beneficial, they cannot rival the impact of training, Jain argued.
“Working directly with teams to help consolidate people’s understanding of best practice can make a real difference to clinical outcomes.”
More resources needed
While communication is an essential tool, Jain said it is important to remember that AMR is an extremely complex problem that requires broad action and support across health care.
“Tackling AMR necessitates global efforts focused on several key areas: robust infection prevention and control measures, access to diagnostics and treatment, surveillance and substantial investment in research and development of new medicines, diagnostics and prevention tools.”
While she acknowledges that resource constraints may limit AMR or infection prevention and control programs, there is a lot health workers can do with simple measures.
“Monitoring the latest advice, prescribing antibiotics carefully and being mindful about environmental cleaning and handwashing. When it comes to AMR and infection prevention and control, every little bit helps.
“And I believe that with a combined effort, we can overcome the challenge.”
Mental health and the Big 5
Professor Nick Titov*
Like you, I am worried about the mental health of Australians. We frequently see media reporting on the mental health challenges affecting our community and we are all aware that the housing shortage and cost of living crisis is making more people more vulnerable.
Those of us working in mental health are not just managing increasing caseloads, but we are also trying to look after the mental health of our co-workers, our loved ones and if we can, ourselves.
This phenomenon is not unique to Australia — rates of psychological distress have increased around the world, more people are being prescribed antidepressants or anxiolytics, and waiting times to see a counsellor, psychologist or psychiatrist are no longer measured in weeks, but in months.
But, what if there were things that we could do for our mental health, to become more resilient? What if there were things we could do which would give us a 10% or 20% buffer in our mental health?
We all know that there are things we can do to look after our physical health (for example, eat three meals a day, brush your teeth twice a day). But are there things we can or even should do to improve our mental health?
For almost two decades my team and I have considered this question, not just from a research perspective, but because, as mental health professionals, we are deeply
concerned that we aren’t doing enough to prevent mental health difficulties. We started with a simple observation, that is, when we successfully treat a person with depression or anxiety, we see profound changes in their behaviour. They become more engaged with life, often become more social and they think differently, or at least, much less negatively. This led to other questions — are some actions more important than others for our mental health and is there a tipping point — that is, do we need to do some things a minimum number of times each week to get a benefit?
We have now conducted studies with more than 20,000 Australian adults and have some basic answers. In an early study we created a list of almost 100 actions that were believed to affect mental health.
This list included actions drawn from the broad scientific and popular literature and from recommendations from colleagues and consumers. Examples of these actions include regular social contact, exercise, healthy eating, gratitude, kindness, meditation and so on.
Over two studies we asked more than 6000 Australians how often they did each of these actions in the previous week plus we measured symptoms of depression, anxiety and satisfaction with life. And, out of all the things people could do, five groups of actions were dominant.
Five groups of actions — the Big 5
These five groups of actions, now called the Big 5, were consistently the most important for most people, regardless of age, gender, employment status or education status. Since then we have consistently found that people who perform the Big 5 actions at least half the days of the week are likely to have good mental health, while people doing the Big 5 less frequently are at risk of poor mental health.
The Big 5 include three groups of actions which have been recognised for centuries as important for good mental health, including 1) Doing things that are meaningful (and often fun); 2) Having regular social contact with people we love and respect; and, 3) Keeping our thinking grounded and keeping things in perspective. But, our work identified two other critical domains, 4) Having healthy daily routines; and, 5) Having goals and plans. In addition, our work has shown that doing the Big 5 is important, but doing these at least half the days of each week is a key to good mental health.
In one recent randomised controlled clinical trial led by Dr Madelyne Bisby, we demonstrated that simply providing
information about the Big 5 and sending SMS nudges to do the Big 5 led to significant improvements in mood in people who had been troubled by symptoms of depression and anxiety. And, the improvements were mostly sustained three months after the SMS messages ended. That study demonstrated how the Big 5 can become embedded in our everyday lives by simply reminding people about things that are good to do.
We recently extended this work by testing what happens when people reduce the Big 5. In a recently published pilot study we recruited a group of 12 psychologically healthy people and after monitoring their mental health for two weeks we asked them to restrict how often they did the Big 5. The results were surprising and profound.
Participants who reduced how often they performed the Big 5 by at least 25% showed significant increases in depressive symptoms within two weeks. After this restriction phase participants were then
instructed to resume doing the Big 5. Then we saw another interesting effect, it took some people twice as long to recover as it did to deteriorate. And the recovery wasn’t smooth, most people said that they had lost their ‘mental fitness’, much like they would have lost their physical fitness if they stopped exercising, although within five weeks of resuming the Big 5 all participants had regained their mental health.
Using the Big 5
For those of us worried about our patients, colleagues, family or even our own mental health, the Big 5 framework provides another option for self-help. Rather than immediately reaching out for professional help, which is appropriate if symptoms are sufficiently serious, focusing on the Big 5 may provide another option for self-care and selfmanagement. The Big 5 builds on a person’s natural strengths — most people are already doing the Big 5, but just might not be doing them frequently enough.
Simple steps
Most people ‘get’ the Big 5 — it isn’t hard to understand or explain. Many of my team have adopted the Big 5 for themselves and their families, and we have used the Big 5 framework as a way of supporting a mentally healthy workplace. We are about to deploy the Big 5 as an initial level of care in our mental health services and see this as offering a non-stigmatising and non-pathologising way to support our patients to improve their own mental health. I personally use the Big 5 and have found the following simple steps have significantly improved my own mental health:
Step 1: Understand that the actions you take each day affect your mental and our physical health. This means you have some control over how you feel.
Step 2: Complete the Big 5 Checklist. This is a simple tool that asks how often a person has done the Big 5 in the previous 7 days. Answers are colour coded with a simple traffic light model and it has suggestions for increasing the Big 5.
Step 3: Increase how often you do the Big 5. Pick one area of ‘red’ or ‘amber’ and plan to do one extra action in the next day. Make sure it is achievable and rewarding. Once that is achieved, pick another action. Completing each action is naturally reinforcing, which encourages doing more.
Step 4: Maintain. My personal experience is that within a week of doing more of the Big 5 my mental health improves. I have a monthly calendar reminder to prompt me to check my Big 5, which I find essential for keeping me on track.
“The Big 5 is a simple strengths-based framework for good mental health.”
When using the Big 5 in a clinical context and with people with chronic symptoms, more prompts and support may be needed, until the extra actions become part of the person’s regular everyday life. A key to success is to make doing the Big 5 a natural part of one’s daily and weekly rhythm.
The Big 5 is a simple strengths-based framework for good mental health. It can be used as a standalone tool for those who just need a reminder about the things they can do to support their own mental health. It can also be used as a complement to a psychological or pharmacological treatment. And, if people can’t apply the Big 5 because of their symptoms of distress, depression or anxiety, they would benefit from professional assessment and treatment.
Copies of the Big 5 Checklist are available on the Health Direct website and the MindSpot website.
*Professor Nick Titov is Co-Director of the eCentreClinic, a research unit that develops and evaluates digital mental health services. He is also Executive Director of MindSpot, at MQ Health, Macquarie University.
MindSpot operates two digital mental health clinics, the MindSpot Clinic and PORTS (Practitioner Online Referral Treatment Service), which serve 25,000 Australians per year.
Titov has co-developed more than 12 online psychological interventions. These have been evaluated in more than 80 clinical trials of internet-delivered treatments involving more than 9000 people across four countries.
iStock.com/SiberianArt
Transforming Patient Safety: The Impact of Unique Device Identification (UDI) for Medical Devices
The Australian Government is enhancing patient safety by introducing Unique Device Identification (UDI) for medical devices. This initiative aims to provide a comprehensive framework for tracking and tracing medical devices, ensuring timely and effective responses to safety issues. If widely adopted across the healthcare sector the UDI system will revolutionise medical device management and significantly improve patient outcomes.
How UDI Works
At the core of the UDI system is the assignment of a unique identifier for each medical device. This identifier comprises two components: the UDI-Device Identifier (UDIDI) and the UDI-Production Identifier (UDI-PI). The UDI-DI specifies the medical device, while the UDI-PI provides production-specific information, such as the lot or batch number, expiry date and serial number.
This identifier will be displayed on labels and packaging, in both machine-readable and human-readable formats.
Benefits of UDI
Historically the accurate identification, tracking and tracing of these devices has been a big challenge, particularly when addressing issues with specific faulty implants. The UDI system aims to overcome these obstacles by providing unambiguous
identification of medical devices. With UDI healthcare providers can quickly and accurately identify medical devices, enabling prompt responses to safety concerns such as recalls or adverse events. This system ensures that healthcare facilities, professionals, and patients receive timely notifications about any issues related to their medical devices, allowing for faster intervention and resolution.
The Australian UDI Database (AusUDID)
A major milestone in the implementation of the UDI system is the establishment of the Australian UDI Database (AusUDID). This database will store UDI information for medical devices supplied in Australia, linking this data to entries in the Australian Register of Therapeutic Goods (ARTG). Sponsors and manufacturers will be responsible for submitting and maintaining device data in the AusUDID, ensuring that the information remains accurate and up to date.
The AusUDID will be accessible to patients, consumers, clinicians and health services at no cost. This transparency allows all stakeholders to access vital information about medical devices, supporting informed decisionmaking and enhancing overall patient safety. Importantly, the database will not collect or store patient information, upholding privacy and confidentiality standards.
Status and Implementation
The development of the AusUDID has been a collaborative effort involving a range of stakeholders, including consumer groups, healthcare providers, and regulatory bodies. The TGA continues to work closely with the Australian Commission for Safety and Quality in Healthcare (ACSQHC) and state-based healthcare pilot sites to refine and optimise the system.
Looking Forward
The introduction of UDI in Australia aligns with a globally harmonised approach to medical device identification and regulation. By joining this international effort, Australia is set to enhance its regulatory framework, improving the management of post-market safetyrelated activities such as recalls. The UDI system promises to deliver value throughout the entire lifecycle of medical devices, from manufacture and supply to patient care and performance assessment.
UDI regulations for medical devices represent a transformative step toward improving patient safety in Australia. By enabling precise tracking and tracing of medical devices, the UDI system will enhance the ability to respond swiftly to safety issues, ultimately safeguarding the health and well-being of patients across the nation.
Learn more about GS1’s global standards in UDI implementation.
The reliability of blood pressure measurements
Asmall-scale UNSW study suggests that many blood pressure readings may be questionable due to the way traditional cuffs are calibrated.
It is already known by experts that the accuracy of brachial cuffs is questionable, but they continue to be the dominant method for blood pressure measurements in hospitals and surgery practices across Australia and the world.
Reliable measurements of blood pressure are critical for diagnostic decisions and treatment strategies. Hypertension affects more than 1.1 billion people worldwide and when not properly managed, increases the risk of cardiovascular diseases, including heart attacks and strokes.
Misdetection of what are known as Korotkoff sounds is a potential reason measurements using cuffs may be significantly unreliable, according to research published in the Journal of Hypertension by Professor Branko Celler, an Emeritus Professor at UNSW in the School of Electrical Engineering and Telecommunications.
Celler’s study, involving only 40 patients, indicates that the accurate detection of
those Korotkoff sounds during calibration of the equipment to the accepted Universal Standard is problematic.
“We’ve actually known for 100 years or more that we systemically underestimate systolic blood pressure, but we’ve never had an answer to it,” Celler said.
“This is a fundamental and important problem that’s been identified. The implication of this study is really quite profound and I acknowledge the fact it’s hugely disruptive to current accepted practices.
“The disruption comes from the fact that, effectively, every non-invasive blood pressure device in the world is calibrated using Korotkoff sounds and may therefore be in error.
“It is not our intention to suggest that blood pressure readings should not be taken using these cuffs. The current methods have served very well in the battle against hypertension.
“What we are suggesting is that improvements need to be made to eliminate the sources of error we have identified.”
Korotkoff sounds
The process to calibrate a brachial cuff begins when it is inflated to the point where blood flow is temporarily stopped in the brachial artery, the main blood vessel in the upper arm. Next, two trained operators listen for what are known as Korotkoff sounds using a stethoscope placed over the brachial artery at the elbow crease. These sounds, named after Russian physician Nikolai Korotkov, who discovered them in 1905, indicate blood flow changes as the pressure in the cuff is released.
The sounds are critical because they indicate when blood starts to flow back into the artery as the cuff pressure is slowly released. The first Korotkoff sound, a clear tapping noise as blood first begins to flow again, is deemed to match the systolic pressure — the maximum pressure in the arteries when the heart beats. As the cuff continues to deflate, the sounds change and eventually disappear. The point at which the Korotkoff sounds completely stop indicates the diastolic pressure — the minimum pressure in the arteries when the heart is at rest between beats. This last audible sound is crucial for determining the lower number in a blood pressure reading.
Accurate calibration is required to ensure subsequent blood pressure measurements taken with the brachial cuff are precise and reflect true systolic and diastolic pressures.
Underestimation
However, the research led by Celler and involving the study of 40 people at the Concord Repatriation Hospital’s Catheterisation Laboratory in Sydney indicates that underestimation of systolic blood pressure, based on that first Korotkoff sound, can be as high as 30 mmHg.
Celler and his team analysed the data of tests on 40 people (35 men and 5 women, with an average age of 64) who had catheters inserted to record their blood pressure from directly within their artery.
Simultaneously, they also had their blood pressure measured using a non-invasive brachial cuff, and the Korotkoff sounds recorded as the pressure in the fully inflated
The results showed that for the group studied, the occurrence of the first Korotkoff sound did not represent an accurate systolic blood pressure reading due to a delayed reopening of the brachial artery as the cuff deflated.
In around one-third of the cases this discrepancy was 10 mmHg or less, but in the remaining two-thirds the error was more significant than that, with the maximum difference being 31 mmHg.
“What we showed is that when you deflate the cuff, the artery sometimes doesn’t open up — and the amount of time that goes on for is very variable,” Celler said.
“In some cases the artery does open immediately, but in other cases it takes a lot longer, when the pressure in the blood is up to 30 mm lower. In our study the average error was about 17 mm. The Universal Standard for the calibration of cuffs allows for an error of between 5 and 8 mm, so this is much above that.”
Although not part of the research team, Professor Alta Schutte, principal theme lead of Cardiac, Vascular and Metabolic Medicine in the Faculty of Medicine and Health at UNSW Sydney, said the results are intriguing. It would take a lot of time and money to amend the current guidelines related to brachial cuffs, Schutte said.
“The findings from Professor Celler’s team are interesting as it shows that the blood pressure recorded with traditional noninvasive methods are not identical to the intra-arterial pressures,” Schutte said.
“Although profound, current medical practice and clinical guidelines are based on clinical trial evidence that showed clearly that cuff-derived blood pressures are strongly predictive of outcomes such as stroke and mortality.
“It is possible that more accurate blood pressure measurements that align better with intra-arterial pressure would have even stronger predictive value, but it would take major studies and millions of dollars to repeat such trials.
“I think it is thus highly unlikely that current
cuff-based blood pressures would change anytime soon.”
Celler acknowledged that solving the known problem of underestimating blood pressure readings using cuffs will not be an easy task.
“I have presented this work at the European Hypertension Conference and some clinicians said these results were too disruptive and the consequences would be too hard to deal with given the widespread use of cuffs to record blood pressure,” he said.
“But others were keen to know more because they recognised that if a blood pressure reading from a cuff was 120 mmHg and the true BP was up to 30 mm higher, then their management of that patient would be very different.
“The problem is that the solution to this issue is not easy. I just hope that identifying the scale of this problem will now spark a raft of new research worldwide.”
Collaborative research required
In the paper, the researchers state clearly that more studies are needed to fully understand the reasons for the delayed reopening of the brachial artery as the cuff pressure is reduced.
Celler has developed mathematical models that allow the prediction of true systolic blood pressure (SBP), based on the data obtained during the research and a study of a number of variables including pulse pressure and peak cuff pressure, as well as the values recorded from the onset and cessation of the Korotkoff sounds.
However, he acknowledges those need to be validated in much larger trials. In the interim, the UNSW academic is looking into more direct instrument-based methods of estimating true SBP.
Via $75,000 of funding from UNSW’s Innovation Community, Celler has already developed a new experimental non-invasive blood pressure device that simultaneously displays different BP estimates from Korotkoff sounds, an oscillometric ratio method, an oscillometric gradient method and his own mathematical model estimate.
In terms of the errors in blood pressure readings when using the cuff, Celler had suspected arterial stiffness might be a cause, but the results did not back up his original hypothesis. Nor was any correlation found between those who had high, or indeed low, blood pressure and the level of discrepancy in their readings.
“This needs to be researched by many more people. I’m trying to build a collaborative team, and I’ve had very strong feedback around the world, including from people at Cambridge University and elsewhere,” he said.
“I don’t present this as if I have all the answers. I have identified the problem and I want to put this out there to see what other people think.
“Because this is so disruptive to traditional methods that have been in place for so long, I know it might take 10 years to find a solution and potentially amend the international standards.
Tech partnerships: working together to unlock healthcare potential
The real and lasting value of a tech partner and how purpose-built software optimises operations and supports better outcomes.
Healthcare is a complex, highly regulated industry and organisations need to adapt in order to keep up. It’s vital for care delivery organisations to provide high quality, value-based services but often their ability to focus on those in their care is hampered by ever-changing industry regulations, workforce management challenges and out-of-date software systems.
What if healthcare providers could empower their workforce to deliver the highest standard of care through automation and integrated software? Technology already exists for this purpose, but without the relevant expertise and advice it’s hard to know where to start. The right tech partner can help create a more efficient and sustainable business so organisations, their staff and the people they support can thrive, now and in the future.
Tech provider vs. tech partner
There are plenty of technology companies just selling out-the-box systems or multiple
stand-alone apps, but a tech partner is more than just a software provider. One company leading digital transformation in the Australian healthcare industry is local tech trailblazer Lumary. With their advanced digital platform, purpose-built for the disability and allied health industries, this software company recognised the importance of building a single, scalable connection point between organisations and multiple digital solutions. Working closely with healthcare providers to identify gaps in their tech, Lumary develops collaborative relationships with their clients to build a longterm, fully connected solution that not only complies with the latest industry regulations, but manages the entire operation end-to-end.
The best kind of tech partner is one that truly understands the fragmented healthcare
industry and its many complexities. That’s why it’s invaluable when software companies serving this sector have experienced industry experts in-house. As well as helping define the product build, these experts readily understand the challenges experienced by support workers and can work alongside the tech team to create tailored solutions that meet the requirements of specific funding bodies, such as those of the NDIS and HCP.
Another factor to consider when aligning with a tech partner is the strength of their delivery and customer success support. Instead of wasting money and resources trying to implement and integrate multiple digital solutions, organisations receive support implementing and updating their software and the peace of mind of a handson customer success team if they encounter issues or require additional functionality.
Connected tech: support workers and care recipients
Integrated tech platforms such as Lumary not only maintain industry regulations like those of the NDIS, they also facilitate information sharing, reduce data irregularities and update records in real time. This transparency means improved collaboration across the care continuum as support workers are able to make more informed decisions and care recipients are afforded greater choice and control over their health care.
“It’s essential that support workers providing face-to-face services are empowered with the right tech in order to provide better services to more people,” says former disability support worker and current Lumary SME, Stacey Sincock. “Workers need to capture and record information in real time and this then supports their employers to effectively claim, report and meet clients’ health needs. If you’re not doing it properly you could be leaving money on the table or creating huge admin burdens.”
Healthcare organisations are in this industry because they care, but they also need to remain profitable and viable to future-proof their operation. Organisations need to embrace technology sooner rather than later. The right tech partner will support the digital transition every step of the way, enabling healthcare providers to improve their care delivery services while also safeguarding the success and growth of their business.
Seize the opportunity to elevate your organisation to new heights. Embrace the power of a Lumary partnership and embark on a journey toward sustainable growth and unparalleled success. Book a healthcare consultation with their team today and experience the difference firsthand. Together, create better wellbeing in people’s lives—one transformative partnership at a time.
» For more information visit Lumary www.lumary.com
Designing with compassion
“The brief was clear — to deliver a Class 9A standard hospital within a dignified, homelike environment as much as possible.”
When Anam Cara — a Geelong-based not-for-profit community service supporting people with life-limiting illness — outgrew its previous four-bedroom facility, its vision for the future was clear. To challenge traditional hospice designs and build “something very special” for the community.
From the beginning of the project more than six years ago, the team at Tectura Architects worked closely with the Anam Cara team to collaborate with the ACHG board staff, families, community organisations, volunteers, specialists and the builder, Nicholson Construction, to bring the project to life — they were all unified by their vision to provide people at the end of life with dignity and choice.
“The brief was clear — to deliver a Class 9A standard hospital within a dignified, homelike environment as much as possible. The architectural response has transformed the philosophy of palliative care, shifting from a physical and pragmatic perspective to one that embraces emotional and spiritual
intangibles. In other words, Tectura delivered a new health model based on guest-focused care — rather than a medical or clinical base,” said Melika Grigg-Baycan, Director, Tectura Architects.
Located on the beautiful grounds of Deakin University, Waurn Ponds, the 20-bed Anam Cara House became possible with support from the local and philanthropic community and grants from the Victorian and Australian Governments.
The key features of the project include: 20 guest bedrooms with ensuites — large enough for family and pets to stay; hidden specialist equipment concealed within joinery, to feel like a real home; shared kitchen, living and dining areas; day palliative care area; library and community resource centre; community outreach office; spiritual area for cultural, belief and religious needs; and landscaped gardens, outdoor areas and walking paths.
“The 2 ha site is located on historical land traditionally owned by the Wadawurrung
people, with beautiful views to the valley below. At every opportunity, this connection to Country is cherished and celebrated as a foundation for care,” Grigg-Baycan said.
“The building features two long, linear wings that work with the gentle contours and fall of the land — the community hub and infrastructure wing is busy and captures sweeping views to the north. The more private residential, bed-based wing sits to the south and embraces views of the surrounding hills and valley.
“The shape of the wings is an architectural expression symbolising the shape of Anam Cara’s logo — a pair of caring hands. They cradle the care activity and gardens within, sheltering a central library and interlinking internal courtyards while a garden weaves around the building,” Grigg-Baycan said. Openings and connections are designed to enable each guest — not patient — to feel the therapeutic benefits of the sun and fresh air on their skin, where they can step or be wheeled outside and feel grounded to nature, look out to horizon views and to the rolling hills and enjoy the sense that the building wraps around them in support.
“Internally, the mass of the building is broken down into clusters to create a
family-friendly, human scale for all people inside. The corridors don’t feel like hospital thoroughfares, while the interiors feature carpeting, soft lighting and timber details. The day services are busy and provide community, resources and therapeutic services, while the quieter residential areas are separate and enhance privacy with careful zoning and planning to deliver a mix of intimate and semi-private spaces. Here, the bedrooms are deliberately more spacious with materials that feel soft, light and warm in keeping with those in a home-like space.
“Seamless timber joinery cleverly hides lifting hoist and medical equipment. Care and comfort are delivered through shared
experiences and simple activities, which inspired the design of the adjoining shared lounges, kitchens and outdoor areas for guests and families to use. Guests can remain in their bedroom, head out to read in the library, enjoy a meal cooked with their family or go outside to the garden — choice is always the priority.
“Designed for the community, by the community, this is a project about human dignity and caring for our most vulnerable,” Grigg-Baycan said.
“In other words, we delivered a new health model based on guest-focused care,” said Elizabeth Grigg, Principal, Tectura.
Innovative chemical solutions for the aged care sector
Ensuring the safety, comfort and wellbeing of nursing home residents is an ongoing challenge for operators amidst rising costs associated with a skills shortage that will see Australia needing an extra 110,000 skilled aged care workers by 2030, according to the Committee for Economic Development of Australia (CEDA).
This, combined with increased water, energy and chemical costs, means operators are turning to trusted solutions and cutting-edge technology to ensure that laundry and surfacecleaning provision is delivered cost effectively without compromising on standards.
On-premise laundry
Managers of care home on-premise laundries, facing a constantly high turnover of bed linen, towels and clothing, cannot afford the time and costs associated with rewashing.
Therefore, there exists a demand for chemical dosing systems that inject detergent, fabric softener and additives with high precision and consistency alongside minimal servicing requirement.
These devices traditionally use solenoid or peristaltic pump-driven dosing, while recent developments include venturi-based units that use water pressure to draw chemical.
These systems, such as SEKO’s LS100, have no moving parts, meaning that maintenance consists of little more than occasional cartridge replacements which helps to significantly reduce costs while maximising in-service time.
With wash performance and reduced chemical consumption among the priorities in care home on-premise laundries, IoT-enabled dosing pump systems are increasingly specified for new installations and upgrades alike.
Surface cleaning
These devices work by harvesting data during operation, including information on wash cycle status, chemical consumption and equipment performance, which can then be accessed historically or in real time via smartphone.
With this vital information at their fingertips, users can programme and adjust wash formulas in order to optimise performance and minimise chemical consumption.
Meanwhile, managers are able to view wash statistics in cost-per-load terms, providing invaluable and accurate insight into their application’s cost which can help them identify chemical wastage and pinpoint areas for potential savings.
Such systems also alert operators to anomalies via smartphone alerts, allowing remedial action to be taken at the earliest opportunity, helping to avoid untimely equipment failure and expensive unplanned downtime.
For those managers responsible for multiple sites or working from home, the ability to take control of their wash operation 24/7 from any location saves time and money while eliminating unnecessary travel as part of a sustainable operation.
Infection control in the aged care sector, where vulnerable residents must be protected against the spread of bacteria and viruses, demands robust dispensing systems that deliver a consistent volume of chemical for repeatable results.
When considering chemical dispensers for surface-cleaning tasks such as counter wiping, floor mopping and sink filling, by opting for systems that allow multi-product dispensing from a single control unit (usually via a selector dial) users can quickly and easily switch between products.
Meanwhile, the inclusion of differentlysized metering tips can help users to make fine adjustments and maximise efficiency depending on the chemical being used.
Such systems — which include SEKO’s modular ProMax range — also typically allow customisation, with products colour-coded on the control unit to ensure the correct chemical is selected.
With the Australian aged care sector welcoming employees from around the world in order to address the skills shortage, this universal identification is especially useful to staff for whom English may not be their first language.
SEKO has almost 50 years’ experience in the design and development of chemical systems for the cleaning and hygiene sector, and has worked extensively with public and private healthcare operators to provide bespoke solutions for sites of every size.
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Improving prostate cancer outcomes
Global prostate cancer cases are projected to rise from 1.4 million a year in 2020 to 2.9 million a year in 2040, according to The Lancet Commission on prostate cancer.
The number of annual prostate cancer deaths worldwide is predicted to rise by 85% over the 20-year period, from 375,000 deaths in 2020 to almost 700,000 deaths by 2040. The true numbers will likely be much higher than the recorded figures due to under-diagnosis and missed opportunities for data collection in lowand middle-income countries (LMICs), according to the Commission.
LMICs are expected to see the highest increase in cases, with the Commission calling for urgent implementation of programs to raise awareness of prostate cancer and for improvements in early diagnosis and treatment in LMICs — where most men present with late-stage disease. Aging populations and increasing life expectancy will lead to higher numbers of older men in coming years. As the main risk factors for prostate cancer — such as being aged 50 or older and having a family history of the disease — are unavoidable, it will not be possible to prevent the upcoming surge in cases through lifestyle changes or public health interventions.
“As more and more men around the world live to middle and old age, there will be an
inevitable rise in the number of prostate cancer cases. We know this surge in cases is coming, so we need to start planning and take action now. Evidence-based interventions, such as improved early detection and education programs, will help to save lives and prevent ill health from prostate cancer in the years to come. This is especially true for low- and middle-income countries which will bear the overwhelming brunt of future cases,” said Professor Nick James, lead author of the Commission, Professor of Prostate and Bladder Cancer Research at The Institute of Cancer Research, London, and Consultant Clinical Oncologist at The Royal Marsden NHS Foundation Trust.
Early detection for those at high risk
In HICs, screening for prostate cancer often involves the PSA test, a blood test that measures levels of a protein called prostatespecific antigen (PSA). However, PSA tests often detect prostate cancer which may never cause symptoms and needs no treatment.
The current approach to prostate cancer diagnosis in the UK and many other HICs relies on ‘informed choice’ PSA testing — when men aged 50 or over with no disease symptoms can request a PSA test from their doctor after a discussion of the risks and benefits.
The Commission argues there is evidence to suggest this approach leads to over-testing
in low-risk older men but does not increase detection of prostate cancer in younger men at higher risk. The authors also highlight huge variations in the likelihood of men being diagnosed with advanced prostate cancer with the ‘informed choice’ PSA testing strategy; for example, The National Prostate Cancer Audit in the UK found that in 2022, 1 in 8 men (12.5%) with prostate cancer are diagnosed with advanced prostate cancer in London, whereas in Scotland more than 1 in 3 (35%) were diagnosed late.
Instead, the authors recommend using MRI scans in combination with PSA testing to screen men at high risk of prostate cancer in HICs, such as those with a family history of the disease, those of African origin and those
carrying the BRACA2 mutation. They argue that this approach would both reduce overdiagnosis and over-treatment, while detecting potentially lethal disease. MRI is effective in imaging cancers and can be used to provide information as to whether the disease is aggressive and likely to be life-threatening. However, biopsies are more effective at identifying aggressive cancers, so MRI alone should not be used to investigate men at high risk of disease.
“With prostate cancer we cannot wait for people to feel ill and seek help — we must encourage testing in those who feel well but who have a high risk of the disease in order to catch lethal prostate cancer early. Pop-up clinics and mobile testing offer cost-effective
solutions that combine health checks and education. In the UK we recently trialled a new innovative outreach program called The Man Van which provided free health checks — including PSA tests — to high-risk men in London aged 45 and over. By bringing a van with quick and easy testing straight to men at work and in the community, and targeting those who have a higher risk of prostate cancer, we provided thousands of health checks which resulted in almost 100 cancer diagnoses in men who might otherwise have only seen a doctor once their cancer has progressed to a more advanced stage. The mix of education, outreach, testing and referral used in The Man Van trial may also be successful in LMICs and we hope to see
similar initiatives rolled out globally to improve early detection of prostate cancer,” said Professor Nick James (also project lead for ‘The Man Van’).
As well as being a major growing challenge, prostate cancer is also an indicator of a wider need to tailor future health care to cope with increases in several diseases, as the numbers of men reaching middle and old age increase worldwide. The Commission calls for trials of prostate cancer screening in LMICs to form part of holistic approaches with a broader focus on men’s health.
Raising awareness
There is a need to raise awareness of the dangers and symptoms of metastatic prostate cancer among men and their families in LMICs. Public awareness of the key features of advanced prostate cancer — such as bone pain, caused by metastatic disease — is poor in many LMICs. Similarly, there is generally low public awareness that treatments which can prolong survival and decrease suffering — including cheap, effective ones such as hormone therapy — are available in many LMICs. As with early diagnostic capacity,
“There is a need to raise awareness of the dangers and symptoms of metastatic prostate cancer among men and their families in LMICs.”
media and influencers. They highlight Project PINK BLUE, an organisation that delivers a range of programs to raise awareness of breast, cervical and prostate cancer in Nigeria, and provides free cancer screening. Many of Project PINK BLUE’s programs utilise digital technologies and involve wellknown public figures and celebrities.
Improving
diagnostic capabilities and treatment
Optimal management of prostate cancer requires the availability of specialist staff and infrastructure to support diagnosis, surgery and radiotherapy to treat localised prostate cancer, and radiotherapy and hormone therapy for metastatic disease.
A major barrier to improved prostate cancer care in LMICs is a lack of trained staff and specialist facilities. These shortages are not limited to prostate cancer, and the 2015 Lancet Commission on Surgery found that 9 out of 10 people in LMICs cannot access basic surgical care.
Expanding early diagnostic capabilities in LMICs will increase the rates of detection of early-stage prostate cancer, further increasing demand for surgery and radiotherapy. Urgent measures are therefore needed to build surgical and radiotherapy capacity in these countries. The Commission authors state that establishing regional hubs could provide the infrastructure needed to increase specialist training and improve patient access to radiotherapy and surgery.
For men with metastatic disease, earlier diagnosis and starting hormone therapy earlier will reduce deaths and prevent serious complications like painful spinal cord compression and urinary retention, which can lead to infection and kidney damage.
More research needed
The Commission authors highlight the need for more research to better understand prostate cancer in men who are not of White European origin, to enable improved detection and care in these groups.
Research and knowledge of prostate cancer is heavily focused on White European men, and most studies have been done in HICs. However, Black men, especially those of West African descent, have a higher risk of developing prostate cancer than White or Asian men, though the reasons for this are unclear. There is also a higher death rate from prostate cancer among Black men, but it is not known if this is driven by the differences in case rates or by other factors such as differing disease biology or societal factors such as deprivation or racism. More data is needed to identify the driving factors behind these trends.
there is a need to scale up availability and improve access to treatments for advanced disease in LMICs.
The Commission authors suggest that programs should involve new technologies and channels such as smartphones, social
The Commission authors call for mandatory recording of ethnicity in clinical trials, and that trials should reflect the ethnic mix of the populations being studied to ensure that the findings apply to all groups. The Commission authors also call for trials examining prostate cancer screening, early diagnosis and treatment in LMICs.
iStock.com/Chinnapong
How cleaning machines are humanising patient care
The primary goal of healthcare hygiene is to prevent healthcare-associated infections. (HCAIs). HCAIs pose a serious risk to patients, staff and visitors and cause significant costs, both financial and in reputation for healthcare providers.
From patient rooms to corridors, every surface plays a crucial role in infection prevention. Floors are often overlooked, but recent research shows that medical staff carry germs around facilities via the sole of their shoes, including into sensitive areas.
Traditionally, mops and standard vacuums have been the go-to tool for floor cleaning, but it’s time to consider how the newer technology can improve patient outcomes.
Why it’s time to drop the mop
Mops spread germs rather than eliminating them. As we drag a dirty mop across the floor, we inadvertently transfer pathogens from one area to another and the water in the bucket quickly becomes a breeding ground for bacteria.
Let’s shine a spotlight on Nilfisk floor scrubbers
Nilfisk scrubber dryers make a big difference in healthcare environments.
Improve hygiene: Nilfisk scrubbers use clean water and detergent to scrub floors thoroughly. Unlike mops, they don’t spread contaminants. The scrubbing action lifts dirt, grime, and bacteria, leaving surfaces truly clean.
Reduce cross contamination: Nilfisk scrubbers have separate tanks for clean solution and waste water. As they move, they pick up dirt and immediately deposit it into the dirty water tank. No more back-and-forth contamination.
Efficiency boost: Nilfisk scrubbers cover more ground in less time — at least 4 x faster. Their rotating brushes or pads agitate the surface, ensuring deep cleaning without manual effort. Staff resources can be allocated more effectively.
Nilfisk SC500 Scrubber/Dryer
The SC500 walk-behind scrubber/dryer has unique features to make it even more efficient:
Smartflow™: automatically adjusts flow of water/detergent based on speed for consistent cleaning.
EcoFlex™: seamlessly provides a power and detergent boost where it is needed most and water-only or light cleaning in less soiled areas, to drive down total cleaning costs.
SilentTech™: reduces sound level from 65dB(A) to 60dB(A) in silent mode to limit disturbance to patients.
Nilfisk Liberty SC50
Autonomous Scrubber/Dryer
The latest technology in floor cleaning, Nilfisk Liberty SC50 utilises robotics to multiply healthcare cleaning workforces. Features include:
Efficiency: while the Liberty SC50 labours on the floors, staff can focus on sanitising high contact areas, and other important tasks that improve the hygiene of the facility.
Consistent cleaning standards: Provides the same quality every time, so floors are kept clean, safe and dry.
Proof of clean: Make data-driven cleaning decisions.
Let’s clear the air on standard vacuums
Vacuum cleaners play a crucial role in maintaining clean floors by removing dirt and debris. However, they can also disturb pathogens hidden on the floor or in carpet. If the vacuum’s filtration system is inadequate,
these pathogens may become airborne, impacting air quality.
Breathe easy with Nilfisk HEPA-filtered vacuums
Nilfisk HEPA-filtered vacuums feature a superior HEPA H13 filter efficiency that complies with the EN1822 standard. As air is drawn into the vacuum it is expelled through the filter and removes at least 99.95% of particles, of 0.3 microns in diameter.
Nilfisk GD930 PRO HEPA S2 Vacuum
The GD930 PRO HEPA S2 is perfect for Healthcare:
Superior filtration: Outstanding performance with a 5x larger HEPA H13 filter for increased lifespan. Fleece bags improve filtration by up to 10% over normal paper bags.
Quiet operation: World-class low sound with a sound pressure level of 52dB(A), reducing to 48dB(A) in quiet mode.
Long lifespan: Built with a durable steel container and detachable cord, to save on total overall costs and reduce environmental waste.
Smart efficiency: Increase productivity with a very high filling capacity 15L container/dust bag, quick-start cord release, fast access HEPA filter, and convenient lid storage.
Safety and ergonomics: Avoid trip and fall accidents with the highly visible orange cable. The lightweight aluminium accessories, rubber grip ensures comfortable handling.
» For more on the GD930 and other Nilfisk products, visit www.nilfisk.com/en-au/ campaigns/gd930-product-launch-ec/
mental health care
Images courtesy of Hassell.
Images courtesy of Hassell.
The Ipswich Hospital Mental Health Acute Inpatient Service facility, designed by multidisciplinary architecture, design and urban planning practice Hassell, was recently recognised at the Queensland State Architecture Awards.
The project — part of Ipswich Hospital, a major acute teaching hospital located 40 kilometres west of Brisbane in Ipswich, Queensland, Australia — received the William Hodgen Building of the Year for the Darling Downs and West Moreton region, The GHM Addison Award for Interior Architecture and the State Award for Public Architecture.
Built by BESIX Watpac, the 50-bed multistorey facility was praised by the jury for “upholding a new model of mental health care”. The holistic design earned The GHM Addison Award for Interior Architecture and the State Award for Public Architecture from the jury for “providing comfort in a calm setting, promoting recovery and normalising mental health care”.
“The architecture, interior design and landscape architecture work together to enhance a feeling of calmness, familiarity and comfort, creating an environment that positively supports a progressive mental health model of care,” said Stephen Watson, Principal, Hassell.
“The benefits from the investment in this exceptional design will translate to improved recovery rates for patients, but also improved conditions for staff and therefore better attraction, satisfaction and retention rates,” Watson said.
“For visitors — family and loved ones — the design extends a warm welcome and supports their participation in the healing process.”
The facility features sunlit rooms and corridors, and verdant courtyard gardens with an aim to create a connection to nature, helping to improve wellbeing and support the healing process. Openness and transparency, enabled by a glazed perimeter and lightwells, ensure passive observation across floors and maximise safety for all.
Through the co-design process, Hassell collaborated with consumers, carers, clinicians, allied health professionals, operations staff and community groups to shape the healing environment, said the company in a statement. “Meaningful engagement with First Nations representatives led to delivery of a culturally safe environment with integrated landscapes, bush medicine, sunlit interiors, colours that reflect Country and artworks by local artists.”
Hassell Health Sector Leader Leanne Guy said the facility supports a nationwide commitment to improve mental health care and sets a new benchmark for person-centred and recovery-orientated care in Australia. According to the Bureau of Statistics, 42.9% of Australians aged between 16 and 85 years have experienced a mental disorder at some time in their life.
“Our duty as designers is to normalise care and improve the recovery process through high-quality design outcomes,” Guy said.
Images courtesy of Hassell.
Images courtesy of Hassell.
Images courtesy of Hassell.
Enhancing hearing loss diagnostics and outcomes
As an audiologist with over 15 years of experience, I’ve witnessed firsthand the transformative impact of early and accurate hearing loss diagnosis. Hearing health is integral to overall physical and emotional wellbeing, yet it often remains overlooked in primary care settings1. Here are some insights and strategies for primary care professionals to enhance hearing loss diagnostics and outcomes, drawn from peerto-peer discussions, clinical observations and available data1, #, ^
Awareness, education and ease
Despite hearing loss affecting 3.6 million people in Australia2, it is frequently undiagnosed. Implementing routine hearing screenings during annual health checkups is essential for early detection and management of hearing loss. Validated hearing screening questionnaires can be quick and non-intrusive, providing a valuable first step in identifying potential issues. A quick online hearing check that considers patients’ hearing abilities in different environments, including background noise, and includes self-evaluation questions can be conveniently taken in any quiet setting, providing an immediate indication of whether a patient shows any signs of hearing loss. If hearing loss is indicated, it is recommended that the patient is referred to an audiologist for further comprehensive hearing assessment.
Primary care professionals and GPs can help raise awareness about the importance of hearing health and the risks associated with untreated hearing loss1. According to Audika’s recent sensory survey*, 77% of respondents claim to know someone who is hard of hearing, highlighting the widespread awareness of the issue; however, many patients may not recognise the early symptoms of hearing loss or might attribute
them to aging and dismiss them. By discussing the potential impact of hearing loss on cognitive function, mental health and quality of life, primary care professionals can encourage patients to incorporate hearing assessments as part of their annual heath checkups.
A
multidisciplinary approach
Hearing loss may be associated with other health issues, such as diabetes3, cardiovascular disease4 and cognitive decline5. Naturally, it can also intersect with age. Hearing health is often neglected by older patients as our survey* revealed. Almost 7 in 10 (67%) respondents aged 65 or over admit they have not had a hearing test or
assessment in the past 12 months, despite almost half (48%) believing they may be experiencing hearing loss^. Adopting a multidisciplinary approach where collaboration between clinicians, primary care providers, otolaryngologists and other specialists can deliver comprehensive patient care. Case studies have shown that integrated care models improve patient outcomes by addressing the multifaceted nature of hearing loss and its comorbidities1,7
Preventative strategies can significantly reduce the incidence of hearing loss, and primary care providers can play a pivotal role in advising patients on protecting their hearing. This includes educating patients about the dangers of noise exposure, the
Lauren McNee*
importance of using hearing protection in noisy environments and the risks associated with ototoxic medications, such as certain antibiotics and non-steroidal antiinflammatory drugs (NSAIDs). Regular hearing screenings are strongly recommended as they can help detect early signs of hearing loss, allowing for timely intervention.
Fostering patient-centred communication
Effective communication is key to managing hearing loss. Patients may feel embarrassed or frustrated by their hearing difficulties, which may lead to social isolation and decreased quality of life8. The Audika sensory survey found that 59% of respondents believe there is a negative stigma surrounding hearing loss*. For older respondents over 65, the survey also revealed an impact on their
feelings toward hearing aids, with 4 in 10 (41%) survey respondents admitting they think there is a negative stigma surrounding hearings aids^. Primary care providers can foster a supportive environment by using patient-centred communication techniques. This involves speaking clearly, facing the patient, reducing background noise and confirming understanding. These practices not only enhance patient engagement but also ensure that hearing concerns are appropriately addressed.
Improving hearing loss prevention, early detection and treatment requires a concerted effort from primary care professionals. By encouraging hearing screenings as part of their annual health checkups, GPs and other healthcare professionals can significantly impact the quality of life for patients with hearing loss.
# The survey was commissioned by Audika Australia. An online survey was scripted and hosted by PureProfile, an independent research services provider. A nationally representative sample of n=1005 Australians aged 18+ were selected via randomisation to participate by the research panel provider PureProfile. Fieldwork was conducted from the 9th of February to the 12th of February 2024.
^ All stats pertaining to 65+ featured a sample size of n=219 segmented from the national representative sample.
1. Australian Government Department of Health. (2021, October). Roadmap for hearing health. https://www. health.gov.au/sites/default/files/documents/2021/10/ roadmap-for-hearing-health.pdf
2. Australian Government Department of Health and Aged Care. (2024, May 14). About ear health. https://www.health. gov.au/topics/ear-health/about
3. Sommer J, Brennan-Jones CG, Eikelboom RH, Hunter M, Davis WA, Atlas MD, Davis TME. A population-based study of the association between dysglycaemia and hearing loss in middle age. Diabet Med. 2017 May;34(5):683-690. doi: 10.1111/dme.13320. Epub 2017 Feb 20. Erratum in: Diabet Med. 2017 Oct;34(10):1488. doi: 10.1111/dme.13511. PMID: 28135010.
4. Baiduc RR, Sun JW, Berry CM, Anderson M, Vance EA. Relationship of cardiovascular disease risk and hearing loss in a clinical population. Sci Rep. 2023 Jan
5. Dawes P, Munro KJ. Hearing Loss and Dementia: Where to From Here? Ear Hear. 2024 May-Jun 01;45(3):529-536. doi: 10.1097/ AUD.0000000000001494. Epub 2024 Feb 21. PMID: 38379156; PMCID: PMC11008448.
6. Busselton Population Medical Research Institute. (n.d.). Busselton Health Study. https://bpmri.org.au/ research/key-projects-studies/busselton-healthstudy-2.html
7. Australian Commission on Safety and Quality in Health Care. (2021, April). The Fourth Australian Atlas of Healthcare Variation 2021. https://www. safetyandquality.gov.au/sites/default/files/2021-04/ The%20Fourth%20Australian%20Atlas%20 of%20Healthcare%20Variation%202021_Full%20 publication.pdf
8. Bennett RJ, Saulsman L, Eikelboom RH, Olaithe M. (2021) Coping with hearing loss distress: A qualitative investigation using Leventhal’s self-regulation theory. International Journal of Audiology. Accepted May 2021.
*Lauren McNee is an Audiologist & National Clinic Coordinator Training Manager at Audika Hearing Clinic. With over 15 years of experience, she is dedicated to improving hearing health, advocates for early intervention and is passionate about enhancing patient care.
Digital health:
the economic imperative
Bronwyn Le Grice*, Chief Executive and Managing Director at ANDHealth
In June, Federal Health Minister Mark Butler requested a review into the $22 billion private hospital system, with pundits arguing that the system was sick and facing substantial viability issues thanks to rising labour and input costs.
In addition, there are widespread reports of severe financial distress across our public hospitals with both Northern & Western Health in Victoria reporting likely layoffs, ward closures and other measures to adapt to the recent Victorian Budget.
The inarguable reality is that our public and private healthcare systems, including primary health, allied care and aged care, are under enormous strain and it will take widespread, significant reform, to secure our health and care systems for the future.
Leveraging technology to enhance care delivery
According to Oscar Boldt-Christmas, Rebecca Kannourakis and Madeline Maud, a shift to more accessible, cost-effective virtual-care models could mitigate increases in healthcare service demand, expenditures and patient dissatisfaction (McKinsey, 2023).
They argue that shifting acute care to the home, and the creation of so-called ‘virtual hospitals’, could deliver three key benefits over traditional brick-and-mortar models of
care: expanded bed capacity, improved patient satisfaction and outcomes, and cost savings.
In Australia, the COVID pandemic saw one of the most rapid shifts in care delivery in history; however, it is becoming increasingly evident that there is a slow, inexorable return to pre-COVID behaviours across the healthcare landscape.
Evidence-based digital healthcare solutions have been proven to achieve significantly improved economic and patient outcomes across a wide range of areas, including chronic disease management, medication adherence, preventative health, diagnosis and rehabilitation, and yet they are still rarely deployed at scale in Australia.
Digital health solutions also have the potential to significantly improve healthcare access and affordability for patients, especially for those in regional and remote areas, where timely access to the appropriate clinician can require costly transport and long waiting times.
Within the ANDHealth pipeline of 950+ operating digital health companies, 20% identify hospitals as their primary enduser setting, whilst a further 19% identify GP and allied health and 8% identify community and subacute care. In short,
50% of innovative Australian companies are primarily trying to disrupt and improve the delivery of care at the coalface.
Patient engagement: the blockbuster of the century
In 2012, Leonard Kish coined the phrase that “the engaged patient was the blockbuster drug of the century” (Kish, 2012), a tenet that has been backed up by significant healthcare leaders around the world many times since.
A combined approach of virtual digital health services and engaged patients through the deployment of new digital health technologies is, without doubt, part of the answer to the relentless demands of healthcare systems on national budgets.
Of the 950+ companies in the ANDHealth pipeline, 29% of digital health companies are currently deploying technologies with a primary focus on self-management of disease, patient behaviour change and medication management, whilst a further 20% listed clinical decision support as their primary purpose.
These types of technologies allow patients, and their care teams (professional and personal), to be informed and engaged in their patient journey. From demonstrating sustained improved HbA1c levels in type 2 diabetes patients to early identification of cancer and coronary heart disease, reduced hospitalisations for those with chronic respiratory conditions, making hearing tests for children accessible from anywhere or delivering best-in-class cardiac rehabilitation virtually, digital products and services across the spectrum of health care have continually proven, through robust clinical trials, that they can deliver outcomes more accessibly, more efficiently and more impactfully than traditional care alone.
Creating an environment for reform
We’ve heard for years the chant that we need to shift to ‘value-based care’ and incentivise those interventions which drive patient outcomes in a more cost-effective way, but
little has really changed. The unfortunate reality is that for new models to emerge, existing models of delivering care need to evolve. Every component of healthcare delivery has an economic model behind it, whether it is the GP practice leveraging MBS codes or the realities of delivering care through public or private hospitals or private health insurance in an environment where costs only ever go up.
To drive change, we need to shift the economic incentives and reward those that drive the uptake of new technologies. Regulation, reimbursement, procurement and performance structures all need to evolve to embrace a new way of delivering care — this is not for the fainthearted and will likely be politically unpopular. However, significant reform is the only way that future generations will enjoy the world-class healthcare system that we have all benefited from our entire lives.
Digital health is certainly not the only silver bullet to our healthcare budget crisis — but it clearly has a big part to play in delivering clinically significant, accessible and affordable health solutions for Australians. And that is something we all need to get behind.
*Bronwyn Le Grice founded ANDHealth — Australia’s only digital health commercialisation organisation — with a specific focus on digital medicine and digital therapeutics in 2017, in collaboration with a consortium of industry partners.
ANDHealth’s unique cooperative commercialisation model has led to significant growth within Australia’s nascent digital health sector and continues to be a driving force for the development of sovereign capability in evidence-based, regulated digital health technologies.
In 2021, Bronwyn was named the recipient of the Victorian Pearcey Entrepreneur of the Year Award for contributions to Australia’s technology sector and the 2020 BioMelbourne Network’s Most Valuable Women in Leadership Award.
with datadriven clinical support Enhancing primary care
T
he deployment of Primary Sense, a non-commercial population health management, clinical decision support and data extraction tool, seems to be in full swing with around 10,000 general practitioners in more than 1500* practices using the resource.
The original tool was developed by the Gold Coast Primary Health Network (PHN) in 2018, with the WA Primary Health Alliance (WAPHA) leading the development of Primary Sense 2.0, which has been in operation since mid-2022.
Data-driven decision-making Primary Sense has been developed in conjunction with general practices, universities and representatives from peak bodies. It has been tried and tested among 700 general practitioners (GPs) in the Gold Coast PHN region.
Gill Yearsley, CEO of the Northern Territory PHN and Chair of the Primary Sense Steering Committee, said, “At a time when particularly regional general practice is under pressure, Primary Sense offers GPs and practice staff an excellent range of features to support patient health management and data-driven decision-making. PHNs are committed to strengthening and enhancing this application to bring greater value to general practice and the primary healthcare system.”
In Cairns, Trinity GPs is one of the many general practices in the country transitioning to Primary Sense to enhance patient care. “Having organised data allows us to treat patients accordingly and is also beneficial during accreditation,” said Trinity GPs Practice Manager Daphne Venkatesh.
The team at Trinity GPs routinely engages in data-driven processes, while also exploring where data can optimise patient care, especially for patients with chronic and complex health needs.
“A patient’s digital health record gives general practitioners a good understanding of a patient’s health and conditions, and allows any GP at our clinic to treat the patient now and into the future. It’s beneficial for us both.
Venkatesh said having optimised data also allowed the practice to communicate
with patients about chronic illnesses or immunisation, giving an opportunity to send reminders and being proactive and preventative in the provision of health care.
The tool is said to be compatible with major practice clinical software products Medical Director and Best Practice, with Genie and ZEDMED in the development pipeline. Primary Sense is securely hosted in Primary Health Insights (PHI) and all data extracted from the tool is privacy protected, and securely stored and managed in Australia.
Risks, needs and patient categorisation
The team at Trinity GPs is excited about using Primary Sense as it provides realtime medication safety alerts, its seamless integration into workflow supporting effective population health management, Venkatesh said.
“These functionalities will elevate patient care, refine clinical decision-making and efficiently target interventions.”
The Primary Sense platform incorporates the Johns Hopkins University Adjusted Clinical Group (ACG) system, which categorises patients based on their care needs and risks, according to the Northern Queensland Primary Health Network (NQPHN).
This allows Primary Sense to quickly identify highly complex or at-risk patients and provide reports and alerts to the practice for recommended services, tests or interventions.
All extracted data is deidentified, meaning the data contains no personal identifying information such as name, date of birth, address or Medicare number. Patients can withdraw their consent to share data through Primary Sense at any time.
Efficient resource allocation
Venkatesh said Primary Sense would enhance patient care with real-time alerts and streamlined workflow integration. “Its population health management tools will help target interventions effectively, improving overall health outcomes,” Venkatesh said. “Being free for practices to share data with NQPHN will save costs and allow efficient resource allocation.
“Additionally, its commitment to data security ensures responsible handling of patient information to build trust with patients.”
Primary Sense operates under the clinical oversight of a national Clinical Advisory Group (CAG), which includes as members general practitioners (GPs), clinical specialists, health research academics and representatives of industry peak bodies such as the Royal Australian College of General Practitioners (RACGP) and the Australian Association of Practice Management (AAPM).
Data is one of the key topics to be discussed at the upcoming Digital Health Conference to be held in Melbourne on 7–8 May. For more information or to register, visit this link.
*Number of GPs recording a patient visit in Primary Sense. Data recorded for February 2024. NQPHN.
Featured Products
Keep up with the latest industry innovations
Silicone superabsorbent dressing
Zetuvit Plus, the superabsorbent dressing known for exudate management, now comes with a silicone layer and border — Zetuvit Plus Silicone Border.
Winner of the Red Dot Award Product Design 2024, this next generation silicone superabsorbent dressing improves healing conditions by balancing the wound microclimate and reducing inhibitors to wound healing.
Combining a silicone contact layer and border for atraumatic removal and protection along with a soft superabsorbent core to lock and trap exudate away from the wound, Zetuvit Plus Silicone Border provides protection inside and out while staying in place for up to seven days.
It is easy to apply and available in a range of shapes and sizes to suit a variety of wound types. Benefits include: effective; patient-friendly; and simple to choose, simple to use.
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Hysterectomy rates have fallen by 20% over eight years as women likely opt for less invasive treatments to manage heavy periods, according to the Australian Commission on Safety and Quality in Health Care (ACSQHC).
As against this, there has been a 10% increase in the rate of the less invasive procedure endometrial ablation (removal of the uterus lining using heat), one of several alternatives for treating heavy periods.
Even though one in four Australian women experience significantly heavy periods that can seriously affect their quality of life, the issue can be hidden and there can be shame in talking about menstruation. The condition remains under-recognised and under-treated. Around 50% of women do not
seek medical care1 despite the debilitating impact on daily life, which can be because they don’t know their period is not ‘normal’ or due to the stigma of menstruation, according to the ACSQHC.
An updated Clinical Care Standard
The Commission’s latest national trend data report reveals that more than 24,000 women had a hysterectomy for non-cancer reasons in 2021–22. The report examines two procedures commonly used for heavy menstrual bleeding — hysterectomy and the less invasive option of endometrial ablation2. It indicates geographical areas with the highest and lowest rates, building on earlier findings of the Australian Atlas of Healthcare Variation series.
The Commission has also released an updated Heavy Menstrual Bleeding Clinical Care Standard (2024) to ensure that women with this condition can make an informed choice about the most appropriate treatment for their individual situation.
The updated Standard continues to support greater choice of treatment options and was first developed in 2017 in response to unexplained variation in rates of hysterectomy across Australia.
The new data and revised Standard aim to build understanding of the risks and benefits of treatments for heavy menstrual bleeding, empowering women to make informed choices about their own health care.
One size does not fit all
The findings are positive, but Associate Professor Liz Marles, Clinical Director for the Commission and a GP, said there is a long way to go to ensure that women with heavy menstrual bleeding can access the full range of treatment options.
The data also revealed a rural–urban disparity, with both hysterectomy and endometrial ablation rates higher in regional areas than major cities and remote areas, indicating that some treatments for heavy menstrual bleeding are not being consistently accessed across Australia.
“Every woman should have access to care that is tailored to her needs. Yet we know that women’s concerns about heavy menstrual bleeding can be overlooked and it can be hard to access suitable care. The fact that treatment differs based on where people live suggests there is more work to do,” she said.
“Heavy periods are a hidden problem that a lot of women live with,” Marles said.
“It can be a sensitive topic that some women do not feel comfortable raising with their doctor. The Commission’s work advocates on behalf of these women, many of whom have had their life substantially affected.”
She also said it was concerning that
Australia’s rate of hysterectomy remains significantly higher than comparable OECD countries like New Zealand and the United Kingdom 3, suggesting women who seek help may have a more invasive procedure than is necessary.
Three key outcomes
Marles said the Commission was seeking three important outcomes. “Firstly, we want women to know they don’t have to put up with symptoms, to feel comfortable talking about their periods and to be aware that there are a range of treatments, which don’t necessarily involve a major operation.
“Let’s also upskill the healthcare workforce so women are offered the full suite of treatment options, and practitioners can deliver minimally invasive treatments if appropriate, such as the hormonal IUD.
“Finally, health practitioners need to ask women about their menstrual health and tailor care to individual needs, so they receive the most suitable treatment, which differs for each woman,” she said.
Higher hysterectomy rates among First Nations women emphasised the need for culturally appropriate care, Marles said, with the new Standard offering guidance to help improve equity.
“While some women may choose hysterectomy, we want to avoid them going straight to the most invasive procedure, without being offered less invasive and effective alternatives and
“Heavy periods are a hidden problem that a lot of women live with.”
information on the risks and benefits. Hysterectomy cannot be reversed and has increased risk of complications,” she said.
Impact under-recognised
Professor Kirsten Black, a gynaecologist with the University of Sydney and a member of expert advisory groups for the Standard and the Women’s Health Focus Report, said the impact of heavy menstrual bleeding on a woman’s health and quality of life remains under-recognised.
“It has been great that we have seen a shift towards less invasive gynaecology
procedures since the first Heavy Menstrual Bleeding Clinical Care Standard was introduced in 2017,” she said.
“We know that many women with heavy menstrual bleeding can be successfully managed by their GP or other primary care practitioner using medical treatments like the hormonal IUD.”
Black said it was important to do a proper initial assessment to identify whether there is a specific cause that may need to be addressed and to check for iron deficiency4 and anaemia.
“Healthcare providers need to understand their patient’s menstrual history and whether the bleeding prevents them from going about daily activities and interacting socially. Some women feel they can’t leave the house when they’ve got their period because of fear of excessive bleeding,” she said.
“For women with heavy menstrual bleeding, finding the right treatment has potential to be life-changing.”
Quality of life
Assistant Minister for Health and Aged Care Ged Kearney MP said, “Women’s health has
for too long been overlooked, ignored and dismissed.
“Heavy periods can seriously impact a woman’s quality of life. I know, I have had very personal experience of this, along with one in four women.
“As a former nurse, I implore all women who are concerned to talk to a trusted healthcare provider about menstrual bleeding. You don’t need to suffer in silence, there are many options to get help.”
1. Henry C, Filoche S. Reflections on access to care for heavy menstrual bleeding: Past, present, and in times of the COVID-19 pandemic. International Journal of Gynecology & Obstetrics. 2023 Aug;162 Suppl 2:23-28.
2. ACSQHC. Women’s Health Focus Report 2024. Hysterectomy and endometrial ablation trends at national, state and territory, Primary Health Network and local area level.
3. OECD. Healthcare utilisation: surgical procedures –hysterectomy. [cited 2023 March 14]. In 2019, there were 215 hysterectomies per 100,000 women in Australia, compared with 126 in New Zealand and 132 in the United Kingdom (for cancer and non-cancer diagnoses)
4. Percy L, Mansour D, Fraser I. Iron deficiency and iron deficiency anaemia in women. Best Practice & Research Clinical Obstetrics & Gynaecology. 2017 Apr; 40:55-67
Gender matters: factors that may reduce CVD risk
Monash University-led research, involving artificial intelligence, has identified differences in social factors that may reduce cardiovascular disease (CVD) risk for men and women.
Researchers employed machine learning (ML) algorithms to pinpoint key predictors of CVD from a set of 25 social factors. They found that being married/ partnered or having social support from others was associated with a reduced risk of CVD for men and women.
For men, activities like playing chess or cards, having 3–8 relatives with whom they feel close and can rely on for help, or having 3–8 relatives they are comfortable discussing private matters with was associated with a respective 18, 24 and 30% lower risk of CVD.
For women, living with others (eg, family, friends, relatives) and having at least three friends with whom they can comfortably discuss private matters was associated with a respective 26 and 29% reduced risk of CVD.
The data came from 9936 initially healthy, community-dwelling Australians aged 70 and more, who were followed for an average of six years after enrolling in the ASPREE* project. It used both machine learning, a type of AI, and conventional models, with findings published in the BMJ Journal of Epidemiology & Community Health
Support vs risk
First author Achamyeleh Birhanu Teshale, a PhD candidate from the Monash University School of Public Health and Preventive Medicine, said support from friends and relatives had benefits for reducing the risk of CVD in men and women.
“Notably, our study found that women’s close friendships, particularly those who had developed to the point of comfort in sharing personal matters, was associated with a lower risk of incident CVD,” Teshale said.
“Discussing emotions and receiving support from family and friends offers significant benefits to physical health as well as mental health and wellbeing”
“While for men, having close relatives with whom one can easily seek assistance or discuss personal concerns was linked to a lower incidence of CVD.
“Additionally, men in this study may have engaged more in socialisation through competitive activities like playing games, while women may have preferred to socialise by surrounding themselves with others regardless of what the activities are. These could, in turn, have a positive effect on cardiovascular health.
“Regardless of your age, the evidence for the benefits of close friends and relatives on cardiovascular health is apparent. This phenomenon might be attributed to the positive impact of sharing feelings with family members, friends or neighbours in fostering a sense of wellbeing and connectedness.”
Research has already established that poor social health due to social isolation, loneliness, low social support and social
integration is associated with a higher risk of CVD. However, the role of a broad range of social health indicators has not been studied in relation to CVD risk.
Considering variables
Senior author Dr Rosanne Freak-Poli, from the Monash University School of Clinical Sciences and School of Public Health and Preventive Medicine, said it was the first to consider an extensive array of social factors for men and women, encompassing 25 socialisation variables across five domains.
They included relative and friend support, living arrangement, volunteering or informally helping others, social interaction or engagement, and employment/retirement. Dr Freak-Poli said the results underlined the need for social outlets and government programs that connected people of all ages.
“Discussing emotions and receiving support from family and friends offers significant
benefits to physical health as well as mental health and wellbeing,” she said. “We advise that older adults seek to maintain connections with their loved ones, as well as getting out to join new activities or new groups to find your next best friend.”
Social prescribing
“Research has shown that our friendship groups tend to change every seven years. So making new friends is an important part of life, no matter what your age. Our findings have the potential to complement or strengthen government-supported strategies designed to increase social support for older people.
“For instance, the Australian Government’s Seniors Connected program also pursues to address poor social relationships through initiatives such as the FriendLine (a free national phone support service) and Village Hubs (which offer a variety of member-led social activities like walking groups and social events).
“It may take time to find the right group for you. We advocate for social prescribing, which allows health professionals to prescribe socialising and other activities as part of people’s health. It provides an opportunity for people to be linked with services already in their community to improve wellbeing and quality of life. This way people get assistance with finding a group right for them.”
A Day in the Life of Grace Larson
a paediatric nurse and first aid crusader
05:00 If I am teaching a PALS course for Medcast I generally have to wake up extra early as I live 1.5 hours out of Melbourne so I am out of the house while the sky is still dark and have to watch out for kangaroos as I make my way into the city.
07:30 We set up the equipment for the day, including the mannequins and skills stations, check the AV for didactic presentations.
06:30 Must grab my large latte on the commute as it’s unlikely I will have another chance to grab a coffee today. I am quite addicted to caffeine I’m sorry to say and will get a massive headache if I don’t prioritise this.
08:30 We check the attendees and get them registered for the course.
10:30 Participants have a quick 15-minute morning tea break and along with the other educators I check the set up for the next session.
09:00 Commence the course with a 1.5-hour overview of paediatric resuscitation principals. Ours is a blended course so participants have completed 6 hours of online learning prior to the day. I am just really refreshing this knowledge and allowing for questions or clarification before we begin the skills and assessments.
10:45 We commence the skills stations, usually rotating advanced airway and manual defibrillation. I like to use rapid cycle deliberate practice methods along with practice of microskills (for example, practising getting defibrillation pads on as quickly as possible) during these stations so that participants feel well equipped for the scenarios.
Grace Larson is a Paediatric Intensive Care Nurse by trade with 17 years’ experience in the area, but has recently turned her attention from the reactive support provided in an intensive care unit to more proactive education. Her roles span across three workplaces but the theme underpinning each of those roles is consistent, educating people on how to get good health outcomes for children.
Grace works as a senior nurse educator with Medcast teaching PALS and ALS and developing paediatric content, she is the co-director of PAEDS Education, her own business that provides education and training for children with complex medical needs in the community and she co-founded the charity The Sisterhood Project with her sister Skye — a not-for-profit that provides free first aid courses to parents and carers in underserviced areas. Grace is also a mother to three children under 10 years of age and lives on a small farm in country Victoria.
It’s a real privilege to be able to take the skills and knowledge that I have gained in nearly 20 years as a PICU nurse and be able to channel that into proactive education that is contributing to keeping kids alive and out of PICU. I enjoy the diversity of each role but also how they all contribute towards the same outcome of educating people about children’s health.
12:30 We break for lunch and the educators and I set up the equipment for the scenario team training then quickly eat some lunch with whatever time remains.
13:00 Participants are split into groups of 6-8 people with a mix of medical and nursing and each is given a scenario of a cardiac arrest in a baby or child. They have to work as a team to resuscitate the patient using the algorithm as per the Australian Resuscitation Council. They also demonstrate good non-technical skills as well, such as closed loop communication and avoiding fixation. We run a scenario for each participant that takes about 10 minutes in total.
16:00 Finish up for the day and pack up the equipment, then enter the data from the course into the admin system so the participants can receive their certificates.
17:00 Sit down at my computer to do some admin and business tasks for my own business PAEDS Education, which provides education to parents and carers who have a child with a complex medical need, along with allied health providers, early childhood educators and school teachers. Develop some education modules for a young child with a seizure disorder that requires emergency administration of midazolam.
18:00 Drive back home, hopefully in time to see my three kids and help put them into bed and hear about their day before they go to sleep. Not every day is as massive as this, but I try to make sure I have spent at least some time with them even if it is just to read them a book before bed.
A Day in the Life is a regular column opening the door into the life of a person working in their field of health care. If you would like to share a day in your working life, please write to: hh@wfmedia.com.au
23:00 I try to get to bed before midnight, but the reality is that most nights I don’t. I do think I am someone who has lower sleep needs than the average person, but could definitely improve in this area still.
21:00 Do some work for my charity The Sisterhood Project, replying to emails from groups that are looking to book in free baby and child first aid courses for their clients. We support parents in rural and remote locations, from low socio-demographic backgrounds, and linguistically diverse or First Nations families as children from these backgrounds are more likely to die from preventable accidents and disease. I might also work up a social media post to raise awareness of the inequalities.
Improving
stroke detection
There were an estimated 39,500 stroke events in Australia — more than 100 every day, in 2020. Stroke was recorded as the principal diagnosis in around 67,900 hospitalisations in the country in 2020–21, with the condition being the underlying cause of 8500 deaths (4.9% of all deaths and 20% of cardiovascular disease deaths) in 2021, according to data from the Australian Institute of Health and Welfare (AIHW).
Strokes occur when the blood supply to part of the brain is interrupted or reduced, which prevents brain tissue from getting oxygen and nutrients. A few minutes of delay can result in permanent damage to the brain cells.
With an aim to improve detection and outcomes, a team of biomedical engineers at RMIT University have developed a smartphone face-screening tool that could help paramedics accurately identify stroke in seconds. The research was led by PhD
scholar Guilherme Camargo de Oliveira, from RMIT and São Paulo State University, under the supervision of team leader Professor Dinesh Kumar.
“Early detection of stroke is critical, as prompt treatment can significantly enhance recovery outcomes, reduce the risk of long-term disability and save lives,” said Kumar, from RMIT’s School of Engineering.
“We have developed a simple smartphone tool that paramedics can use to instantly determine whether a patient is post-stroke and then inform the hospital before the ambulance leaves the patient’s house.”
Faster detection
The smartphone tool, which is said to have an accuracy rating of 82% for detecting stroke, would not replace comprehensive clinical diagnostic tests for stroke, but could help identify people needing treatment much sooner.
“Our face-screening tool has a success rate for detecting stroke that compares favourably to paramedics,” Kumar said.
Symptoms of stroke include confusion, partial or complete loss of movement control, speech impairments and diminished facial expressions.
“Studies indicate that nearly 13% of strokes are missed in emergency departments and at community hospitals, while 65% of patients without a documented neurological examination experience undiagnosed stroke,” Kumar said.
“Many times, the signs are very subtle. On top of that, if first responders are working with people who are not their race or gender — most notably women and people of colour — it is more likely that the signs will be missed.
“This rate can be even higher in smaller regional centres. Given that many strokes occur at home and initial care is often provided by first responders in non-ideal conditions, there is an urgent need for realtime, user-friendly diagnostic tools.”
How the technology works
The novel AI-driven technology uses the power of facial expression recognition to detect stroke by analysing facial symmetry and specific muscle movements, known as action units.
The Facial Action Coding System (FACS), initially developed in the 1970s, categorises facial movements by the contraction or relaxation of facial muscles, providing a detailed framework for analysing facial expressions.
“One of the key parameters that affects people with stroke is that their facial muscles typically become unilateral, so one side of the face behaves differently from the other side of the face,” de Oliveira said.
“We’ve got the AI tools and the image processing tools that can detect whether there is any change in the asymmetry of the smile — that is the key to detection in our case.”
Video recordings of facial expression examinations of 14 people with post-stroke and 11 healthy controls were used in this study.
A potential collaboration
The team plan to develop the smartphone tool into an app in collaboration with healthcare providers so that it will be able to detect other neurological conditions that affect facial expressions.
“We want to be as sensitive and specific as possible. We are now working towards an AI tool with additional data and where we are going to be considering other diseases as well,” Kumar said.
“Collaboration with healthcare providers will be crucial to integrate this app into existing emergency response protocols, providing paramedics with an effective means of early stroke detection.”
The study ‘Facial expressions to identify post-stroke: A pilot study’ has been published in Computer Methods and Programs in Biomedicine
PhD scholar Guilherme Camargo de Oliveira (right) demonstrates the face screening tool with Visiting Associate Professor Nemuel Daniel Pah from RMIT University.
Seamus Daniel, RMIT University.
Nurturing skin health through simplified Incontinence-Associated Dermatitis (IAD) care
Did you know up to 20% of people suffering from incontinence develop incontinence-associated dermatitis (IAD)?1 This condition reduces quality of life and increases the risk of severe complications, including a 44% higher likelihood of developing pressure injuries.2 Effective IAD management is crucial, with early detection and streamlined care practices being essential.
Traditionally, managing IAD has required multiple products and significant time investment from caregivers. However, a recent study at Sanctuary Care, one of the UK’s largest care homes with over 250,000 residents, suggests this approach may be unnecessarily complex.3 The study reveals that using 3-in-1 cloths can streamline IAD care, improve skin integrity, and offer substantial cost and time savings. These multifunctional cloths combine cleansing, moisturising, and barrier protection, simplifying the care process by eliminating the need for separate products for each step.
Replacing complex routines and multiple products with this 3-in-1 solution has led to remarkable improvements.
The findings highlight a 55% improvement in skin integrity among residents using these cloths.3 This significantly helps reduce the risk of further complications, improving the quality of life for individuals with IAD.
In addition to the health benefits, the study reports cost savings of up to 40%.3 For care homes operating on tight budgets, these savings can be redirected towards other essential services and improvements. The reduction in the number of products required also means less storage space is needed, further contributing to operational efficiency. Moreover, the time saved by using 3-in-1 cloths is considerable. The study estimates a reduction in time by 34 minutes per patient/resident, per day,4 equivalent to the workload of one full-time carer per home per year.3 This is a significant finding, as it helps in part to address the chronic
issue of staffing shortage. By freeing up carers’ time, homes can ensure better overall care and attention for their residents.
This study shows that multiple products are not necessary to manage IAD effectively. The use of 3-in-1 cloths offers a simplified, cost-effective, and efficient approach to care, improving both residents’ lives and care homes’ operational dynamics. Early detection and streamlined management practices are vital in preventing IAD from worsening. This solution represents a significant step forward in the care of individuals with IAD.
Contiplan combines all three essential skincare steps to effectively prevent and support the management of IAD. In addition to its practical benefits, using Contiplan can lead to a more dignified experience for patients and residents, as they receive comprehensive care through a simplified process. This holistic approach not only addresses physical health but also promotes emotional well-being by reducing the discomfort and stigma associated with incontinence care.
Experts recommend using 3-in-1 cloths to prevent IAD due to their superior bene�its. Contiplan by Clinell supports this recommendation by providing:
• Superior Moisturisation: The cloths penetrate deeply to improve hydration and strengthen the skin’s barrier.
• Advanced Barrier Protection: They deliver a 10% protective barrier for superior protection against moisture and irritants.
To download free IAD best practice resources or to request a free 2 week Contiplan evaluation*, scan the QR code or visit http:// www.gamahealthcare.com. au/preventIAD
Additionally, watch the short webinar on Prevention and Early Intervention of Incontinence-Associated Dermatitis (IAD).
* For Australian facilities only. GAMA Healthcare’s free evaluation is available for a limited time for assessing one client in a single facility. This offer is subject to our discretion.
1. Kayser SA, Phipps L, VanGilder CA, Lachenbruch C. Examining Prevalence and Risk Factors of Incontinence-Associated Dermatitis Using the International Pressure Ulcer Prevalence Survey. J Wound Ostomy Continence Nurs. 2019;46(4):285-290. https://pubmed.ncbi.nlm.nih.gov/31276451/ 2. Demarre, L., Verhaeghe, S., Van Hecke, A., Clays, E., Grypdonck, M., & Beeckman, D. (2014). Factors predicting the development of pressure ulcers in an at-risk population who receive standardized preventive care: secondary analyses of a multicentre randomised controlled trial. Journal of Advanced Nursing, 71(2), 391–403 https://onlinelibrary.wiley.com/doi/10.1111/jan.12497 3. Chitura M, Wares KD, Saviolaki G. Nurturing skin health through simplified incontinence-associated dermatitis (IAD) care. EWMA Conference 2024; May, 2024; London. 4. Ousey, K., O’Connor, L., Doughty, D., Hill, R., & Woo, K. (2023). IAD made easy. Wounds International. https://woundsinternational.com/wp-content/uploads/sites/8/2023/02/a83af36c7505b2eede34a0a59ee118cb.pdf
» For more information visit www.gamahealthcare.com.au
Tackling psychotropic medicines harm
Prescriptions for psychotropic medicines for all Australians have increased by a staggering 60% over the past three decades1
Older people are particularly susceptible to adverse effects from psychotropic medicines, including worsening cognition and an increased risk of falls, stroke and death.
While an increased awareness of the risks associated with using these medicines has led to a slight decline in antipsychotic prescriptions among older Australians2, significant challenges persist.
To tackle these challenges, the Australian Commission on Safety and Quality in Health Care (the Commission) has introduced a national standard to improve the care of people with cognitive disability or impairment.
The Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care
Standard outlines clear actions to ensure the responsible and appropriate use of psychotropic medicines, representing a significant step towards ensuring safer, more effective treatment practices.
In Australia, aged care residents have a 22% higher risk of death in the first 100 days when antipsychotics3, a commonly used type of psychotropic medicine, are prescribed. Around a third of people with intellectual disability are prescribed psychotropic medicines and are exposed to potential shortand long-term adverse effects.
While psychotropic medicines play an important role in treating mental health conditions, they are also commonly used to manage behaviours of concern experienced by people with cognitive disability or impairment. This is despite the known harms of these medicines and the lack of evidence that they are effective for managing behaviours, which may include aggression, agitation and sometimes self-harm.
Non-medication interventions
The standard aims to curb the inappropriate use of psychotropic medicines and promote patient safety. It highlights the importance of non-medication interventions as the primary method for addressing behaviours of concern, with psychotropic medicines reserved as a last resort option when other strategies have failed, or there is a high risk of harm to the person or others.
Importantly, non-medication strategies should be designed around the person’s individual needs and expressed wishes, and in consultation with family and others the person has agreed should be involved in their care.
The Royal Commission into Aged Care Quality and Safety and the Royal Commission into Violence, Abuse, Neglect and Exploitation of People with Disability revealed concerning trends in psychotropic medicines misuse and overuse in the aged care and disability sectors.
Risks and benefits
Conjoint Associate Professor Carolyn Hullick, Chief Medical Officer at the Commission and Emergency Physician in Hunter New England Health NSW, emphasised the significance of this standard, which is a long-overdue recognition of the rights of people with cognitive impairment to safe and effective treatment options.
“From my perspective, I think it’s essential for prescribers and clinicians to be mindful of the way they’re using psychotropic medicines because of their risks and liamited benefits for people with behaviours of concern. Psychotropic medicines do have a place, but it is imperative that we use them judiciously and with a clear understanding of their purpose,” she said.
Professor Julian Trollor, Director of the National Centre of Excellence in Intellectual
Disability at the University of New South Wales Sydney, advocates for greater support for prescribing practices for people with intellectual disability.
“When prescribing these medicines, it’s essential to have clear objectives and ways to measure their impact, including by collaborating with behaviour support practitioners to ensure that your prescribing has the intended response,” he said.
Regular reviews
Juanita Breen, an Affiliate Associate Professor and a credentialed pharmacist specialising in dementia research at the University of Tasmania, explained the importance of monitoring and evaluating prescribing practices. “Clinicians and doctors should regularly review medicines to ensure their effectiveness and be mindful of potential side effects. We should always be asking: Could this medicine dose be reduced? Can
we improve these symptoms through nonmedicine approaches?” Breen said.
When people with intellectual disability or impairment receive care in different settings, this can result in a disjointed and inconsistent experience, which can be very difficult to navigate. Effective communication during transitions of care and support for decision-making processes is essential to upholding patient autonomy and safety so that medicines and other strategies are used consistently wherever the person is treated.
The standard applies to all healthcare services provided to people of all ages with cognitive disability or impairment and is relevant in any setting where they receive care, including hospitals, aged care facilities and the community.
Information sharing
Professor Eddy Strivens, Geriatrician and Clinical Director, Cairns and Hinterland
“The standard applies to all healthcare services provided to people of all ages with cognitive disability or impairment.”
Hospital and Health Service, emphasised the need for coordinated efforts. “This is a supportive standard for prescribers and clinicians. It provides practical information, encourages sharing information across care settings and will help ensure that these agents are used least and last, rather than first and foremost.”
In March 2022, the Commission joined with the Aged Care Quality and Safety Commission and the NDIS Quality and Safeguards Commission to release a joint statement on the inappropriate use of psychotropics to manage the behaviours of people with disability and older people.
The joint statement highlighted the detrimental impact of the inappropriate use of psychotropic medicines for older people and people with disability. The release of this standard joins other efforts to improve the safety and quality of health care, aged care and disability support for all Australians.
The Psychotropic Medicines in Cognitive Disability or Impairment Clinical Care Standard and resources are available at safetyandquality.gov.au/psychotropics-ccs.
1. AIHW
2. ACSQHC
3. Harrison et al. Aging Clin Exp Res 2021
Speeding up wound healing
Around 20,000 Australians with diabetesrelated foot ulcers could benefit from a new project trialling a supervised exercise program to speed up wound healing.
University of South Australia nursing lecturer Dr Lisa Matricciani will lead a $713,532 federal government project to test this hypothesis in a 12-week trial involving the Central Adelaide Local Health Network (CALHN).
Contrary to concerns that movement will delay or impair wound healing, there is emerging evidence that gentle physical activity does the opposite by increasing blood flow to the ulcer and promoting healing.
“Diabetes is a serious health concern in Australia, affecting more than one million people, 30% of whom will develop a foot ulcer in their lifetime,” Matricciani said.
“A combination of obesity and lack of exercise is expected to drive that number upwards in coming decades, contributing to a staggering $14.6 billion health bill in Australia.
“Unfortunately, the evidence we have gathered to date shows that people with diabetic foot wounds are alarmingly inactive, and this is not helping their recovery.”
Matricciani said both clinicians and patients need more evidence to understand how effective exercise can be, addressing any concerns they may have that physical activity could impede wound healing.
Partnering with CALHN, Matricciani and UniSA colleagues will develop a supervised exercise program for people with a diabetes-related foot ulcer, using artificial intelligence and inshoe sensors to assess wound healing over a 12-week period.
Blood glucose levels and wellbeing will also be tracked among the participants and compared with a control group who will not undertake any exercise.
“We are keen to see the effect of a supervised, appropriately prescribed exercise program on people with diabetes.
“Diabetes-related foot wounds are one of the most costly and debilitating complications of diabetes, requiring months to heal and often accompanied by a decline in health. We are confident this trial will provide important insight towards an innovative solution to a growing health problem in Australia.”
The project is among Medical Research Future Fund grants announced recently to tackle diabetes and cardiovascular disease.
Wound care is an incredibly exciting, ever-evolving area of health care. As the national peak body, Wounds Australia represents wound care professionals in the country; the clinicians, researchers and corporate partners who drive innovation in best practice.
Much of this work has been formally acknowledged by the Australian Government in the form of grant funding. One of our industry partners, Visionflex, for example, was recently awarded a prestigious Game Changer Grant of almost $1.5m by the Hunter New England and Central Coast Primary Health Network to develop a pioneering telehealth tool that will enable remote wound assessment.
The tool — the high-quality GEIS camera combined with a real-time video call facility — promises to enhance wound care delivery in Australia’s health sector, in particular in the rural and remote communities we know are disadvantaged by ‘the tyranny of distance’. Visionflex is working closely with Wounds Australia and with wound clinician Hayley Ryan, in her capacity as the principal of independent wound care company WoundRescue. We believe this important initiative offers a
Driving innovation in wound care
Jeff Antcliff*, Chief Executive, Wounds Australia
potentially transformative shift in wound management around the country.
Long-time Wounds Australia member Associate Professor Dr Michelle BarakatJohnson of Sydney University is leading a team of researchers in developing the Digital Model of Wound Care. Supported by a $1.5m Partnership Grant from the National Health and Medical Research Council (NHMRC), the team is working closely with metropolitan, regional and remote partners to test, evaluate and disseminate an evidence-based and cost-effective digital care delivery system. It’s thrilling work that we’re proud to support.
These projects are just the tip of the iceberg, announcements made in the last three months alone. Many other exciting initiatives are in the works to improve wound assessment and management.
As our Wound Awareness Week Ambassador, burns surgeon and ‘Australian living treasure’ Professor Fiona Wood AO, said in a recent webinar for our members, communication and knowledge-sharing are crucial to improving best practice.
Wound care researchers, clinicians and industry partners converge biennially at the Wounds Australia Conference, which will be held in 2024 on the Gold Coast, 14–16 October. It’s a chance to share insights, challenge current thinking, explore the
research and engage with other frontline professionals working in hospitals and throughout the Australian healthcare system. Innovation features heavily in our program and touches every area of wound care: education, diagnosis and management, patient shared care, and more.
*Jeff Antcliff has extensive experience in the commercial and the not-for-profit sector in developing strategy and driving commercial growth. His previous senior executive roles have included the St Vincent de Paul Society, Victoria, where he led the commercial and fundraising operations, Sigma Health Care and Specsavers Australasia.
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The Camfil CamSafe 3 housing units are customisable, available as single modules or multi-module systems based on the required filtration stages and air volume.
Thermostatic mixing valves
The Galvin CliniMix range of thermostatic mixing valves (TMVs), powered by RMC Reliance Valves, is manufactured with Australian-made and lead-free materials, providing quality products that are suitable for the local market and comply with NCC 2022 Lead Free requirements.
Key features include: temperature precision — the valves offer control over water temperature, minimising the risk of scalding and cold water shock by delivering tempered water to designated outlets; adhering to Australian Standards, these valves are designed to provide consistent protection for the most vulnerable in high-risk, high-care settings; versatility — the range includes a variety of TMVs to suit different needs, from traditional cabinet models to compact mini options for space-efficient installations; the valves are designed to offer flexibility without compromising performance; reliable operation — designed for low-pressure systems; the CliniMix TMVs are said to operate reliably even at pressures as low as 20 kPA — with a temperature stability of ±2°, these valves offer consistent performance despite fluctuations in water pressure and temperature.
The valves can be installed in various configurations, with adjustable inlet connections to accommodate different pipework orientations. Whether horizontal or vertical, the valves adapt seamlessly to diverse installation requirements.
CamSafe is a modular and highly adaptable product line tailored for the exhaust of contaminated air in various containment applications such as biosafety levels L1 to L3+, safety laboratories, pharmaceutical and chemical industries, hospitals and animal facilities.
Equipped with a wide selection of particulate or molecular filters, the CamSafe housing features a patented clamping mechanism with a single-action lever and a double safety feature to facilitate precise filter positioning and gasket compression. The inclusion of a service bag collar enables contamination-free BIBO filter changes, providing safe replacement of each individual filter.
CamSafe has undergone rigorous testing at ±6000 Pa, meeting all relevant international standards for air tightness, including EUROVENT 2/2:Class C, EN1886: Class L1, ISO 10648-2: Class 3 and EN 12237:Class D.
For in situ testing support, the system offers a Manual Integrity Probe (MIP) scan within the filter housing and the option to integrate a ducted injection module into the configuration. This design aims to offer reliable and effective filter testing with qualified leak detection capabilities using reduced aerosol quantities.
Additional configuration options include a comprehensive range of collectors, supports, bubble-tight dampers, decontamination features and more. Products within the CamSafe family are highly customisable and can be tailored to meet specific requirements, offering additional features, functions, custom finishes, unique formats and seamless integration.
Contact your Camfil representative for customised solutions or visit camfil.com for more information.
Camfil Australia Pty Ltd www.camfil.com.au
Workforce management solutions
Humanforce is a global provider of an employee-centred, intelligent and compliant human capital management (HCM) suite for frontline and flexible workforces, comprising of Workforce Management (WFM), intelliHR, Payroll and Thrive Wellbeing.
The HCM suite is said to be fully integrated, composable and configurable to suit each organisation’s unique needs. It is designed for mid- to large-sized organisations that seek secure and robust cloud-based solutions for managing complex workforces, and serves people managers with the tools they need, including onboarding, rostering and scheduling, time and attendance, endto-end payroll, award interpretation, performance management, employee engagement, and financial wellbeing perks and benefits.
Employers can also use the comprehensive workforce analytics, intelligent AI-driven people analytics and reporting functions to optimise labour usage, enhance compliance, and improve overall business performance. Additionally, employees and managers can stay connected and gain access to everything they need to work effectively on-the-go with the Humanforce mobile app. Humanforce www.humanforce.com
Advanced pharmacy is not revolutionary,
it’s evolutionary
As the most common healthcare intervention, medicines are crucial to all aspects of Australians’ health.
Medicines prevent and mitigate sickness, make stays in hospital shorter and more comfortable, expedite recovery and support lifelong wellbeing for those living with a range of chronic diseases.
But medicines are complex, costly to supply and procure, and even costlier when mismanaged.
The unique skill and expertise of pharmacy professionals is essential to maximise the positive benefits of this crucial frontline care.
Over the past few months, members of the Society of Hospital Pharmacists of Australia (SHPA) have been engaged in consultation to ensure our inclusive and evolving identity and mission meets the future needs of Australian patients, carers and consumers within our future healthcare system.
We know there are challenges — too many Australians are being hospitalised and harmed each year for preventable, medicines-related issues. Medicines are increasingly complex and being taken more regularly by more people as the population ages.
What we have proposed to our members and the broader industry is a future-state for the profession achievable through ‘advanced pharmacy’.
Advanced pharmacy facilitates the evidence-based pillars of hospital pharmacy — including specialty roles in collaborative,
team-based care; deprescribing; and pharmacist-led stewardship programs — outside the four walls of the hospital. It reimagines the boundaries of Australian pharmacy to effect meaningful change, ensuring specialty pharmacy expertise can be fully harnessed for the benefit of patients everywhere.
Advanced pharmacy is not a revolutionary concept, it is evolutionary and, in fact, has a strong history here in Australia.
The Advanced Pharmacy Practice Framework was released in 2012, endorsed by the Pharmacy Board of Australia, defining scope of practice and prerequisite competencies for Australian practitioners to assist the development of the profession to meet the changing healthcare needs of the community.
This framework was subsequently embedded into national pharmacy competency standards and formed the academic basis of the Australian and New Zealand College of Advanced Pharmacy (ANZCAP) launched last year.
At a time when we need professionals working at the top of their scope of practice, advanced pharmacy recognises the skills, knowledge and experience of the professionals our organisation has always represented — pharmacists and technicians practising as part of multidisciplinary teams to deliver best practice medicines management to patients around the country, within and beyond hospital settings.
We are seeing see this in our profession already through the GP pharmacists working alongside our medical colleagues to reduce waiting times and improve timely access to medicines for patients...
Through Aged Care On-Site Pharmacists who work with the healthcare team to improve medication use including safe and appropriate use of high-risk medicines for some of our most vulnerable patients...
And through pharmacist-led prescribing models such as partnered pharmacist medication charting (PPMC), which has proven to reduce medication errors, length of stay and hospital costs for our patients who are at their most unwell.
The role of pharmacists in delivering a strong and resilient healthcare model has never been more important than it is today.
We believe advanced pharmacy is the conduit to a better future-state for pharmacy in Australia...
A workforce that is more inclusive, connected and collaborative...
A health system in which pharmacists and technicians are fully integrated into interdisciplinary care teams, where their medicines expertise is indispensable... And most importantly, a pharmacy profession that meets the needs of each Australian, regardless of their place, their care setting or vulnerabilities.
Tom Simpson, President, SHPA
Where Australia stands in reducing harm from illicit drugs
Federal and state governments are spending more on law enforcement in illicit drug policy compared to treatment, prevention and harm reduction combined, reveals a new report from UNSW Sydney.
The report highlights that governments spent approximately $5.45 billion in the 2021/2022 financial year on illicit drug countermeasures — of this, nearly 65% ($3.5 billion) went to law enforcement programs, including $1.8 billion on routine policing against drugs.
As against this, less than 2% ($90 million) was spent on harm reduction measures such as needle syringe programs and supervised injecting facilities, according to the report.
“Governments do invest a significant amount of money on proactive drug policy, and
where they spend that money shows what they consider as important in responding to drugs,” said Professor Alison Ritter AO, lead author and drug policy specialist at the Social Policy Research Centre, UNSW Arts, Design & Architecture.
“This research provides the foundation for evaluating the investment and whether Australia is on the right path to reducing drug-related harm.”
Chronic underinvestment?
Dr Annie Madden AO, Executive Director of Harm Reduction Australia (HRA), said the report reveals the true extent of governments’ chronic underinvestment in harm reduction.
“Australian governments have continued to claim their position as a global leader in
harm reduction over many decades. In this case, however, the evidence does not lie,” Madden said.
“We know that frontline harm reduction services such as needle and syringe programs, opioid treatment, take-home naloxone, drug consumption rooms and drug checking services reduce potential harms including drug-related deaths.
“The fact that harm reduction spending has continued to decline in the face of unprecedented evidence of impact and effectiveness is deeply concerning for many reasons, not the least of which is the undeniable fact that harm reduction saves lives.”
The UNSW’s Australian ‘drug budget’: Government drug policy expenditure 2021/22
report estimates spending on proactive responses to illicit drugs by governments across Australia.
The proportion spent on prevention, such as in-school education programs, slightly decreased since the last report in 2009/10, down from 9.5% to 6.7% in 2021/22. Spending on harm reduction also decreased from 2.2% to just 1.6%, and that on drug treatment services rose from 22.0% to 27.4%.
State and territory governments spent the most against illicit drugs, accounting for 76% or $4.11 billion of the total proactive expenditure, the majority of which ($2.87 billion) was for state law enforcement.
“The lion’s share of the investment is from state governments and continues to be in law
enforcement, and that’s related to the policing of drugs, which we know is an expensive activity,” Ritter said.
“At the same time, the amount that’s invested in helping people who are experiencing problems with illicit drugs is significantly less as a proportion of spending.”
Illicit drug use is a significant health, social and economic issue for Australia, with the latest National Drug Strategy Household Survey 22/23 population survey showing a small increase last year in use, Ritter said. There has also been a noticeable shift in the types of illicit drugs being used, including crystal methamphetamine and hallucinogens.
Need for evidence-based prevention initiatives
Dr Erin Lalor AM, CEO of Alcohol and Drug Foundation, said despite efforts from law enforcement, there’s been a concerning increase in the number of Australians experiencing drug-related harms, such as hospitalisations and fatal overdoses. She says prevention is a crucial part of a comprehensive approach needed to reduce the impact of drug-related harms, particularly among young people.
“The number of drug-induced deaths in Australia is unacceptably high and has sadly been increasing since 2006,” Lalor said.
“These heartbreaking deaths are mostly preventable and have a ripple effect on the community, with friends and families suffering.
“We need increased, long-term funding commitments for evidence-based prevention initiatives that reduce risk factors for harmful illicit drug use and boost protective factors, as well as targeted education campaigns in populations at greater risk of harm and those that address stigma,” Lalor said.
While the total amount spent by governments against illicit drugs more than tripled from the last report in 2009/10 ($1.7 billion), the 2021/2022 estimate represents just 0.63% of all government spending, down from 0.80% in the last report.
“These figures suggest that despite a significant increase in proactive government spending on drugs since the last report, this reflects overall growth in government spending and not growth in spending on drug countermeasures,” Ritter said.
“However, what’s striking is that despite the percentage reduction in proactive expenditure, there hasn’t been any significant shift in the proportion of investment amongst the four domains of drug policy.”
Impact on service providers
Dr Robert Stirling, CEO of the Network of Alcohol and other Drugs Agencies (NADA), the peak body for NGO AOD service providers in NSW, said services on the frontline are suffering from the lack of growth in investment.
“We have a noticeable, growing unmet demand for services in the sector from underfunding, demonstrated by increasing
wait times for treatment and workforce shortages from a lack of secure working conditions,” Stirling said.
“At the NSW level, money for treatment has predominantly been spent on new services rather than investing in existing services to ensure they can deliver quality services and create healthy workplaces and conditions.
“Meanwhile, at the Commonwealth level, funding has been going backwards, leaving services struggling to retain staff and needing to reduce services to communities.”
Emma Maiden, General Manager of Advocacy and External Relations for Uniting NSW.ACT, said governments should consider removing criminal penalties and redirect funding towards the other pillars of drug policy.
“To see that the largest expenditure in the latest Australian ‘drug budget’ is once again directed to law enforcement, and how that spending monsters what is spent on drug treatment, prevention and harm reduction programs, is of great concern,” Maiden said.
“We need our governments to have the courage to take action and invest the lion’s share of our drug budget in the things we know will make a difference.”
Assessing effectiveness
The report, Ritter said, does not assess the effectiveness of the investment across domains, and the relative value of the estimates is more important than any absolute value.
“There is no line item in government expenditure estimates that explicitly lays out how much they spend on illicit drugs,” Ritter said.
“So, there are some assumptions behind every figure, which we have accounted for in our sensitivity analysis.”
The latest National Drug Strategy Household Survey also shows Australians want roughly equal investment across education, treatment and law enforcement in illicit drug policy.
“Most people, on average, want governments to spend equal amounts on policing, treatment and prevention,” Ritter said.
“So, the current investment mix does not necessarily match how most Australians would prefer governments to allocate funding across the domains of drug policy.”
Professor Alison Ritter. UNSW Sydney.
In Conversation
...with AEHRC’s Dr David Hansen
Amy Sarcevic
Of all the innovations across CSIRO’s digital health portfolio, there is one which stands out to Dr David Hansen, CEO of CSIRO’s Australian e-health research centre (AEHRC), when picturing our technology-led future.
“Artificial intelligence,” he told Hospital + Healthcare in a heartbeat.
“Of course, it’s been around for decades now, but we are finally at the point where it’s crossing the invisible line between something peripheral that only nerds (like myself) are interested in, to something which appeals to people without a technical background.
“The opportunities are flowing and we are on the cusp of something great with it.”
Improving health
Hansen, of all people, would know, having just overseen the new ‘AI trends in healthcare report’.
The report shines a spotlight on CSIRO’s health AI research portfolio and foretells the impact AI will make on the health of Australians.
meaningful conclusions from — as it comes from different cognitive tests and scales.
“Thanks to my colleague Rosita Shishegar and her team, we have harmonised this data using an AI-based method and created the largest dataset of Alzheimer’s disease in the world.
“This will help us make accurate predictions about a disease that has been notoriously hard to understand.”
“One of the things we are most excited about is how our AI research is making a difference in healthcare and medical research, including dementia — Australia’s second leading cause of death.
“For example, one of our teams is solving the problem of the torrents of data from patients with Alzheimer’s disease which, until now, has been hard to bring together and draw
Reducing burnout
The AI Trends in Healthcare report also gives hope to clinicians who may be facing burnout from overwork.
In recent years, a surge in demand for healthcare services, along with acute workforce shortages, have place added burden on clinicians, who are 9% more likely to suffer burnout than the general population.
“We think we can use AI to ease the administrative burden for clinicians and help them work at the top of their profession.
“It will relieve them of tasks they likely find repetitive and stressful, like processing large amounts of data, and leave them with more meaningful tasks which they excel at — like connection and holistic thinking.
“Ultimately, it will help them get more joy and pride from their work.”
Abating public concern
Hansen’s optimism around AI may be warranted, but it appears to contrast public opinion.
A survey conducted this year found that 80% of Australians are concerned about catastrophic risks from advanced AI systems, and believe these risks are on par with pandemics and nuclear war.
Among the fears around its use in health care are inaccurate diagnoses and treatments, and heightened privacy risks.
For clinicians, there are also concerns around the lack of compatibility between different AI-based technologies, which can interfere with workflow.
Hansen said these concerns are on his radar, but believes many are fading as the technology advances. As lead of Australia’s national digital health research program, his job is to ensure tools being developed at AEHRC are fit for purpose.
“It’s up to us to make sure AI is high quality, ethical and meeting the requirements of the healthcare system — including the needs of both patients and clinicians.
“Thankfully, we are in a position now where we have enough data and cloud computing power that we can do machine learning with
meaningful impact. And by that I mean supporting clinicians to make even more wellinformed decisions more efficiently or give really accurate predictions.
“Many of the risks people are concerned about are diminishing year by year.”
Staying at the forefront
While Hansen admits AI is far from reaching its potential in health care, he said his team is working tirelessly to ensure it does.
At times, this has meant long hours and restless nights.
“We have some big projects with big deliverables for federal and state agencies. Meeting those, whilst keeping abreast with the pace of change, and staying at the forefront of digital health research, is no small task. But it’s one we are deeply committed to.”
Despite more than two decades in his profession, Hansen consistently credits his team for CSIRO’s world-class research portfolio and track record in delivering value. According to a recent analysis, every $1 invested in CSIRO generates at least $8.40 in value for the country.
“I work with some incredible scientists and if I had to pinpoint one success factor, it would be them. We all care profoundly about our work and share a vision for a technologyenabled healthcare system.”
Alongside project deliverables, a key measure of success for Hansen will be when public optimism around AI replaces scepticism.
“An AI-based healthcare system that everyday Australians are comfortable to embrace will be the ultimate legacy,” he concluded.
Childbirth coping strategies — time for change?
New research is challenging traditional categorisations of coping strategies in a bid to promote autonomy and create empowering childbirth experiences that are aligned to women’s individual preferences and values.
A proposed framework by La Trobe University’s Judith Lumley Centre, in the School of Nursing and Midwifery, comes amid growing concerns about birth trauma and maternity care experiences that were highlighted in the final report of the New South Wales Parliamentary Inquiry into Birth Trauma, handed down in late May.
Researchers examined the current pharmacological and non-pharmacological grouping of strategies, with the findings suggesting a shift towards a more holistic approach where medication is viewed as one of several supportive tools for coping during childbirth.
Women’s perspectives
Dr Laura Whitburn, senior researcher and study lead, with long-term collaborator and senior researcher Dr Lester Jones and lead author Janine Shifman, a physiotherapist and birth doula, have proposed reframing coping strategies as ‘intrinsic’ and ‘extrinsic’ to better reflect women’s perspectives and shift the focus away from medical interventions.
Intrinsic strategies are those that can be self-generated by women, while extrinsic strategies require the use of equipment or the help of someone else.
“The current framing immediately assumes that pharmacology is going to be the main solution in helping a woman when she feels she is not coping,” Whitburn said.
“We know that for some women, pharmacological pain relief is important and effective; however, by introducing the concepts of intrinsic and extrinsic, we’re turning the focus back to women and their sense of autonomy throughout the process.”
Factors most important to women
The study surveyed 56 women in late pregnancy, between February and May 2021, having their first baby at Mercy Hospital for Women: one of Victoria’s largest tertiary maternity hospitals.
Thinking about labour pain as productive and purposeful pain, feeling safe and supported,
and preparing a range of coping strategies to help manage were identified as three factors most important to women.
“People may assume that pain relief or having their pain under control during labour is a priority but, in fact, it wasn’t explicitly listed among the most important factors to women,” Whitburn said.
“What mattered was feeling supported and safe, thinking positively about the process and feeling well prepared.”
Intrinsic strategies
The most common intrinsic strategies identified by respondents included breathing techniques, generating a positive mindset, as well as movement and keeping active.
“Thinking positively, reminder that we are not alone in the experience, excitement of meeting my baby,” said a study participant.
“Mindset, staying calm. Understanding that it’s a completely natural and normal process. I just have to let my body do what it knows how
to do and get my mind out of the way,” said another study participant.
Extrinsic strategies
Extrinsic strategies, such as using a bath or shower, the use of a TENS machine or having physical contact from support people or a known support person, were recorded as the most common among respondents.
“Relying on my partner and knowing he will be my spokesperson if I can’t cope well. Trusting that I’m in a safe space, surrounded by experts who can help if things go wrong,” said a study participant.
All women in the study planned to use a combination of intrinsic and extrinsic strategies, acknowledging that coping with labour would, at various points, involve both self-trust and autonomy, as well as external support.
“The intention is not to reject or stigmatise the use of pharmacological options, such as an epidural, but to present them as one component of a suite of extrinsic options available,” Shifman said.
“We recognise a range of extrinsic options may help to re-centre a woman’s focus and enable her to re-engage with the intrinsic strategies as her labour progresses.”
It is hoped that reframing coping strategies will encourage healthcare providers to prioritise women’s autonomy and enhance their birthing experience, rather than being framed by medical intervention.
“We’re hoping this will change the conversation and mindset from ‘you’re not coping anymore, so let me take over’ to ‘you’re not coping anymore, so let’s support you with what you need to get you back on track’,” Shifman said.
