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HealthSpeak
issue 16 • August 2016
THE VOICE FOR HEALTH PROFESSIONALS – FROM TWEED TO PORT MACQUARIE
MAKING
DIGITAL
HEALTH
WORK
FOR YOU
page 15
7
NCPHN Lead
Site for mental
health
Immunisation
10 news
Aged care
25 update
What is
29 Feldenkrais?
New Health & LIfestyle section
Head Office
106-108 Tamar Street
Ballina 2478
Ph: 6618 5400
CEO: Vahid Saberi
Email: [email protected]
Hastings Macleay
53 Lord Street
Port Macquarie 2444
Ph: 6583 3600
Cnr Forth and Yaelwood Sts
Kempsey 2440
Mid North Coast
6/1 Duke Street
Coffs Harbour 2450
Ph: 6659 1800
editor
Janet
Grist
W
elcome to the August
issue of HealthSpeak
with a special feature on getting
to grips with MyHealth Record
Tweed Valley
145 Wharf St, Tweed Heads 2486
Phone: 07 5589 0500
Contacts
Editor: Janet Grist
Ph: 6627 3300
Clinical Editor: Andrew Binns
Design and illustrations:
Graphiti Design Studio
Display and classified advertising at
attractive rates
HealthSpeak is published three
times a year by North Coast Primary
Health Network. Articles appearing
in HealthSpeak do not necessarily
reflect the views of the NCPHN. The
NCPHN accepts no responsibility
for the accuracy of any information,
advertisements, or opinions contained
in this magazine. Readers should
rely on their own enquiries and
independent professional opinions
when making any decisions in relation
to their own interests, rights and
obligations.
©Copyright 2016
North Coast Primary Health Network
Magazine designed by
Graphiti Design Studio
www.gdstudio.com.au
Printed by Quality Plus Printers
HealthSpeak
is kindly
supported by
2
Dr Chris Ingall turns his pen to
the topic of coffee.
And Clinical Editor Dr Andrew Binns shares his knowledge
about the benefits of high intensity interval training – I’ve heard
he can be spied climbing the
stairs near his work for his high
intensity workouts at lunchtime.
Suggestions for topics for our
new section are welcome, and if
you’d like to submit an article, I’d
love to hear from you!
The Long and Winding Road
Northern Rivers
Tarmons House 20 Dalley Street
Lismore 2480
Ph: 6627 3300
Health
Speak
in your practice and an update on
aged care.
Also in this issue, we have a
new four-page section at the
back of the magazine devoted to
Health & Lifestyle. In our first
spread, we have an informative
article from Anna Huddy of
the Health Promotions Unit at
NNSWLHD about those high
caffeine, sugar loaded ‘energy’
drinks kids are often seen consuming and the impact on health.
ceo
Vahid
Saberi
R
ecently I had breakfast
with Mr Chris Crawford,
the just retired long-standing
Chief Executive of the Northern NSW Local Health District.
In the course of our conversation about health care home,
I highlighted the importance
of bilateral (NSW State and
Commonwealth) agreement
to implement integrated care
and “bend the curve” on health
costs – which I thought was
pertinent. Chris reacted to this
in an animated manner, unlike
his usual calm and steady style.
He commented that this is
looking at the issue from the
treasury lens. “We should not
make the argument about good
health care a financial one. The
value should be about providing the right care at the right
place. If good care is provided,
where it should be provided,
the system will improve and
the cost curve will bend as the
result.” I found Chris’s observation instructive and insightful.
It is true that somehow this
discussion often lands in the
finance terrain and becomes
about reducing costs rather
than improving care.
Talking about better health
care, the concept and strategy of
Health Care Home, aka Medical Home, has gained quite a
bit of media attention and no
doubt will be headline for many
symposiums and conferences in
the coming months.
The Commonwealth in
response to the recommendations from the Primary
Health Care Advisory Group
is trialling the Health Care
Home pilot. The intention is to
trial a payment methodology
that incentivises caring for the
whole patient which the current
fee for service MBS payment
methodology does not encourage or incentivise. The pilot
will be implemented in seven,
yet to be announced, Primary
Health Care regions. The target
population is those over the age
of 45with two or more chronic
conditions. Stage one of trials,
commencing on 1 July 2017,
will include 200 general practices and 65,000 patients. The
patient enrolment is voluntary
and the patient will choose the
clinician to coordinate their
care. This is an important trial
and the Government should
be congratulated. Payment arrangements do influence care.
Where the payment rewards
fragmented episodes of care –
that is what will be delivered.
At the same time, it is also
important to recognise that the
a publication of North Coast Primary Health Network
Commonwealth trial only targets one dimension of a multidimensional task. Transforming
the healthcare system is a major
change management process
that requires action on many
fronts, time, and a shift from
rewarding volume and throughput to rewarding value and
outcomes (from the patient’s
perspective).
The objective of the Health
Care Home is transformation
of the health care system to one
that is person-centred, joinedup and delivers accessible, equitable, high quality, integrated
care. Dr Tony Lembke sums it
up this way – “In a person centred health system, each person
and their family can access the
care team that they need, that
team is of high quality, and care
is experienced as 'joined up’”.
This team is their care home,
they know the team, the team
knows them, they can access
them when they need them,
and that team grows to incorporate members of the wider
healthcare neighbourhood as
required by the patient.
The transformation road
ahead is long and winding, yet
there is much room for optimism. As Chris Crawford put
it, the argument should not be
about the cost curve but right
care. We all should not forget
this fact and ensure that the
argument does not become a
financial one.
healthspeak August 2016
Ice epidemic – is it really?
I
recently attended North Coast
Primary Health Network’s
travelling educational talk on the
use of crystal methamphetamine
or ice. It was pleasing to receive
a more professional airing of this
topic than we sometimes hear
via the media. The tabloid media
like to ‘beat it up’ but what are
the real issues behind the hype?
On a cursory look at the
figures, the ice issue is small in
numbers compared with alcohol
related problems. Amphetamine use and abuse has been
around for decades, so what’s so
concerning now? The answer lies
in the purity and potency of the
product now on the market. The
crystal form is readily available
and when smoked or injected
is much more potent than the
previously used powder or base
forms of the drug. In addition,
the use of crystal meth is increasing significantly compared with
other forms of amphetamines.
According to the National
Drug Strategy Household
Survey 2013, only 2.3% of
Australians over the age of 14
used amphetamines during the
past year and only half of this
number used the crystal form
ice. This compares with 86.2%
that used alcohol – numbers that
have not changed significantly
over 10 years. These figures also
show that 75% of amphetamine
users take the drug infrequently
– around once a month. Those
who are regular users (once per
week) are the biggest concern
with potential dependence,
severe mental health problems,
sleep and nutritional deficits and
self harms.
The incidence of poly-drug
use is also high with cannabis
and alcohol being the most common among ice users.
Crystal methamphetamine
affects three neurotransmitters
in the brain, serotonin leading
to feeling good and connected;
noradrenaline leading to alertness, concentration, increased
energy; and dopamine leadAugust 2016 healthspeak
ing to reward, motivation and
pleasure. As the dose and usage
increases, the initial euphoria,
alertness, reduced appetite and
increased sex drive can lead on
to nervousness, agitation, teeth
grinding, jaw clenching, nausea,
hot and sweaty, vomiting and
headache. In severe cases there
can be chest pain, breathing
problems, tremor, seizures, confusion, disorientation, muscle
rigidity, panic and psychosis,
many of which may lead to a
hospital presentation.
Possible long term effects are
physical such as seizures, heart
failure, stroke, kidney failure,
cardiac disease, extreme weight
loss and malnutrition. Dental
problems include extreme dry
mouth, severe tooth decay, gum
disease, poor oral hygiene and
effects of teeth grinding. Psy-
Motivational
interviewing,
cognitive
behavioural
therapy, support
groups and a
healthy lifestyle
are important
in recovery
treatment
chological and cognitive effects
are common, including memory
problems and psychosis. The social consequences are significant
disruptions to individuals and
their families including criminal
activity.
Managing intoxication can be
challenging and it is important
for carers to stay calm, non judgmental, listen and respond appropriately, allow personal space
and be clear in their communications. Avoid confrontation.
Withdrawal from ice is difficult and lengthy with various
stages in the process. There is
an initial crash with prolonged
sleep, increased appetite, irritability, feeling flat, dysphoric and
anxious. Then there is a phase
with mood swings, agitation,
anxiety, sleep disturbance, poor
concentration and memory,
strong cravings of hunger and
thirst and suicidal thoughts.
In the longer term, which may
take 18 months, there are still
strong cravings, poor concentration and memory and an inability to experience pleasure.
The good news is that affected
people can recover from crystal
meth dependence. And the 75%
of methamphetamine users using less than once per month can
eventually quit without major
clinical
editor
Andrew Binns
problems.
There are no designated
medications for treatment and
counselling, although motivational interviewing, cognitive
behavioural therapy, support
groups and a healthy lifestyle
are important. For those who
have a past history of major
trauma such as adverse childhood experience, there needs
to be culturally sensitive trauma
informed care available. Family
and community support and
understanding are vital for a successful recovery.
It is often the most vulnerable
young people in our community who become addicted to
ice, particularly those whom
have suffered trauma. There is
concern that the potential for
ice addiction will become an increasing public health problem.
What’s much needed is a
regional residential facility for
long term rehabilitation plus
better understanding by the
community and health professionals of the issues surrounding
the use of ice.
3
Finalists selected for Excellence Awards
T
welve finalists have been
shortlisted for the Inaugural Primary Health Care
Excellence Awards hosted by
the North Coast Primary Health
Network (NCPHN). The
awards evening will be held in
Coffs Harbour on September 9.
“These new Awards showcase
the excellent work being done
by GPs, allied health practitioners and community health
workers right across the North
Coast, from the Tweed down
to Port Macquarie,” said the
NCPHN’s Chief Executive Dr
Vahid Saberi.
Three finalists were chosen in
each of the four Award categories with project topics ranging
from the health of mothers
and babies/young children,
improving the wellbeing of
disadvantaged people, and the
eVillage in Byron Bay/Bangalow
connecting Feros Care residents
with GPs, specialists and the
community.
Several of the projects focus on
Indigenous health, including the
1 Deadly Step exercise program
in Casino and the early detection
of chronic kidney disease.
The finalists are:
1. Tresilian Lismore Family Care Centre - Enabling
Service Provision through
Partnership
2. North Coast Primary
Tweed event connects GPs
and specialists
I
n late June, NCPHN in
partnership with John Flynn Private Hospital hosted an
evening based on the speed
dating format for GPs to
meet specialist colleagues in
an informal atmosphere.
Seventeen specialists and
12 GPs took advantage of
the event to get to know each
other. NCPHN GP Adviser
Dr Brett Lynam said often
GPs or specialists receive
correspondence or phone
calls from colleagues they’ve
never met – but work in the
neighbourhood.
“It’s really helpful to put a
face to the name, and the evening also enabled colleagues
to catch up with others they
know but rarely meet,” he
said.
During the night, the
doctors were able to ask questions about special interests,
4
These Awards
spotlight the often
unseen efforts
that help make
improvements
to health care
outcomes in nonhospital settings
Health Network (Mid North
Coast) - No Longer on the
Backburner: Re-Developing
Musculoskeletal Models of
Care
3. NCPHN, NNSWLHD, Bulgarr Ngaru, UCRH, Solid
Mob and NSW Country
Rugby League - 1 Deadly
Step, Casino
4. New Access - New Access
initiative
5. Nimbin Neighbourhood
& Information Centre
Inc - Nimbin Independent
Services (NIS)
6.NCPHN - Needs Assessment
7. New Directions - Mothers
& Babies Program
8. NNSWLHD Renal Services
and Bugalwena General
Practice - Early Detection of
Chronic Kidney Disease in
Aboriginal People
9.NCPHN - Improved Health
from the Winsome Health
Outreach Clinic in Lismore
10.NCPHN - First Responders
CPR Program
11. Bay Medical Centre, Byron
Bay, Feros Care - eVillage
12. MNCLHD, Royal Far West
& NCPHN - Nambucca Val-
ley Healthy Kids Bus Stop
“The Primary Health Care
Excellence Awards honour the
partnerships, teams and individuals who work tirelessly to
find new ways to keep community members healthy and out of
hospital,” Dr Saberi said.
“These Awards spotlight the
often unseen efforts that help
make improvements to health
care outcomes in non-hospital
settings. Not just the finalists
but all of the 40 accepted entries
are winners in their own way,
although the true winners are
the patients and clients whose
health and wellbeing is benefiting from the efforts of our wonderful health care professionals,”
he added.
For more information go to:
http://ncphn.org.au/excellence/
New owner for Nimbin Medical Centre
O
Tweed Speed networkers
training, referral pathways,
consulting rooms and clinical
questions.
The networking evening
involved specialist colleagues
from the Tweed Hospital
– both staff specialists and
VMOs, and John Flynn
Private Hospital specialists
on one side of the tables. GPs
from Tweed Valley catchment were on the other. side.
n August 1, the ownership of Nimbin Medical
Centre was transferred from
North Coast Primary Health
Network (NCPHN) to Dr
Vinay Potumuthu of McKid
Medical, Kyogle.
The medical centre will continue operating with the same
doctors and services. The transfer of ownership comes after a
change in the role of Primary
Health Networks.
Nimbin Medical Centre first
opened its doors in 1982 and
has been run by North Coast
Primary Network (and its previous entities) since 2003. It is a
unique and enduring medical
centre with a history of tremendous community support.
Network would like to thank the
Centre’s doctors and practice
staff for their service to the community over the past 13 years.
We wish Dr Vinay all the best as
the new owner of Nimbin Medical Centre.
Clinical Council Symposium:
communication and integration
N
CPHN’s first Clinical
Council Symposium was
held in June in Coffs Harbour
to bring together all the GPs
involved in the three clinical
councils set up by NCPHN
across our region.
The Symposium gave participants an understanding of the
Primary Health Network’s vision, structure and priorities for
the next 12 months. GPs were
invited to provide input into
the topics of Commissioning,
Learning and Developing and
LHD Integration Priorities.
The three Chairs of the
NCPHN’s Clinical Councils –
Dr Adrian Gilliland (Mid North
Coast), John Vaughan (Hastings
Macleay) and Peter Silberberg
(Northern Division) facilitated
the sessions with presentations from NCPHN Chair Dr
Tony Lembke, Chief Executive
Vahid Saberi, Tracy Baker from
MNCLHD, Clinician Engagement Manager Monika Wheeler
and GP Clinical Adviser Dr Dan
Ewald.
Chair of the Hastings Macleay
Clinical Council, Dr John
Vaughan, said the symposium
was a refreshing chance for primary care practitioners to come
together and to reflect on ways
to work together.
“Working together we can
try to improve the quality
and efficiency of primary care
delivery across the North Coast.
The Symposium was a positive
and energising experience for
us all, allowing us to see from
different perspectives how we
can all contribute to a better and
more positive outcome for our
patients.
“It was particularly heartwarming to have such a diverse
group representing general practice, allied health and Aboriginal
health at the meeting.”
In John’s opinion, the key to
improving health outcomes is
through much improved comAugust 2016 healthspeak
Often people
assume that
communication will
happen on its own,
but resources must
be available to
enable the building
of networks and
relationships
NCPHN's Coffs Harbour Clinical Council Symposium attracted GPs
from all over the North Coast
munication not only between
health practitioners, but also
between the hospital and community health sectors.
As Clinical Council Chair
I see my role as a facilitator
between various primary health
practitioners and also as a bridge
to the hospital sector in our
district. Remaining positive in
the face of the many obstacles is
one of my main aims, as well as
welcoming and including allied
health and Aboriginal health
practitioners into the Council,”
he added.
Dr Adrian Gilliland, Chair of
the Mid North Coast Clinical
Council, said he’d welcomed
the opportunity to meet other
council members at the Symposium. He saw two main things
come out of the gathering, the
need to focus on integration
and improved communication
between health professionals.
“The PHN has a key role to
link together the different silos
that currently exist in healthcare. It’s important that we get
the different components of the
health system talking to each
other and working together,” he
said.
Adrian is also keen to see
the resources needed put into
improving communication.
“Networking is required for
people to get to know each
other and it requires trust. That
takes time to build and it takes
resources. Often people assume
that communication will happen on its own, but resources
must be available to enable
the building of networks and
relationships. You need these
relationships before you can
expect outcomes.”
Adrian became Chair following his experience as Primary
Care Clinical Adviser to the
Wellington District Health
Board in New Zealand.
“In that role I was a key
integrator across primary and
secondary care and we made
significant progress. I would
Continued page 12
Nursing students a boon
for general practice
A
lstonville Clinic recently
hosted two SCU nursing students for placements
to give the students a taste for
the work of practice nurses.
Alstonville Clinic Practice
nurse Kim Eggins said that
students sometimes assumed
that not much went on in
general practice, but she said
at Alstonville Clinic patients
often presented at the clinic
rather than go to Lismore or
Ballina to hospital.
“We get patients turning
up with heart attacks and
other acute conditions, so our
students get a broad range of
experience in dealing with
patients,” she said.
One student came on
placement when Kim’s two
PN colleagues were on leave
and her presence was much
appreciated.
“Jennifer Schultz came on
a work placement when I was
here on my own and having
an extra pair of hands really
made a difference. Some students aren’t suited to general
practice but Jennifer was terrific and we’re keen to hear
from her when she finishes
her studies.”
SCU would like to place more
nursing students in general
practice. If your practice is
interested contact Michael
Grande at michael.grande@
scu.edu.au
5
NAIDOC WEEK 2016
NAIDOC Week celebrates
Aboriginal and Torres Strait
Islander heritage, culture,
arts, and achievements and
recognises the significant
contributions that Indigenous
Australians make to our
country.
This year’s theme was
Songlines: the living narrative
of our nation. Songlines
speak of the Dreamtime - a
community spirit in both places,
and we felt very privileged to be
involved. I most enjoyed engaging with the kids who went away
with new knowledge about making good health choices,” said
Claire Malseed.
time when the earth, people
and animals were created
by our ancestral spiritual
beings. In 2016 Australians
were invited to explore the
Songlines in their local region,
and to explore how they
connect people to country,
and country to people.
NCPHN’s Aboriginal health
team attended more than 20
NAIDOC events this year.
Coffs Harbour
Tweed Heads
Here NAIDOC celebrations
commenced with the official
flag raising and church service
at Minjungbal Museum, ending with the traditional street
march down Wharf Street and
a corroboree in Jack Evans’ boat
harbour.
The Aboriginal Health team
took part in the Health & Sports
Day held at Arkisnstall park,
South Tweed attended by around
250 Community members.
The team at Tweed for the NAIDOC Sports Day
Byron Bay
The day began with a street
march through Johnson St into
the Denning Park area, overlooking the beach. In addition to running a health information stall,
the NCPHN team also worked
with a nurse from a local medical
centre to offer free blood pressure and blood sugar checks.
Lismore & surrounds
Kids performing at the Tabulam Community Day
Staff from Hastings/Macleay at the Kempsey NAIDOC Day march
6
The Aboriginal Health Team
attended nine community events,
including Bonalbo, Casino,
Lismore, Tabulam, Grafton, and
Kyogle, promoting programs including Mums and Bubs groups,
diabetes information sessions,
and supermarket tours.
Highlights included the
Lismore Council event that included exhibitions and stall from
more than 50 local organisations
and services.
The team particularly enjoyed
travelling to Bonalbo and Tabulam.
“There was an impressive
In Coffs Harbour the Aboriginal
Health team hosted a Men’s day
in Nambucca Valley offering
haircuts, massages, and lunch, a
Women’s gathering in Macksville
offering crafts and beauty treatments, and a Family Fun day in
Nambucca Heads. These events
were hugely successful with over
300 locals attending.
Community members and
Elders groups also attended the
Planting the Seed event at Diggers Beach Reserve in Coffs Harbour, where NCPHN partnered
with National Parks and Wildlife
Service and a bush tucker tour
was enjoyed by about 50 people.
Hastings Macleay
There were events in Kempsey,
Port Macquarie and Wauchope. Family fun days in both
Kempsey and Port proved
popular and around 130 people
completed a health survey, with
39 requesting a call to talk about
how to improve access to health
services.
At South West Rocks there
was a BBQ and picnic sponsored
by NCPHN with games and sand
modelling competitions. The
team also attended flag raisings
in Kempsey, Port Macquarie,
and Wauchope and collaborated
with other services, including
Durri Aboriginal Medical Service
and Bunyah Land Council in
Wauchope to sponsor morning
tea after these events.
A community event was held
at the Port Base Hospital featuring Aboriginal dancers and singers as well as a BBQ and health
information stalls. Golf days in
Port and Kempsey completed
the activities.
North Coast a ‘Lead Site’
in mental health
T
he North Coast Primary
Health Network (NCPHN)
is delighted to announce that it
has been selected as a Lead Site
to test models of care in the roll
out of the national mental health
reforms. A key focus of this work
will be services for people with
severe mental illness and complex needs.
NCPHN is one of 10 Primary
Health Networks around Australia selected through application
to be a Lead Site for the reforms.
The focus of the Lead Site work
h will take place from 2016 to
2019.
Tailored care
The ‘Stepped Care Model’ is
central to the reforms announced
late last year. Under the stepped
care model, primary mental
health services (those delivered
outside of hospitals) will move
August 2016 healthspeak
towards an approach where care
suits individual needs, rather
than a ‘one size fits all’ approach.
Primary Health Networks
will be in charge of commissioning the mental health services
considered necessary and appropriate to meet the needs of
local communities. For example,
decisions about the youth mental
health services required in a local
community will now be made
by that local community, not
Canberra.
Suicide Prevention
As part of the reforms, North
Coast Primary Health Network
will be overseeing the implementation of a system-wide approach
to suicide prevention to meet
local needs.
Indigenous Australians
More funding will be available
for NCPHN to provide greater
access to mental health services
for the Aboriginal and Torres
Strait Islander population.
NCPHN’s Director, Mental
Health Reform and Integration,
Dr Megan Lawrance, said as a
Lead Site, North Coast Primary
Health Network would be a
champion and pioneer in primary mental health reforms.
“We’ll be testing models of
coordinated care for adults
with severe mental illness and
complex needs. Implementing
a systems approach to suicide
prevention will also form part of
our work.
“Working alongside consumers, carers and health professionals, NCPHN will lead the
development and modelling of
innovative approaches to stepped
care in mental health,” said
Megan.
briefs
Research into
early alcohol sips
A survey of 2000
Australian families has
found that 60% of 13
year olds have had a sip
or taste of alcohol.
However, researchers
at the University of
NSW also found that
it was not the early sip
of alcohol from parents
that led to young
people abusing alcohol,
but other factors such
as peer pressure or
exhibiting rule breaking
behaviour.
Lead author Dr Monika
Wadalowksi said her
research will be tracking
the children over the
next four years. She said
early findings suggested
parental supply was just
one factor influencing
future drinking habits.
7
Health Pathways update
Lung Cancer Pathway
The Lung Cancer HealthPathway
provides localised assessment,
management and referral information for the Mid and far North
Coast region.
Background
Lung cancer is projected to account for 3,210 deaths in NSW
in 2020¹ and accounted for over
20% of cancer deaths in NSW
in 2012. Incidence continues to
climb in females while falling in
males. Survival rates are improving for those recently diagnosed
with lung cancer and it is clear
that lung cancer will affect our
communities for a long time
despite the current success of
smoking prevention and cessation programs.
Lung cancer symptoms can be
non-specific and masked by other
diseases. Lung cancer is prevalent
in rural and disadvantaged communities resulting in statistically
poorer health outcomes.
Project
Cancer Institute NSW provided
funding to Northern NSW Local
Health District to participate in a
pilot project to map the current
referral pathways for patients
with lung cancer in the region
and define an optimal pathway
for management and referral.
The project had secondary aims
of developing a cancer pathway
development toolkit that could
be used across NSW for lung and
other cancers.
The project team used clinical
improvement methodology
to engage key stakeholders in
primary and specialist care to
work iteratively and collaboratively in defining the optimal care
pathway for the region.
Pathway
There is no national consensus
about screening for lung cancer.
Symptoms and signs that prompt
assessment for lung cancer include a persistent cough, change
in cough or haemoptysis. The
Lung Cancer Pathway identifies
respiratory physicians that attend
multidisciplinary cancer care
team meetings as the optimal
first point of referral for patients
with suspected or early stage
cancer. They are identified within
the Lung Cancer Pathway along
with other cancer team members including medical oncologists, radiation oncologists and
cardiothoracic surgeons. Any of
the specialists are available to be
contacted regarding where the
initial referral should be made.
Next steps
The Lung Cancer Pathway will
be continually assessed for accuracy and relevance to local needs.
It provides an effective tool for
general practitioners by clearly
identifying the local services
available and the optimal steps to
assess and refer patients. Information on the Lung Cancer Pathway has been presented to staff of
Aboriginal Medical Services and
to local Clinical Society meetings
with more presentations to follow. Over time the Pathway will
Check it out!
View Mid and North Coast
HealthPathways localised
for our region: https://manc.
healthpathways.org.au/
Username: manchealth
Password: conn3ct3d
be expanded to include optimal
treatment options, supportive
care and follow up recommendations.
¹Cancer statistics, Cancer Institute
NSW, 2016.
Chronic Hepatitis C
update
The new Direct Acting Anti-viral
drugs are now available for GPs
to prescribe when a specialist
service gives approval. This usually does not require the patient
to be seen by the specialist. The
new treatment regimens have
significantly higher cure rates
(95%), better tolerability and
simple dosing regimens, better
accessibility, shorter duration.
The HealthPathways Chronic
Hep C pathway has been updated to guide GPs through these
changes.
Networking in Grafton connects professionals
A
The organisers behind the networking evening. From left: Rachel
Gorman, NCPHN; Dr Marion Tait; Amanda Chircop NCPHN; Steve
Brierley, CEO St Vincent’s Hospital; Leah McCarthy, St Vincent’s
Hospital and Monika Wheeler, NCPHN.
8
partnership between
NCPHN and St Vincent’s
Private Hospital in Lismore
resulted in a very informative
speed networking event in
Grafton in June where specialists working at St Vincent’s travelled down to meet local GPs.
Leah McCarthy, Executive
Assistant from St Vincent’s,
approached NCPHN about
running an event in Grafton
following a similar successful
networking night by the PHN
in the Northern Rivers. Thirteen VMOs from St Vincent’s
met the Grafton based doctors
in a relaxed atmosphere at the
Vines at 139 café which was
hired specially for the evening.
“GPs are quite nomadic and
there can be a high turnover
in regional areas,” Leah told
HealthSpeak.
“We were keen to let Grafton
GPs know what specialist
services are offered here at St
Vincent’s and for them to meet
the specialists face to face.”
The feedback from both
specialists and GPs was very
positive and Leah is looking
at jointly organising another
similar event with North Coast
Primary Health Network for
the hospital’s VMOs in Ballina.
Launch: Centre for
Healthcare Knowledge
Can schizophrenia
be reversed?
A
J
une 15 marked the launch
of an exciting new arm of
Network – the Centre for
Healthcare Knowledge & Innovation.
The Centre aims to stimulate
and grow innovation in the
region. It will bring national
and international scholars to
the North Coast to share their
knowledge with the local health
and social services workforce, fuelling innovation and creativity.
One of the first scholars invited by the Centre was Dr Nick
Goodwin, co-founder and CEO
of the International Founda-
tion for Integrated Care in the
UK. Dr Goodwin took part in
the launch at Byron Bay and
led a workshop focussed on the
integration of healthcare.
Network’s Chief Executive Dr
Vahid Saberi said he hoped the
Centre would be an inspiration
and driver of healthcare improvement across the Australian
East Coast.
“The new centre will host a
range of experts to foster discussion and engagement around
new models of working in
healthcare, innovation and novel
ideas,” he said.
study has shown that
the brains of patients
with schizophrenia have the
capacity to reorganise and
fight the illness. Schizophrenia is associated with a widespread reduction in brain
tissue volume. However, research has found that a subtle
increase in tissue also occurs
in certain brain regions.
The study followed 98
patients with schizophrenia
and compared them to 83
patients without schizophrenia. The team used Magnetic
Resonance Imaging and
an approach called covariance analysis to record
the amount of brain tissue
increase. This had not been
demonstrated in patients
before now.
According to Lawson
Health Research Institute's
Dr. Lena Palaniyappan, there
is an overarching feeling
that curing people with a
severe mental illness, such as
schizophrenia is not possible.
This comes from a
long-standing notion that
schizophrenia is a degenerative illness.
"Our results highlight
that despite the severity of
tissue damage, the brain of a
patient with schizophrenia
is constantly attempting to
reorganise itself, possibly to
rescue itself or limit the damage," she said.
The study, "Dynamic
cerebral reorganization in the
pathophysiology of schizophrenia: a MRI-derived
cortical thickness study" was
published online in issue
Psychological Medicine, 26
May 2016.
The NCPHN Practitioner Newsletter – your fortnightly source for
networking and educational events. Separate editions covering Tweed
Valley, Northern Rivers, Mid North Coast and Hastings/Macleay.
Also in the electronic newsletter:
•
•
•
•
•
Specialist medical topics
Latest HealthPathways
Latest resources linked to the NCPHN website
MBS/PBS & immunisation updates
New health services & clinicians
Not subscribed? Go to http://ncphn.org.au/practitioner-newsletter/
NCPHN’s Practitioner Newsletter is the primary source of information to general practice.
9
Immunisation news
Specialist immunisation
advice line
ganise a telehealth consultation,
call the clinic on 1800 679 477).
T
Issues with reporting
dosages
he NSW Immunisation Specialist Service (NSWISS)
has been set up to provide
clinical advice and support to
immunisation providers on
complex issues.
Specialised nursing and medical staff from the National Centre
for Immunisation Research &
Surveillance at Westmead Children’s Hospital are available to
provide advice on immunisation
for patients with complex or unusual medical backgrounds. They
also provide advice on adverse
events following immunisation.
NSWISS operates between 9
am and 5 pm Monday and Friday. For all other immunisation
clinical advice call your Public
Health Unit on 1300 066 055.
What does NSWISS provide?
• Assessment and management of a child or adolescent who has previously
experienced an adverse
event following immunisation
• In-depth consultation with
parents who have vaccination concerns - side-effects
and possible adverse events
• Administration of vaccines
under close supervision, if
appropriate
• Follow-up by telephone call
after vaccination
• Outline of schedule options for future vaccination
(which may differ from the
standard schedule depending on the nature of the
adverse event experienced)
• Vaccination under sedation
for children unable to be
vaccinated in the community setting
• Telehealth consultation
• Phone advice and referral
for adults to an appropriate
specialist according to the
concern or adverse event
experienced
To arrange a referral or to or-
10
There are issues with providers
reporting 18 month DTPa (Infanrix or Tripacel) and adolescent dTpa (Boostrix/Adacel).
To clarify, children born on or
after 1 October 2014 will need
five doses of DTPa and it is populated automatically for children
on the Australian Childhood
Immunisation Register (ACIR).
These children are funded for
the additional vaccine under the
National Immunisation Program.
Children born before 1 October
2014 only need four doses of
DTPa and are not funded for an
additional dose of DTPa at 18
months of age.
When reporting a DTPa dose
on an electronic medical record
or directly on to the ACIR,
remember the DTPa given at 18
months must be reported as the
fourth dose and not first. This
is also applies for adolescents
receiving a booster dose of dTpa
at 12 years of age. Note what
the last DTPA dose given in
childhood and record it on your
electronic medical system as the
next consecutive dose. Therefore
if the last know dose was dose
4, you must record the dTpa as
dose 5. However; if a child born
before 1 October 2014 receives
a fourth dose of DTPa before
their 3 ½ year old schedule dose,
this must be recorded as a repeat
dose 3. Recording this as dose 4
will remove a child 4 year DTPa
due for a child.
If the DTPa/dTpa dose is
recorded incorrectly to ACIR,
the child will be classified as
overdue. This will affect parents/
carer who receives the child care
benefit, child care rebate and/or
Family Tax Benefit Part A.
Australian Immunisation
Register
From the 1 September 2016
the Australian Childhood Im-
munisation Register becomes
the Australian Immunisation
Register (AIR). Vaccinations
administered to all ages will be
registered on the AIR. If your
facility does not have access to
online ACIR, now is the time to
act. Any facility with a provider
number can obtain access to the
ACIR. If your facility doesn’t
have a provider number; go to
the online form and details:
https://www.humanservices.
gov.au/health-professionals/
services/medicare/australianchildhood-immunisation-register-health
If you have a provider number,
request access through the ACIR
site https://www1.medicareaustralia.gov.au/ssl/acirCIRGRACC
HealthPathways topics
in this issue
B
elow are the HealthPathways topics related
to health topics found in this
issue of HealthSpeak.
COPD
• COPD Assessment
• Management of COPD
• Preventing Deterioration in COPD
• Optimising Functioning
in COPD
• COPD Support
Networks
• End state COPD
management
• Medications in COPD
Immunisation
• Immunisation –
childhood
• Immunisation – adults
• Influenza immunisation
• Immunisation –
adolescent
• Pertussis vaccine for
pregnant women
Hearing
• Adult Audiometry
Assessment
•Asymmetrical
Sensorineural
hearing loss
• Otitis Media with
Effusion (Glue ear)
• Newborn hearing
screening & intervention
• Child Audiometry
Assessment
•Tinnitus
Methamphetamines
• Drug & Alcohol Services
• Alcohol reduction
• Drug & Alcohol Services
Login to find these topics
View Mid and North Coast
HealthPathways localised
for our region: https://manc.
healthpathways.org.au/
Password: conn3ct3d
Substance Misuse Update
S
ince April NCPHN has run
Community Conversations
on the topic of crystal methamphetamine (ICE) in Grafton,
Casino, Tabulam, Maclean, Ballina and Lismore.
These events have all been
well attended with lots of
questions from the community
after the presentations given
by NCPHN staff members and
other community members,
such as police and representatives from Aboriginal health and
community organisations.
Out of each of these meetings,
Working Groups have been developed and each is working on
the issues identified as important to address the ICE problem
in the various regions.
For instance, in Lismore the
main actions identified were
• Support for families
• Innovative ideas for detox
and withdrawal – option
for home and ambulatory
detox programs
• Campaign around real
life ice users – to reduce
the shame of users and to
change the stereotypes of
ICE users
• Look at ways to lessen
discrimination around users
and their interactions with
community
In Casino and Evans Head,
the Working Groups identified
actions as organising more rehab
programs and finding opportunities for youth to address their
boredom which often leads to
drug experimentation. The community is keen to find ways to
build resilience in their youth.
Substance Misuse Training
A year long Substance Misuse
Training program has attracted
more than 30 Expressions of
Interest from community and
health organisation staff in the
Coffs Harbour region.
NCPHN Program Manager,
Christine Minkov, said that
the aim of the training was to
Smart Recovery Groups
These groups are an alternative
to NA and AA. Smart Recovery
Groups are peer-based support groups based on a CBT
model for behavioural change.
NCPHN staff have run two
trainings and now 16 people are
trained to be facilitators for this
program. Two more trainings
will happen in September. Then
32 trained facilitators will then
be available to run these Smart
Recovery Groups.
Communities
are keen to find
ways to address
youth boredom
which often
leads to drug
experimentation
Climate Schools
empower people working in
a variety of organisations to
effectively work with clients
presenting with a drug and/or
alcohol problem.
“The people training are
generalist case workers, so you
might have them working in
Housing, Juvenile Justice, an
employment service, headspace
etc. The case workers often
find that their clients’ use of
substances is getting in the way
of them achieving their goals.
Goals such as getting into housing, going to school or finding a
job,” said Christine.
Participants are taught how
to engage with the client, screen
them on potential misuse problems and work with them using
some low intensity Cognitive
Behavioural Therapy interventions. These include identifying
that the person has a problem
in the first place, goal setting,
and identifying the triggers that
result in substance misuse.
have been trained to deliver GP
specific training on the topic
of crystal methamphethamine.
Fourteen sessions have been
held from Tweed to Grafton at
lunchtime for general practice
staff. All have been well attended
and staff found the sessions
informative and useful.
LOOKING FOR SOME
NEW WHEELS?
Lismore’s Southside Health
and Hire Centre (in
association with Southside
Pharmacy) have a large
range of quality BARIATRIC
and standard equipment
for hire or purchase
including shower chairs,
lifters, electric beds,
wheelchairs, seating,
walkers, commodes and
more.
Workforce Development
Programs
SOUTHSIDE
HEALTH & HIRE
CENTRE
NCPHN has tailored intensive
training around ICE and provided this training to a number
or organisations including the
Family Law Court, OTCP,
psychologists at the Department
of Education, and counsellors at
Southern Cross University.
GP Specific training
NCPHN Practice Support staff
An online Drugs and Alcohol program for high school
students, Climate Schools is delivered in the classroom by the
Personal Development teacher.
Each lesson plan costs $950 for
one year. NCPHN has funding
available to pay for all schools in
the region to deliver this innovative program. Already 16 schools
have signed up.
Call us today on (02) 6621 4440 or
come in and say hello at 5 Casino
Street, South Lismore.
Southside Health & Hire Centre
Where your health is our total
concern.
Nurse on Duty
www.southsidehealthandhire.com.au
8:30am - 5pm Mon - Fri
8:30am - 12:00pm Sat
Closed Sunday
11
From page 5
now like to help to improve the
Australian health care system
particularly in my new home,
the Mid North Coast,” he added.
Chair of the Northern Region
Clinical Council, Dr Peter
Silberberg, sees the lack of integration between health services
as a recurring and significant
problem in Australia and one
that the clinical councils are well
placed to work on.
“Lack of integration leads to
poor health outcomes, inefficiency and sometimes has terrible consequences for patients.
Specific examples include
inadequate information transfer
between providers leading to
huge monetary and time wasting – an inefficiency our health
system can no longer afford.
“Fortunately the federal and
state governments appear to be
getting on board the integration
theme. An example of the federal commitment has been the
establishment of the Primary
Health Networks across Australia and the clinical councils
have been established as part of
this structure to provide clinical
guidance to the PHN.
“To this region’s credit, there
are many hard working people
in our health sector who believe
in integration and want the system to improve. I hope that my
role as the chair of the Northern
Clinical Council can in a small
part help contribute towards
this long term and vital goal,”
Peter told HealthSpeak.
briefs
Melanomas falling
in younger folk
While skin cancers account
for the largest number
of cancers diagnosed in
Australia each year, the
good news is that for
people under 40 the rate
has dropped, from 13 cases
per 100,000 people in 2002,
to about 9 in 2016.
The Australian Institute
of Health and Welfare
(AIHW) report, Skin cancer
in Australia, estimates
that almost 13,300 new
cases of melanoma will
be diagnosed in Australia
in 2016, with about 1,800
people dying from the
disease.
“Since 1982, the rate of
melanoma in the population
has almost doubled-up
from 27 to 49 cases per
100,000 people,” said AIHW
spokesman Justin Harvey.
Public education
campaigns on the effects
of sun exposure may be
related to the reduction in
melanoma for those aged
under 40.
The report also shows
that survival from
melanoma is relatively high,
with people diagnosed in
2007–2011 having a 90%
chance of surviving at least
five years.
ADVERTORIAL
Exchanged Traded Funds – What are they?
By Michael Carlton
CEO & Senior Adviser, PECUNIA
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Market liquidity for ETFs is maintained
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Private Wealth Management
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An Exchange Traded Fund (ETF) is
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12
How ETFs work
An ETF is a sharemarket-quoted fund
that comprises an investment portfolio
of shares, bonds or property securities.
Through purchasing a single ETF share,
investors gain access to this portfolio.
ETFs are constructed using an indexing
approach, so their value moves in line
with the index they track. For example,
a 2% rise or fall in the index would
result in approximately a 2% rise or fall
for an ETF which tracked that index.
Buying an ETF share is an easy, fast
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ETFs are bought and sold on the
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The structure of ETFs ensures this
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Important information
and disclaimer
This publication has been prepared
by Michael Carlton, an Authorised
Representative (AR No: 239724) and
Carlton Family Trust ABN 51 283 954 577
t/a PECUNIA Private Wealth Management
a Corporate Representative (CAR No:
1233485) of Dover Financial Advisers Pty
(AFSL No: 307248). His advice is general in
nature and readers should seek their own
professional advice before making any
financial decisions.
Dr Peter Silberberg: Following his passion
T
he past 12 months has
been a time of great change
for Northern Rivers GP Dr
Peter Silberberg.
Until last year, Peter enjoyed
two fulfilling roles – one as a
GP at Lennox Head and the
other as an educator at North
Coast GP Training (NCGPT).
Sadly, NCGPT closed its doors
in 2015, leaving a big hole in
Peter’s working life.
“It was a great opportunity to
have a creative outlet outside of
medicine, creativity in the way
you presented information to
the registrars and it was really
rewarding watching people
learn. The best thing as a teacher
is when you watch the penny
drop and see someone get
something for the first time or
maybe change their behaviour
for the better,” he said.
Peter first worked in this
region in 1999 and worked
locally for a while, in between
completing his training as a GP
and junior doctor. He also did
some public health research in
the Northern Territory.
“I was based at Darwin and
did a stint at Alice Springs, my
first experience working in an
Aboriginal Medical Service.
“That was a great experience
I loved it. I learned heaps and
enjoyed meeting the unique
population that lives there.”
For a few years Peter and his
family went back to his home
town Melbourne. There he did
GP work, including working
with an organisation looking after youth with drug and
alcohol and mental health issues. In 2008 he returned to the
Northern Rivers.
It’s clear that Peter is a man
with an appetite for change.
“When NCGPT closed, that
was challenging, but one of the
great things about medicine
and especially general practice
is that when one door closes,
another one opens.”
His change in circumstances
meant that Peter has been able
to get back into an area of health
Would you like to
work at Jullums?
Lismore Aboriginal
Medical Service is
looking for GPs who
have experience in
working in Aboriginal
health or have a desire
to get some experience
in this interesting field.
Anyone interested in
the opportunity, should
contact Greg Bishop at
[email protected]
Peter is enjoying his work in Aboriginal health
he’s passionate about – Aboriginal Health.
“I’ve been at Jullums [Lismore Aboriginal Medical
Service] since March and I’m
really loving it. It’s definitely
different to mainstream general
practice. Our patients are the
first custodians of our country,
but unfortunately are highly
disadvantaged. The history of
service provision to Aboriginal
people is not great in Australia
and so you feel like you are part
of an organisation that is trying
to change that experience. Jullums is a place where Aboriginal
people can feel safe and access
easily. That’s really fulfilling
in itself, apart from the medicine which is generally pretty
interesting as well. It’ a privilege
to serve this community,” said
Peter.
This year, Peter has also
become Chair of the Northern
Regional Clinical Council at
Network. What made him take
on this role?
“I guess deep down a desire to
be part of change. The goals of
the PHN are good ones, trying
to integrate our health system.
While it’s a huge challenge, it’s
something we definitely need
to be doing. I think everyone
The PHN has a
mandate to create
change and that’s
really encouraging.
But it does take
time and we need
to be patient
agrees with that, it’s just about
how we get there."
Being Chair of the Clinical
Council also allows Peter scope
to look at the broader picture,
briefs
Rosacea &
dementia
Rosacea is associated
with an increased risk of
neurological disorders such
as Alzheimer’s disease and
dementia, according to a
large population study.
Danish researchers
studied nearly 5.6 million
adults and found those
with rosacea had a 25%
increased risk of Alzheimer’s
disease and a 7% increased
aside from the minutiae of general practice.
“Working clinically and on
the clinical council is a great
balance. We need to get all the
players talking to each other, all
the stakeholders, the LHD and
other community providers and
go from there. There’s tremendous goodwill in this region.
“Everyone knows what the
problems are and people have
for decades have been constrained by the system and
that’s led to a lot of burnout and
throwing your hands in the air.
But the PHN has a mandate
to create change and that’s
really encouraging. But it does
take time and we need to be
patient. If we try to rush these
things and look for changes too
quickly, we’ll fail.”
risk of dementia compared
with those who did not
have the skin complaint.
Rosacea sufferers aged 60
years and over were at the
higher risk end and women
with rosacea had a slightly
higher rise of Alzheimer’s
than men.
The researchers point
to rosacea’s association
with increased levels of
metalloproteinases and
antimicrobial peptides
that are also implicated in
neurological disorders such
as Alzheimer’s disease and
dementia.
13
Awards for organ donation research
A
n Honours research thesis
highlighting the barriers to
organ donation has earnt Emily
Sharpe a Southern Cross University Medal and an award from
the Australian Psychological
Society for academic excellence.
Emily, Zoe Moore and Prachi
Batra, who all completed the
Bachelor of Psychological
Science with Honours, were
awarded the University Medal
at the Coffs Harbour graduation
ceremony in June.
Emily, who moved to Coffs
Harbour from Sydney to complete her Honours year, said she
was very excited to receive the
awards.
“It was a really good year. My
supervisor Dr Gail Moloney was
amazing. The staff really wanted
us all to succeed and they really
pushed us,” Emily said.
Her thesis titled ‘The Effect
of Attitudes and Registration
Opportunity on Organ Donor
Registrations’ found that while
there was high societal support
Emily Sharpe and Prachi Batra receiving awards at the Southern
Cross University Honours Psychology Research Conference in
2015. The pair will both receive University Medals on Saturday.
for organ donation, this had not
translated into registrations on
the Australian Organ Donor
Register.
“I found that a lot of people
have conflicting attitudes about
organ donation and registration.
There are a lot of misconceptions that make it hard for
people to commit to signing the
register,” she said.
Through her study Emily
found that when people were
offered an immediate opportunity to register, as opposed to a
delayed registration, they were
much more willing to commit.
Emily hopes her research
leads to more Australians on the
Organ Donor Register.
NNSWLHD Nurse
& Midwife Awards
HealthSpeak congratulates Northern NSW nurses Sandy O’Brien
and Josie Bates, who have been
recognized for their outstanding
service through two awards.
Sandy, Integrated Care CNS1–
Mental Health/Drug & Alcohol
Services & Integrated Care
Program, won the Jane Ackerman Memorial Award for Clinical
Excellence.
Sandy works between Tweed
and Lismore with NNSWLHD,
general practice, the North Coast
Primary Health Network and
AMSs to build relationships,
communication channels and collaborative working arrangements.
Sandy has been an important
collegiate link between North
Coast Primary Health Network
and LHD staff in driving integration improvements.
Josie, NUM Surgical 1/Orthopaedics at The Tweed Hospital,
won the Meryl Brown Memorial
Award for Outstanding Achievement in Midwifery Management.
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n mid July more than 3.8 million people had
registered for the My Health Record system
following the addition of almost a million
new records in the two opt-out trial regions
earlier in the month.
The consumer view of the system has also
undergone a complete revamp both in terms
of the user interface and ease of use. The
home page view now lists the person’s shared
health summary, personally entered notes and
advance care information, with clinical documents accessible through drop-down menus.
After years of false starts and grappling with
privacy and confidentiality issues, the federal
government launched the revamped My
Health Record (MyHR) in March this year.
All Australians can register for a MyHR and
have access to a summary of their personal
health information whenever they need it.
STOP PRESS
MyHR now mobile friendly
The MyHR system is now
accessible on mobile devices
and will shortly reach the
milestone of four million
consumers registered, Health
Minister Sussan Ley said in
late July.
Addressing the Health
Informatics Conference
Ms Ley said the platform
was now mobile accessible
allowing patients and health
professionals to access their
record anywhere at anytime.
POTENTIAL IMPACT
Federal Health Minister Sussan Ley claims
that if all Australians signed up to MyHR,
around 5000 lives could be saved a year. It
could also help avoid two million primary
care and outpatient visits, 500,000 emergency
visits and 310,000 hospital admissions.
Benefits of shared health information:
• Provides a more complete view of patients’ health
• Provides access to medical information
that you might not otherwise have
• Includes allergies, drug reactions and
medication history
• Includes prescribed medications and
discharge summaries
• Can lead to improved clinical decisions
• Fewer adverse events for patients and
fewer avoidable hospital admissions
• Better health outcomes
• Complements but does not replace local
clinical records
• Can be valuable when treating patients
with a range of healthcare providers and
those with complex health conditions
• Helps care for patients who don’t have a
regular doctor or travel to receive health
services
• And, if your data has been maintained, a
Shared Health Summary can be created
in two clicks!
TRIALS OF MYHR USING THE OPT OUT
METHOD
Earlier this year, Federal Health Minister
Sussan Ley announced the start of two trials
of MyHR in North Queensland and in the
Nepean/Blue Mountains area in NSW. This
trial will include the automatic creation of
electronic health records for more than a million residents to improve coverage rates using
an opt out system, reversing the previous opt
in system.
Residents of the trial, which runs to the
end of the year, have received a letter about
the trial and information on how to opt out if
they wish. The trial will run until the end of
the year.
GP INCENTIVES FOR REGISTERING
General practice is being encouraged to
register and use MyHR through the revised
Practice Incentives Program (PIP) eHealth
incentive. Eligible practices can receive a
maximum payment of $12,500 per quarter.
The new eligibility requirement is for general practices to contribute shared health summaries to the MyHR system for their patients.
General practices will be required to upload
Shared Health Summaries for a minimum
of 0.5% of the practice’s standardised whole
patient equivalent to be eligible for the PIP
eHealth Incentive payment.
MYHR AND PHARMACY – IS IT READY?
The Federal Department of Health has stated
that around 65% of community pharmacies
have dispensing software compatible with
MYHR. However, on 3 July 2016, there were
1,219 of the 5500 retail pharmacies across
Australia registered with the MyHR system.
In the opt out trial areas, at the end of
March, 19 North Queensland pharmacies had
registered, and six in western Sydney.
President of the Pharmaceutical Society of
Australia Joe Demarte said that while progress
with digital health had been slow, pharmacies
needed to register with the MyHR system.
Pharmacy’s IT technology is also catching
up. One pharmacy software specialist Fred
IT will trial its MedView Medicines Workspace during the later stages of the North
Queensland trial. Fred IT CEO Paul Naismith
said that in the early stages the new software
would allow pharmacists to do medicine
reconciliations by giving them access to medicines information from a variety of sources.
This information would also be available to
hospital clinicians and GPs, and eventually
would be able to inform the MyHR itself.
Pharmacies with software able to
connect to MyHR can register online
at: www.nehta.gov.au
Once registered, pharmacies need
to contact their software vendor to
complete the connection process.
Contact NCPHN’s Digital Health
officer Tony Browne on 6618 5405 for
assistance in registering with MyHR.
15
DIGITAL HEALTH
I
FEATURE
3.8M REGISTERED FOR MY HEALTH RECORD
A PRACTICE NURSE PERSPECTIVE: BANORA
SHOPPING VILLAGE MEDICAL CENTRE
NCPHN’S NEW DIGITAL
HEALTH OFFICER
FEATURE
Tony Browne
has a
background in
IT, focusing on
how systems,
processes and
people work
together more
effectively.
Project management has been
a big part of Tony’s background
and he spent a number of years
in Queensland Health in among
a number of government and
private IT organisations across
south east Queensland.
Tony’s really looking forward to
the challenge of improving the
ease of access and quality of
information for both patients
and health practitioners through
the uptake of MyHR across the
region. “My Health Record is a
thing that everyone should have.
It’s even more important than a
Facebook account,” he said.
INTEGRATED HEALTH
Rachel Roy, Practice Nurse at Banora
Shopping Villiage Medical Centre
B
NCPHN CAN HELP
Network staff are working with
general practice to support
them in registering their practice
and patients for My Health
Record. For individual attention
and assistance and help with
any aspect of My Health
Record, please contact your
support officer on 6618 5405.
The team has also created
some easy to understand
pages about registering for
and using My Health Record on
the NCPHN website. View them
at: http://ncphn.org.au/digitalhealth/
16
anora Shopping Village Medical Centre
Practice Nurse Rachel Roy told HealthSpeak that two years ago when she tried
to register patients with the then Personally Controlled Electronic Health Record
(PCEHR), she was confused and dismayed by
the amount of paperwork and time required.
But recently with the help of NCPHN’s
general practice support officer, Kelli Babovic, Rachel has become a My Health Care
Record ‘champion’. She said it takes only
around 30 seconds per patient and generally
she registers six patients a day.
“Kelli has been just terrific. She has
encouraged me and if I have a query I just
email her and she gets back to me usually within half an hour. I’d encourage any
practice to make use of their general practice
support team to help register patients.”
Rachel said that the Medical Centre had
come up with a system of registering patients that was quick and easy and could be
done within other appointments.
“We’ve written an email to all our doctors,
reminding them to broach the question of
My Health Record with each patient they see.
“The doctors ask patients for their permis-
sion and go through the various checks before giving me their names and I go through
the process of logging the patient’s consent
and adding them to the system,” she said.
With a great many patients over 75 and
without access to computers or smartphones
or iPads, Rachel takes the opportunity to ask
patients about My Health Record when doing health care plans or health assessments.
“That’s when I publicise the electronic
health record with them, giving them a flyer
to read if they want to know more. It’s all
about convenience for them as many don’t
have transport and can’t easily get to the
Medicare office.
“So if the patient is sitting with me, I can
show them what I’m doing and they can
consent to what’s in front of them on my
computer screen.”
On the day I visit, Rachel has seen four
patients already and all four have agreed to
register. She said she’s only had a couple of
patients who were concerned about sharing
their information and how it would be used.
Rachel shared some tips on using My
Health Record.
SO IF THE PATIENT IS SITTING WITH
ME, I CAN SHOW THEM WHAT I’M
DOING AND THEY CAN CONSENT TO
WHAT’S IN FRONT OF THEM ON MY
COMPUTER SCREEN.
RACHEL’S TIPS
• Make use of the PHN’s general practice
support team to help you set up a system that works.
• When you register a patient on My
Health Record, enter the information
slowly as if it’s entered too fast, the
system will throw up errors.
• When an error message occurs, click on
the Refresh button and start over.
• Bring up the topic during consults
about care plans or health assessments.
LOCAL DIGITAL HEALTH CHAMPIONS
A GP'S PERSPECTIVE
I
t was through involvement in the Integrated
Care Collaboratives, run by North Coast
Primary Health Network, that Graham and
his staff met with Chris Barron, Nurse Unit
Manager, Byron Shire Community Nursing,
now based at the new Byron Central Hospital
- about the mutual benefits of MyHR.
“Chris was keen for us to consider MyHR
as a better means of communication between
the hospital and Bangalow Medical Centre.
We decided that it would be helpful to get
our significantly chronically ill patients onto
MyHR, so that when they presented at Byron
ED, the doctor on duty could access their past
medical history and medications,” Graham
told HealthSpeak.
Graham works occasional shifts at the new
Byron Central Hospital, and because the practice has now registered their sicker patients –
those more likely to need a hospital stay - he is
now able to talk Individually to doctors in ED
to ensure that they start using MYHR.
“Once these significantly ill patients are registered, it’s really all about trying to get other
health professionals to know that the records
are there and to make use of the information,”
he said.
At Bangalow Medical Centre, the system to
encourage patients to register for a MyHR has
become more streamlined.
“For a couple of months, every time
someone came in who looked like they might
end up in hospital, we talked to them about
feeding their information into MyHR and
then it spread to each time someone came in
for a health assessment and sometimes for a
care plan as well.”
The practice nurses generally look after
updating the patients immunisation and alAugust 2016 healthspeak
WE TRY TO INVEST IN THE MEDICAL
RECORDS AS MUCH AS WE CAN
What Graham would like to see is more coordination with Community Health workers
regarding MyHR.
“At this stage it doesn’t appear to be part of
Community health routine to send the GP a
letter outlining the completion of a series of
patient visits or a treatment episode form. I’d
like to see these people making use of MyHR
as well.
“I’m not quite sure where the community
health records end up, but at the moment we
don’t see any of that in our practice.”.
Graham would also like regular coordination meetings around MyHR set up in order
to improve the flow of information and refine
systems.
“It would make sense to have six monthly
coordination meetings between those people
who have access to MyHR in some way - senior people in community health, in ED and
specialist representatives. It would be useful
to have ongoing ‘get togethers’ to keep people
using the system in the best possible way,” he
added.
NEED HELP WITH
MY HEALTH RECORD?
FEATURE
North Coast Primary Network’s
General Practice Support team
is ready and willing to help
practice staff register and use
My Health Record. If you’d like
a personal visit from one of our
team, contact Tweed team on
07 5589 0500; Lismore team
on 6627 3300; Mid North Coast
team on 6659 1800 and the
Hastings/Macleay team on
6583 3600.
ONLINE TRAINING
Online training for the My
Health Record system includes
simulations on how to view
and upload information to
the My Health Record system
using some common clinical
information systems, as well as
the My Health Record Provider
Portal.
DIGITAL HEALTH
Dr Graham Truswell from Bangalow Medical
Centre
lergy information and the process of patient
consent for MyHRs. The practice also made
use of their medical student to talk to patients
about consent.
“We’ve always spent a lot of time maintaining past medical history, results, discharges
and specialists’ letters, so it isn’t too onerous
to upload usually. Some doctors are better at it
than others. It’s become one of the processes
within the practice and we try to invest in the
medical records as much as we can.”
Graham said that patients have not had any
privacy issues around MyHR, although some
have requested that certain past medical history items be deleted.
Graham has no concerns about discharge
summaries from Emergency Departments –
the practice is receiving them and the system
is working well through Byron, Lismore and
Tweed Hospitals. However, he is hoping that
if one of his patients registered with MyHR
goes to a Sydney hospital, then he’ll receive
a discharge summary from there, something
that hasn’t happened in the past.
Examples of the topics covered
in the training are:
• The types of clinical
documents held in an
individual’s My Health
Record
• Consent and how it
relates to viewing and
uploading of clinical
information
• Accessing an individual’s
My Health Record in the
event of an emergency
• Ensuring quality data is
uploaded to My Health
Record.
To access this training, visit
myhealthrecord.e3learning.
com.au.
17
THE INTRODUCTION OF
'HEALTH CARE HOMES'
N
HEALTHDIRECT
Healthdirect offers the following
services
FEATURE
• National Health Services
Directory: http://www.
healthdirect.gov.au/
australian-health-services
• Healthdirect nurse helpline:
call 1800 022 222
• After Hours GP Helpline: call
1800 022 222
• Pregnancy, Birth & Baby:
advice and support on 1800
882 436
•Mindhealthconnect
website: http://www.
mindhealthconnect.org.au/
INTEGRATED HEALTH
• Palliative Care After Hours
Helpline: Phone 1800 548 225
5pm to 9am, 7 days a week.
• My Aged Care: information
on care and local services
on1800 200 422
• Carer Gateway: Help for
carers, call 1800 422 737
Monday to Friday 8am to
6pm.
18
ext year there will be a staged rollout
of a nationally supported Health Care
Home model to provide Australians with
improved co-ordination, management and
support for chronic conditions.
The Health Care Home (often referred
to the ‘Medical Home’ or ‘Patient Centred
Medical Home’) is a high quality and cost
efficient approach to patient care.
Health Care Homes will be rolled out
from July 1, 2017 in seven trial regions based
on Primary Health Network boundaries.
Health Care Homes will be trialled in up to
200 general practices and Aboriginal Medical Services.
This model will allow patients to nominate
a GP practice as their ‘home base’, where
they will have access to tailor care packages and simplified care management. Up
to 65,000 Australians will participate in the
two-year trial of Health Care Homes which
is limited to Medicare-eligible patients with
two or more complex or chronic conditions.
The aim of a successful Health Care Home
model is to keep patients healthy at home
and out of hospital by providing continuity
of care, coordinated services and a team approach based on the needs of the patient. My
Health Record will be an essential element
of the Health Care Home trial.
NEW HEALTH DIRECT PRODUCTS
Heath Direct continues to manage and
strengthen the GP After Hours Helpline.
As you may know, the free Helpline service
provides access to a GP over the phone, and
operates at night from 6pm to 8am, as well
as weekends and public holidays.
Practices should also be aware that the
Helpline will refer patients, when a face to
face consult is required, to local general practices which are open by using the National
Health Service Directory (NHSD).
Therefore, simply ensuring your practice details are up to date can bring in new
business. Knowing this may support your
decision to consider extending your practice
hours by opening earlier, closing later or
introducing new Saturday or Sunday hours.
The NHSD is a national register of allied
health services which provides consumers
with easy access to reliable health services
information. This includes medical clinic
contact details, location, opening hours,
wheel chair access and bulkbilling services.
To check your NHSD listing. go to http://
www.nhsd.com.au/ If you aren’t already
listed in the Directory, register at: www.
healthdirect.gov.au/nhsd-registration If
your service is currently listed but the information is incorrect or incomplete please
email updates to [email protected]
Your Primary Health Network General
Practice Support Team can assist you to add
your service information to the NHSD if required. Once registered, consider diarising a
staff member to update details every month
or so to ensure your practice information is
accurate.
Health Direct also has funding from the
state and federal governments to provide a
number of other health information services
for the consumer.
The 24 hour Palliative Care Helpline
Supports people who receive palliative care,
their carers, parents and families, particularly
when other medical care is not available after
hours. They provide advice and support for
pain management, medication information,
equipment (eg syringe pump) and basic
counselling support. The hotline number is
1800 548225. http://www.healthdirect.gov.
au/the-palliative-care-after-hours-helplinensw-only
Pregnancy, Birth and Baby (PBB)
A support and information service for expecting parents and parents of children aged
0-5 years. It provides trusted information
from healthcare professionals. The service is
available seven days per week and the number is 1800 882 436 or via a video call www.
pregnancybirthbaby.org.au
Over the coming weeks your General
Practice Support Officer will be mentioning these services as well as offering a range
of promotional material for the use of your
patients. If you require more information or
resources immediately, contact Diana Anderson, Senior Program Coordinator – After
Hours on 0409 249 728 or danderson@
ncphn.org.au
The vital role of mental
health nurses: Ochre
GP Superclinic, Grafton
I
t’s a Tuesday morning and
the waiting room is bustling
with patients. HealthSpeak has
been invited to meet the clinic’s
two credentialed mental health
nurses, Scott Hanson and Bronwyn Gibson. Practice Manager
Carol Pachos explains the need
for these specialist nurses.
“Because we have so many
GPs here, there’s a flow on effect
with allied health, we could have
another full time mental health
nurse here,” she said.
Doctors at the SuperClinic
refer patients to the nurses and
numbers are growing with Scott
and Bronwyn having 160 patients
on their books.
Both nurses are flexible and
never knock back a patient
desperate to see someone. Scott
and Bronwyn are permitted 500
consultations each per year under
the mental health care plan and
Scott also sees clients under
North Coast Primary Health Network’s Healthy Minds program.
They also use Extended Primary
Care plans.
Bronwyn is warm and bubbly
with a quirky sense of humour
that puts people at ease. She’s
always had a passion for mental
health.
For nine years Bronwyn’s
worked as a mental health nurse
and came to Ochre after colleague Scott, with whom she’d
worked before, encouraged her to
get credentialed.
“I did my Masters, a prerequisite, and Scott was hounding me
when I was working out the back
of Broken Hill to get the paper
work done to become credentialed,” she said.
Bronwyn has now been working in Grafton for two years.
“We provide counselling and
support for patients, help them
with paperwork, whatever they
require. Mental health isn’t just
what’s going on inside your head,
it’s also your external environment. It could be looking for
housing which around here is difficult, financial struggles, limited
work opportunities. Helping
them this way relieves some of
their anxiety or depression, they
know there’s someone to support
them,” she explained.
Both nurses have a four week
waiting list and manage clients
with a range of conditions.
The clinic has also set up a free
Healthy Lifestyle group on Fridays where clients are invited to
come in and do some craft work
together.
“Scott’s trying to get a men’s
group up and going too and I
also do a women’s group - Sassy
Sadie’s Sewing, we call it to make
people feel a bit better.
You don’t realise
how isolated
some people are.
Here they listen to
each other might
exchange numbers
to connect over
coffee
“A lot of people with anxiety
can’t go out in public, so they
come to the group, share food
and sit around talking. You don’t
realise how isolated some of these
people are. Here they listen to
each other might exchange numbers to connect over coffee.”
Scott’s been working at the
SuperClinic for four and a half
years. He discusses clients with
the doctors to work out the most
suitable program. Clients with
anxiety and depression make up
three-quarters of cases.
Practice Manager Carol Pachos and nurse Bronwyn Gibson with some
of the artwork created by clients in their Healthy Lifestyles group.
“There are a lot of personality
issues involved and I’d say clients
with comorbidities as far as
alcohol and cannabis and ice are
concerned would run at around
75%,” said Scott.
He is understandably proud
that despite the caseload he and
Bronwyn manage, over four
years they’ve only had a tenth of
one per cent of clients who’ve
ended up in hospital, a brilliant
outcome.
Scott would love to see the
clinic employ at least one more
mental health nurse. He’d also
like to see university programs
encourage nurses to consider going into mental health while they
are training.
As I leave the SuperClinic,
Carol tells me a story that sums
up the compassionate approach
the clinic extends to its patients.
“A couple of weeks ago a grandma came in with a 14-year-old
boy experiencing mental health
issues – he’d been using cannabis
since he was 11. They’d been up
to the hospital and he’d been dis-
charged without seeing anyone
from the mental health team. She
said ‘I think this is his last day on
the planet’. She was at her wit’s
end and he was not even our patient. So I took the grandma and
the boy out into our courtyard.
Bronwyn came out and had a
chat and took the boy in with her
and started to connect with him.
He’s now in our program and has
the support he needs.”
View past issues
Did you know you
can read HealthSpeak
online?
Go to www.issuu.com/
healthspeak and see all
16 issues.
19
Koori Grapevine
Visit to
low vision
clinic
N
CPHN’s Closing the Gap
program officer in Coffs
Harbour Helen Lambert has coordinated regular Wellness Days,
providing health information for
the Elders of Jagun Aged Care.
Recently, a Guide Dogs NSW/
ACT team from Coffs Harbour
has collaborated with NCPHN,
resulting in a group booking for
Jagun Elders at the Low Vision
Clinic at Eyecare Plus in Nambucca Heads.
Blindness rates in Aboriginal
and Torres Strait Islander people
are six times higher than those
found in other Australians.
Around 94 per cent of vision loss
is unnecessary and much of it
can be resolved overnight, yet 35
per cent of Indigenous Australians have never had an eye
examination. The leading causes
of blindness and vision impairment are: cataract, diabetic
retinopathy, refractive error and
trachoma.
The Elders had their vision tested and lifestyle issues
relating to their vision will be
addressed by Guide Dogs NSW/
ACT Orientation and Mobility
Instructors. Where required, appropriate Low Vision Aids were
issued to clients to improve their
quality of life, and follow up
plans put in place to ensure the
clients’ ongoing needs are met.
Seven elders had vision and
eye health tests with three
clients requiring new glasses.
Two clients were referred to an
ophthalmologist and assistance
was provided through NCPHN’s
Care Coordination and Supplementary Services program to
cover the cost of consultation
and transport to and from the
appointment.
boriginal Elders of Bowraville and the Nambucca
Valley have produced a stunning
triptych painting and presented
it to North Coast Primary Health
Network in appreciation of the
Wellness Days the Network
helped to instigate.
The painting tells a story of
“the gathering of learning, to
balance wellness within the community”. NCPHN’s Indigenous
Health Program Officer Helen
Lambert said staff were very honoured to be given the painting.
“It’s an honour for us to work
with the Ngambaga Bindarry
Community Services (NGBCS)
Elders to improve their health
20
Guide Dogs NSW/ACT Jeremy Hill & Lyndel Bosman, with NCPHN’s Helen Lambert (centre)with the staff and
Elders from Jagun Aged Care.
Elders show their appreciation
Pictured from left: Aunty Laura, Ken, Sue, Bev, Rhonda, Bill, Aunty Vi,
Maria, Aunty Loretta, Les and Muriel.
A
outcomes. The painting will hang
in a prominent place in our office
for everyone to enjoy,” she said.
The painting was completed
at an art and craft day run to
celebrate the success of the
Wellness Days, which have been
running now for 18 months.
A year and a half ago, Helen
Lambert met with Rachael Gillin of NGBCS to develop the
idea of health information days
(Wellness Days) for Elders at
the service and those living in
Bowraville and the Nambucca
Valley. NBGCS provides support
services to Aboriginal people
who are elderly, frail aged, living
with a disability or act as a carer.
The Elders embraced the idea
and named the events Girrwaa
(Gumbaynggirr for big mob)
Wellness Days. Such gatherings
are important for this community which is a remote area and
lacks public transport, an ambulance station, hospital or taxis.
At each monthly Girrwaa Wellness Day, health professionals
provide information on a particular health topic such as diabetes,
foot care, dementia, nutrition
etc. The information is delivered
in an informal way to ensure a
culturally safe space exists, which
in turn promotes active interaction and participation.
Helen Lambert said that the
Wellness Day events provide an
opportunity for yarning, discussing health issues, making them
personally relevant and taking
away learnings
“The Wellness Days contribute to the social and emotional
wellbeing of the group. In addition, the yarning circle allows the
group to support and encourage
one another. By increasing the
health literacy of the group, participants can keep one another
on track for a healthier lifestyle,”
she said.
NNSWLHD commits to bigger Aboriginal workforce
N
orthern NSW Local
Health District (NNSWLHD) has made a commitment
to a more diverse workforce by
embracing NSW Health’s Stepping Up campaign.
Stepping Up is a website that
helps Aboriginal people find jobs
in the health sector.
NNSW LHD Chief Executive
Wayne Jones said Stepping Up
assisted employers in finding Aboriginal candidates for positions
across the health sector.
“Stepping Up provides information and tools to help managers
find the best person for each
position,” Mr Jones said.
“It’s important we place people
in jobs that match their skills,
experience and aspirations so
they’re more likely to stay in the
health workforce and carve a
meaningful and successful career.
“NNSW LHD is committed to
increasing Aboriginal representation in our health workforce and
it’s very encouraging to see such
a high number of hits on the
Stepping Up website.”
The website highlights a range
of employment opportunities including medical and primary care
practitioners, nurses, midwives,
service and program managers,
Aboriginal Health Workers, Aboriginal Mental Health Workers,
Wayne Jones
administrators and leadership
positions.
The Stepping Up website
provides:
• Guidelines on employing
and supporting Aboriginal
staff
• Information on cadetships
and scholarships
• Help with searching for a
job
• Information about available
positions
• Job application tips
• Information about submitting a job application
• Details on screening and
checks.
The Stepping Up website can be
viewed at: www.steppingup.
health.nsw.gov.au
Aboriginal mothers: much greater
risk of preventable death
A
study by researchers at the
Telethon Kids Institute
has found Aboriginal mothers
are at a significantly greater risk
of preventable death than other
Australian mothers.
The study, published in BMC
Public Health, found Aboriginal
mothers were much more likely
to die from external causes,
such as accidents, suicides and
homicides, and usually left more
and younger children.
Telethon Kids Institute
researcher Dr Carrington Shepherd said the loss of a mother
can have a deep-rooted impact
on families and the team’s study
highlighted the need for more
to be done to protect this at-risk
group from premature death.
“Maternal loss can have a
particularly traumatic impact
on children and their development,” Dr Shepherd said.
“This can include prolonged
periods of grief, depression,
stress, anxiety, problems with
identity development, the
difficulties associated with the
transition to out-of-home care,
and the onward elevated risks of
substance abuse and suicide in
later life.”
Bulgarr Ngaru wins Kidney
Health Award
Staff receiving their award on Reconciliation Day
I
n late May, Kidney Health
Australia’s Indigenous
Project Officer Michael
Mullins travelled to Casino
to present Bulgarr Ngaru Aboriginal Medical Corporation
with an Award of Excellence
for service in addressing
Chronic Kidney Disease in
the region.
While there Michael
met with the Casino AMS
Chief Executive Officer
Steve Blunden and key staff
members to discuss possible
opportunities that may arise
in the near future.
The Official presentation
of the Award was made to
coincide with the Reconciliation Day Celebration where
Michael presented the Award
to the Chronic Disease
Coordinator Kylie Wyndham
and clinical staff renal nurse
practitioner Graeme Turner
and Debbie Caldwell.
Michael acknowledged
their tremendous work in
addressing Chronic Kidney
Disease and expressed hopes
that Kidney Health Australia
can look forward to working
more closely together in the
future.
Bulgarr Ngaru’s award was
one of the new Primary Care
Awards given out by Kidney
Health Australia. The Awards
were adjudicated through
Kidney Health Australia’s Primary Care Education Committee, comprising prominent
kidney specialists, health
professionals and educators.
Congratulations to Bulgarr
Ngaru for their great work in
the field of chronic disease.
21
Transfusions spread HIV in India
Anti-viral condoms for athletes
A
T
t least 2,234 Indians have
contracted HIV while
receiving blood transfusions
in hospitals over the past 17
months.
The information was revealed
by the country's National
Aids Control Organisation in
response to a petition filed by
information activist Chetan
Kothari. Mr Khothari told the
BBC that he was "shocked" by
the revelation.
India has more than two million people living with HIV/
Aids.
The highest number of
patients who had been infected
with HIV as a result of contaminated blood in hospitals, were
from the northern state of Uttar
Pradesh with 361 cases, Mr
Kothari's query revealed. The
Indian capital Delhi is at number
four with 264 cases.
Under law, it is mandatory
for hospitals to screen donors
and the donated blood for HIV,
hepatitis B and C, malaria and
other infections.
"But each such test costs
$US18 and most hospitals in
India do not have the testing
facilities. Even in a big city like
Mumbai, only three private hospitals have HIV testing facilities.
Even the largest government
hospitals do not have the technology to screen blood for HIV,"
Mr Kothari said.
his month, Australia will
compete at the Olympics
in Rio de Janeiro, and will supply them with condoms and
antiviral lubricant that provide
more protection than regular
condoms.
The condoms and lubricant will help protect against
sexually transmitted diseases
including HIV, genital herpes,
and human papillomaviruses. They might also protect
against the Zika virus.
The condoms help prevent
infection through a combination of defences. The first layer
of is the the condom itself.
The second layer of protection is the lubricant, called
VivaGel.The condoms are only
antiviral when used with the
lubricant.
The VivaGel lubricant also
potentially provides added
protection against HPV which
is a causative agent in the development of cervical cancer.
Third symposium a great success!
By Professor Iain Graham
Dean, School of Health
and Human Sciences
Southern Cross University
I
n May, the third annual
Nursing and Midwifery
symposium organised by the
School of Health and Human
Sciences, at SCU, in partnership with the Nursing and
Midwifery Directorate of the
NNSWLHD took place.
The reviews were most positive and the event is maturing
nicely. The title was, ‘ Celebrating the Diversity of Nursing
and Midwifery Practice’. Acting CNMO, Anne Robertson
presented the key address.
The papers presented by the
region’s nurses and midwives
went under four themes – Research Activity and its impact
on nursing actions; Patient
Centred Care; Employment/
Work relationships and Technology; and Self-Care Skills
and Knowledge.
Ms Robertson provided
some interesting insights into
how nurses and midwives are
22
responding to the impact of
health system change. The
needs of an ageing population,
technological developments,
advances in self-care and
chronic health care management all require a strong
nursing voice and role she told
delegates - and one which this
region’s nurses and midwives
were responding to.
The first theme demonstrated the importance of
nurses’ involvement in research
to expand evidence-based care
structured around quality indicators. The papers presented
also suggested that research
helps nurses to find their voice
and ensure their contributions to care are warranted and
purposeful.
The second theme’s papers
raised issues around systems,
processes and evaluating care
provision. The need for such
systematic approaches to
care is due to the fact that the
complexities of human nature
and the experiences of patients
throughout their health and
wellbeing journey require a
sophistication not considered
when organised health care was
first devised.
The importance today of
matching resources to patient
need is crucial and these papers
spoke about the need for
nurses to understand workflow,
care delivery and the required
interventions in order to
provide a more patient centred
approach to care. This requires
a synthesis of both the art and
science of nursing in order that
the actions of review- plan-actreview-change can be achieved.
The third theme’s papers
included discussion about
the fact that nursing requires
that nurses themselves listen
to each other about care
provision more honestly and
reflectively.
Nursing is a 24/7 business built around team work
and requiring ongoing
educational development
and execution. Patient care
defines the role of the nurse
or midwife. The patient’s story
should inform them as to what
work is required, but the need
to continually ensure one’s
competence and capability as a
practitioner was central to this
theme.
The last theme focused on
the concept of professional accountability and responsibility.
Assuming responsibility allows
one to be held accountable and
thereby be granted a degree of
autonomy for one’s practice.
These papers raised the need
for nurses to know what was
required of them by patients
and from others if this was to
be achieved.
The demands on our evolving health and social care systems will require a reappraisal
of many current practices and
activities. I look forward to
the offerings at next year’s
Symposium.
Ensuring children are ready to learn in Tabulam
A
s a joint initiative between
Bulgarr Ngaru Medical
Aboriginal Corporation – Richmond Valley, Northern NSW
LHD, North Coast Primary
Health Network and The Royal
Far West, child health check days
have been held at Tabulam Primary School in May and July this
year; and at Tabulam pre-school
in March.
The child health days aim to
improve the health and wellbeing
of all children involved, through
the identification of health issues,
the early detection of risk factors
and the promotion of healthy
lifestyles.
At Tabulam Primary School,
all students from Year K to 6
completed a comprehensive
child health check which included growth, vision, hearing,
oral health, nutrition, developmental and medical screening. In
addition, students from Year K
to 3 had a speech and language
assessment. Hearing assessments were performed on the
Royal Far West Healthy Kids
bus which was at all screening
Kinship
Day:
promoting
healthy
living
I
Staff from the various organisations that partnered to hold the Child
Health Check Day in Tabulam.
days to complement the services
provided. All families received
feedback after the screening and
follow up appointments with
clinicians were recommended if
needed.
Joan Clay, Child and Family
nurse at Bulgarr Ngaru – Richmond Valley said that it was great
to watch the children go through
the various health stations and
interact with each of the staff.
“At the end of the day we all
get together and have a case
conference to plan forward for
the children’s health as required,”
she said.
Claire Malseed, Aboriginal
Maternal and Child Health
Program Officer at NCPHN said
that schools were an ideal setting
to conduct these multidisciplinary health checks.
“It is important that health
and education staff are working
together to ensure that children
have no health issues affecting
their ability to learn at school.”
Ticks: potential for anaphylaxis
R
esearchers have reported
the first confirmed cases of
tick-induced anaphylaxis in the
world and they are in NSW and
Queensland. They came about
during attempts to remove ticks
rather than killing them while
under the skin.
Published in the Journal of Allergy Clinical Immunology Practice online July 6, the researchers
from the Australian Venom
Research Unit in Melbourne
and Watkins Medical Centre
in Brisbane said that usually
tick-related deaths are linked to
paralysis from tick toxins.
To find the cases, the
researchers combed coronial
and hospital mortality reports
identifying four cases attributed
to anaphylaxis following bites
between 1979 and 2013.
One death occurred in a man
with a severe allergy history to
ticks and bees – he lost consciousness after removing a
tick from his neck. Despite the
administration of adrenaline,
the man died the following day.
The researchers can’t be certain
whether the device failed or it
was a case of epinephrine-resistant anaphylaxis.
The other cases involved a
man with a history of pneumo-
thorax and mild asthma who
collapsed after a tick was dislodged from his scalp; another
who died within an hour of a
tick being taken out of his hand;
and a woman with a history
of tick bite allergy and asthma
who was found to have a tick on
her scalp during a post mortem
examination.
In a research letter, the authors said the cases were most
likely attributable to I holocyclus [the paralysis tick] and
represent the first documented
fatalities from tick bite-related
anaphylaxis.
They added that ‘given the
lack of recent fatal tick paralysis
cases, tick-induced anaphylaxis seems as important, if not
potentially more significant than
tick toxicity.’
n May, members of the
Northern Rivers and
Tweed Aboriginal Health
teams represented North
Coast Primary Health
Network at the Murwillumbah Kinship Festival,
to celebrate Aboriginal
kinship, culture, and connection during National
Families Week.
The festival opened
with a traditional smoking ceremony and corroboree. Other features
included local musical
performers, a free bush
tucker lunch, arts and
craft workshops, and
elders sharing stories and
wisdom.
In addition to providing resources and
guidance regarding the
services offered through
the NCPHN, the team
enjoyed the chance to
talk with the community
about making positive
health choices, particularly in relation to food.
Aboriginal Health Project Officer Ruth Taylor
commented: “We see
nutrition as being absolutely foundational when
it comes to the Closing
the Gap initiative, and
while education regarding
food choices is only one
element, because other
barriers to good nutrition
are also significant, these
events provide the perfect
platform for education,
and so we want to take
advantage of that!”
23
Changes to Children Protection Act
C
hapter 16A is a chapter of
the NSW Children and
Young Persons (Care and Protection) Act relating to information
exchange.
Its objective is to help provide
services to children or young
people by authorising and requiring the sharing of information
between ‘prescribed bodies’ in a
collaborative fashion. Information that relates to the safety,
welfare or wellbeing of a child
can be exchanged without client
consent and takes precedence
over other laws.
Since the enactment of the
Act, the following are prescribed
bodies:
• the NSW Police Force;
• a NSW government department or public authority,
including the Department of
Family and Community Services, Community Services;
• a NSW government school
or a registered non-government school;
• a NSW TAFE;
• a NSW public health organisation or a licensed private
health facility;
• a FACS-accredited or
FACS–registered out-ofhome care agency;
• a FACS-accredited adoption
service;
• the Family Court of Australia, the Federal Magistrate’s
Court of Australia, Commonwealth
• Department of Human
Services and the Commonwealth Department of
Immigration
& Multicultural & Indigenous
Affairs; and
• any other organisation
which has direct responsibility for, or direct supervision
of, healthcare, welfare, education, children’s services,
residential services, or law
enforcement, wholly or
partly to children.
The Regulation brings the
following private health practitioners into the requirements of the
Care Act, regardless of whether
they work for an organisation or
not:
•nurses
• registered medical practitioners
• registered midwives
• registered psychologists
• persons registered under the
Health Practitioner Regulation National Law to practise
as occupational therapists
(other than as students),
• speech pathologists eligible
for membership of Speech
Pathology Australia.
The Regulation also extends alternative reporting arrangements
to the Health Child Wellbeing
Unit under section 27A of the
Care Act to all registered medical
practitioners and general practice
nurses (NB not all groups above).
This will enable these health
professionals to report child
protection concerns to the NSW
Health Child Wellbeing Unit
as an alternative to the Child
Protection Helpline thus fulfilling
their obligations as mandatory
reporters under the Care Act.
The contact number for the Child
Wellbeing Unit is 1300 480 420.
This information can be found on
the HealthPathways website at
: https://manc.healthpathways.
org.au/88091.htm
Password: conn3ct3d
For further information contact:
Anne Norman, Child Wellbeing
Coordinator (Mid North Coast
Local Health District) anne.
[email protected]
Nicole Ashby, Child Wellbeing
Coordinator (Northern NSW Local
Health District) nicole.ashby@
ncahs.health.nsw.gov.au
It’s a hearing hat trick
L
ike many Aboriginal and
Torres Strait Islander
Australians, Bundjalung man
Joshua Fares, and his 15-yearold-son William, both experienced middle ear infections
throughout childhood, which
has led to them developing
hearing loss.
The good news for William
is that he is the recipient of
a ‘hearing hat’, a first for the
Clarence Valley region, but
an innovation that families in
remote communities would be
familiar with through Australian Hearing.
“On a recent visit to Bulgarr
Ngaru for his hearing check,
the audiologists from Australian Hearing told us about
a hearing aid that goes into a
24
hat,” explained Joshua.
“We only needed to pay
for the hat William wanted
which was $20. The hearing
aid was supplied by Australian
Hearing.”
The hearing hat has a bone
conduction hearing aid tucked
securely inside. Microphone
tubing pokes through a hole
on top of the hat to pick up
speech sounds. It is a clever
option for young people like
William who might feel more
comfortable in a hat than
wearing a hearing device on
its own.
“The hat makes it easier to
wear hearing aids as I don’t
feel like it stands out so much,”
said William. “I got to pick the
style and it’s just right for me!”
William and Joshua with the hearing hat in Grafton.
William, his parents and
teachers all agree the hearing
hat has brought improvements
to his schooling including
having the confidence to ask
and answer questions, while
feeling happier overall.
Australian Hearing provides
government-funded hearing
services and hearing devices
for eligible Aboriginal and
Torres Strait Islander children
and adults.
To contact the nearest
Australian Hearing Centre call
131 797 or visit www.hearing.
com.au
Easier referral pathway for aged care
ups,” said Sue.
Here’s a summary from the
fact sheet about how to make
referrals:
How do GPs make referrals?
To refer a patient on to My
Aged Care for an assessment, it
is preferred that GPs use either
of two methods:
• Use the online health
professional referral form
that be accessed via the
‘Contact Us’ page on the
My Aged Care website or
via MyAgedCare.gov.au/
referral; or
• Call the My Aged Care
contact centre on 1800 200
422.
Note that referrals can also
be faxed to the My Aged Care
contact centre, however be
aware that if a referral is made
via fax (1800 728 174), the
contact centre will be unable
to acknowledge receipt of the
Feature
Ps will know that over the
last 12 months there have
been a lot of changes to the My
Aged Care website and how to
refer older patients for assessments. These changes, while
improving the process, have
created a lot of confusion among
health professionals.
Sue McGuigan, RAS Manager, Northern NSW Aged Care
Assessment Team (ACAT) told
HealthSpeak that a new fact
sheet and webform will make
things a great deal easier and
smoother for both doctor and
patient. The new fact sheet will
also, hopefully, clear up any
confusion.
“By using the new webform,
which recognises GPs as a
trusted referral source, GPs can
bypass the contact centre staff,
where assessment referrals can
go astray, and have their referral
sent directly to ACAT staff.
There is also a tracking system
with an ID number for follow
referral.
When the online referral form
is used referrers will receive confirmation that their referral has
been received as well as a unique
reference number so they can
follow up the referral if necessary. Further benefits include
faster processing and the ability
to print and save the web form
as a Portable Document Format
(PDF).
The fact sheet including
information on the webform can
be found at:
https://agedcare.health.gov.
au/programs/my-aged-care/
general-practitioner-fact-sheetjune-2016-update
Promoting Healthy Living
M
ost people do not look
forward to the day when
they move from their own
home to an aged care facility
to get the support and health
care they need. Feros Care, with
three villages in the Northern
Rivers, is working to make the
transition to residential aged
care a positive one. Pets are
welcome and another way
to help residents connect is
through Feros Care’s use of
technology.
Using video conferencing,
Feros has partnered with Bay
Medical – a general practice in
Byron Bay - to meet the needs
of seniors living in residential
care with complex conditions.
Over the past two years,
Bay Medical has conducted
more than 400 video calls with
Feros Care Village in Byron
Bay involving four GPs and 48
seniors. This video access has
Feros resident Maggie in a video conference session with her GP
meant that 52 hospital admissions have been avoided, and
the transport cost for seniors
reduced by a massive $40,000.
In addition, care has been able
to be provided in after hours
situations without the resident
having to leave the facility.
A weekly virtual clinic has
been operating for 18 months.
The video call replaces faxes
and phone calls with a more
meaningful connection for both
seniors and general practitioners.
The use of video conferencing in this way has resulted in
this project between Feros Care
and Bay Medical becoming a
finalist in both the inaugural
Care Excellence Awards and
the 2016 HESTIA Aged Care
awards.
Helping seniors embrace
technology to improve their
wellbeing is another aim for
Feros Care. Wheel.I.Am, a telepresence robot, beams vision
of art gallery tours, surf checks,
and local street life back to
residents in villages who would
otherwise be unable to experience these things. Similar technology enabled Alma to attend
her grandson’s wedding in the
UK virtually from Feros Care’s
Wommin Bay village. According
to Alma, she had the best seat in
the house. “The wedding was
so far away but was right there,
on my tele. It was so special, not
just for me, but for my grandson
too” she said.
25
Aged Care Update
G
Feature
Symposium put spotlight on dementia
A
Aged Care Update
two-day Aged Care
Symposium being held
in Ballina in late July focused
on the theme The Forgotten
Issues of Dementia - Emerging
Insights and Developments. The
Symposium was a collaborative
event hosted by the Northern
NSW Local Health District and
Network.
More than a dozen guest
presenters took the stand over
the two days covering a range of
topics from caring for someone
with a cognitive impairment to
the delicate topic of sexuality
and dementia.
The guest line up provided
Kate Swaffer
a broad understanding of the
challenges faced by people
living with dementia. Two
workshops were held at this sold
out event concurrently looking
at the experience of dementia
as well as how to build memory
bridges and establish care competency goals with dementia.
The day that HealthSpeak
attended, the Symposium had
three fascinating speakers – former nurse Kate Swaffer who has
written a book on her personal
experience off onset dementia;
Professor Wendy Moyle talking
about the use of robots, such as
harp seal lookalike Paro in residential aged care and psychiatrist Dr Graeme Halliday who
brought the audience up to date
on severe domestic squalor and
the mental states of those living
in such conditions.
Relevant
HealthPathways
topics
HealthPathways has a
number of pathways relating
to older patients.
Go to https://manc.
healthpathways.org.au
(username: manchealth;
password conn3ct3d) and
clock on older person’s health
on the menu tab at the left.
Pathway topics in this section
include Cognitive Impairment
& Dementia; Elder Abuse &
Neglect, Falls Prevention;
Depression in Older Persons;
Navigating Services for Older
Persons and Before Entering
Residential Aged Care.
Most common hospitalisation for dialysis
D
uring 2014/15 there were
over 10 million hospitalisations overall, with the most
common reason being dialysis for
kidney disease (1.4 million hospitalisations), followed by cancer
(1.1 million).
This information is contained
in an Australian Institute of
Health & Welfare report released
in late July.
About one in four hospitalisations involved surgery, with 60%
of surgery occurring in private
hospitals. Cataract extractions
were the most common surgeries
performed (246,000).
Public hospitals admitted
Free program to reduce
alcohol use
N
SW Health has
launched a free alcohol
reduction program to help
people improve their health
by reducing their alcohol
consumption.
The program, The Get
Healthy Service, consists of
10 coaching calls, coupled
with alcohol-related education, management and goalsetting strategies. Participants
can set a weight, healthy
eating, physical activity or alcohol reduction related goal.
Designed for people aged
18 and over, the program is
aimed at people wanting to
reduce their alcohol consumption to reduce risk fac-
26
tors for chronic disease and
achieve a healthier lifestyle.
All participants will be
screened for their alcohol
risk at the time of enrolment using the Alcohol Use
Disorders Identification Test
(AUDIT). To ensure safe
clinical practice, people who
are drinking harmful levels
of alcohol will be referred to
appropriate specialist services
such as the Alcohol and Drug
Information Service.
To register a patient or for
more information visit the
Get Healthy Service website
www.gethealthynsw.com.au
or telephone 1300 806 258.
about 700,000 patients from
elective surgery waiting lists, with
50% admitted within 35 days of
being placed on the waiting list.
For the first time, outpatient
clinic data were provided for all
public hospitals that provide
these services.
Around 34.9 million outpa-
tient services were reported.
About 46% of outpatient service
events occurred in allied health
and/or clinical nurse specialist
clinics.
Thirty per cent occurred in
medical consultation clinics, 13%
in procedural clinics and 10% in
stand-alone diagnostic clinics.
Updated COPD Resources
F
ollowing the latest revision
of the COPD-X Guidelines,
Lung Foundation Australia has
updated the corresponding resources including the COPD-X
Concise Guide – a useful summary of the COPD-X Guidelines
available online as a fully searchable PDF with practice tips to
aid clinical care.
Other valuable resources
updated include the Stepwise
Management of Stable COPD,
COPD Action Plan and the
COPD Medicine Wall Chart.
All the resources now include
the latest pharmacotherapies
which were updated in the
COPD-X Guidelines after a
review of the published evidence
up to December 2015.
Download resources here:
The Stepwise Management
of COPD
http://lungfoundation.com.au/
health-professionals/guidelines/
copd/stepwise-managementof-stable-copd/
COPD Action Plan
health-professionals/clinicalresources/copd/copd-actionplan/
COPD Concise Care Guide
http://copdx.org.au/wpcontent/uploads/2016/03/
LFA-COPD-X-Concise-Guide_
V3.02_0316_web.pdf
COPD Medicines Wall
Chart
wp-content/uploads/2014/02/
COPD-Medicines-Wall-Chart_
A4.pdf
What is health literacy?
Health
Literacy
Northern NSW
Health literacy is important because
it affects how well you can:
Health Literacy is a
priority to improve
the health of people
in Northern NSW
Health Literacy means how
well people can access,
understand and act on health
information and services. It
also means how easy health
systems are for people to
navigate, and how health
professionals communicate
with patients and carers.
Find the right services
and doctors
Manage your own
chronic health conditions
Show up at
appointments
Take medicine the
right way
Fill out health
forms
Tell doctors about your
medical history
Approximately
Look after your
own health
Health
Literacy
eLibrary
Understand how risky
behaviours affect health
CAP
Consumer/
Health
carers
Professionals
Ambassador
Literacy
Program (CAP) Champions
Better:
Follow advice about how
to stay healthy
Health
System
Policy
Patients
as Partners
in their
own care
60
%
of Australian adults do not
have the level of health literacy
needed to meet the complex
demands of day to day life.
patient quality of life
patient satisfaction
patient care experience
Healthier people in Northern NSW
[email protected]
What is?
What is Feldenkrais?
Profile
Janet
Auret –
Feldenkrais
Practitioner,
Clunes
F
Moshe Feldenkrais in a training session
The aim is a body that is organised
to move with minimum effort and
maximum efficiency, not through
muscular strength but increased
consciousness of how it works.”
Moshe Feldenkrais, D.Sc.
T
he Feldenkrais Method
facilitates learning through
lessons that explore movement,
posture and breathing, resulting
in mproved ability in all aspects
of life.
The Feldenkrais Method is
tailored to meet an individual’s
needs and interests and is beneficial in a variety of applications
- from childhood development
to older adults, sport and performance to chronic conditions, injury prevention to rehabilitation.
People of all ages can participate, from babies and children
through to senior citizens, with
interests ranging from dancing,
music and athletics to people
seeking to relieve movement
difficulties, stiffness or pain, or
simply to learn a new way.
The Feldenkrais Method uses
the brain’s ability to change in
response to specific sensory
input. This neuroplasticity is
central to the Method’s effectiveness.
Participating in this learning process can lead to better
28
health and well-being, improved
attention, thinking, emotional
resilience, posture, coordination and balance, easier ways of
doing tasks, easier breathing,
reduced pain and control over
muscular tension.
The Feldenkrais Method is
delivered in two ways:
Classes called Awareness
Through Movement® - a Feldenkrais practitioner guides
participants through a planned
sequence of movement explorations.
Individual lessons called
Functional Integration® - The
lessons are tailored to each
client’s needs. The practitioner
guides movements through
precise touch. The client lies or
sits, comfortably clothed, on a
low padded table. The practitioner brings present habits into
focus and offers new movement
options. The learning is then
applied to activities such as
reaching, sitting, standing and
walking.
To locate a practitioner go
to: www.feldenkrais.org.au/
directory/practitioner/search/
results
To find out more, go to: www.
feldenkrais.org.au/practisingfeldenkrais/health-professionals
or many years, Northern Rivers Feldenkrais
practitioner Janet Auret felt
silenced.
“Because Feldenkrais is
an experiential method it
is so outside of the medical
paradigm. I felt silenced when
talking to physiotherapist colleagues or medical professionals because the way in which I
look at someone’s movement
is different and the language is
different.
“There were no randomised
controlled trials and what is
referred to as ‘evidence based’
research, although Feldenkrais
would argue that he worked
from the evidence before
him. In fact, the Feldenkrais
method does not fit with
randomised controlled trials
because it is so responsive
to each situation. However,
research in recent years on
neuroplasticity has given
Feldenkrais practitioners
voice.”
It was a great relief to Janet
when this research came out,
validating the Feldenkrais
Method and proving that
the brain is a plastic, living
organ that can change its
structure and function, even
into old age. A boost towards
wider acceptance came when
psychiatrist Norman Doidge
included a section on the
benefits of Feldenkrais in his
book The Brain’s Way of Healing. In his first book The Brain
that Changes Itself, Dr Doidge
told stories of stroke patients
recovering their faculties,
children with cerebral palsy
learning to move more gracefully, entrenched depression
and anxiety disappearing,
and lifelong character traits
altered.
“With Feldenkrais we
would say ‘You can do this
movement one way, let’s find
two more options. Our system
has almost infinite possibilities,” Janet said.
Pain and dysfunction can
be relieved by widening our
options.
Janet has been in the Northern Rivers since the early ‘80s
and has worked mostly in rehab, an area of complex injury
and neurological difficulties,
including people with strokes
and acquired brain injuries.
“I was a physio for 10 years
before I came across Feldenkrais, and working in inpatient
rehab I became frustrated at
the limitations of working as a
physiotherapist”’
While Janet’s physio training in Melbourne had been
eclectic, offering a range of
techniques, she soon came
to see that a lot of what she’d
been taught was not what
she saw in the clinical setting.
“One of the things said was
that the most recovery you get
from any brain injury is in the
first six weeks, and after six
months no further recovery
is possible. Yet two years out
as a physio I had a job in a big
rehab complex and one man
came in, a very quiet man
who’d had a stroke four years
previously. He said to me
‘Janet, my fingers have started
moving’ and for four years
they hadn’t moved at all.”
After seeing this recovery
and witnessing that some
people after a stroke were not
up to doing rehab in the first
weeks at all, Janet realised there
were no rules to follow and all
sorts of things could be tried.
However, she still felt frustrated
that she couldn’t do more.
It was around this time that,
during a dance rehearsal, Janet
witnessed a friend doing movements that fascinated her – they
were based on the Feldenkrais
Method.
“They were more organic,
much more about easy movement in space, not so much
dance form as based on normal
movement, and I thought ‘ooh,
that’s interesting.’”
A Feldenkrais practitioner
since 1991, Janet works from
home at Clunes with people
from infancy up. Her practice
is predominantly based on
individual sessions but she also
conducts weekly Awareness
through Movement classes.
For Janet, the great satisfaction of being a Feldenkrais
practitioner comes from the
pleasure of helping people to
find new movement possibilities in themselves.
So how does the Feldenkrais
Method impact on a person’s
life when they have restricted
movement or pain?
“What matters is what’s
important to that person, how
they want to live their life, so
I’m looking to marry what their
interests are with what we can
do to help them get towards
that.
“In the individual sessions
people come to me for all sorts
of reasons, sometimes they’d
like to be better as musicians
or performers, they’d like to
do a movement more easily or
they have a glitch in something
they’re trying to do. Sometimes
it’s because they are starting to
get pain and they can’t perform
as much or as easily as they
used to.
“Others come because
they are unable to move well
post-operatively. They say ‘I’ve
broken my leg, I can’t walk
properly anymore, it’s all healed
but I can’t do what I used to do’.
Neurological work – children
with cerebral palsy and people
who’ve had strokes are big interests of mine.”
Janet harks back to her frustration with terminology when
trying to explain Feldenkrais to
medical colleagues.
“For example the word ‘function’ has a very different meaning in Feldenkrais. Colleagues
talk about getting someone to
walk as a functional activity and
I said ‘This is fine as long as it is
comfortable for them, but if it is
not then we have to teach them
how to walk, so that it becomes
a pleasurable thing for them to
do. It’s about the peeling back
of movement to the level where
you are not stuck in the habit
and you can do it in a different
way.”
Janet describes working
within a Feldenkrais framework
as moving towards improving
people’s lives.
“That may sound grandiose,
but most of us just want to
reach our best potential and
that can be very different from
someone else’s. There’s no
one size fits all, no recipes in
Feldenkrais, other than that you
are working all the time with
the neuroplasticity, our capacity
to learn experientially.
“So I often will start working
with what’s easy for someone
rather than going to the “problem”. I want them to understand
what it is to feel that things
aren’t difficult. When movement feels easy then we will
happily adopt it’ our system will
go ‘yes thank you’, I’m using less
effort I have more energy for
other things, why not?”
Janet also loves the fact that
Feldenkrais is gentle work and
she doesn’t have to use any
technique that causes pain.
“People get to learn to move
and feel better about themselves. And with the children,
particularly those who’ve
been born with a brain injury
(cerebral palsy), giving them
ways, giving them pieces of the
puzzle that they couldn’t get
to themselves so that they can
move through space, so that
they can problem solve, so they
figure it out, that is the greatest
pleasure.”
So, in summary what does
Feldenkrais offer?
“Provided someone is willing
to learn, it offers ways around
situations, ways through. You
are learning to move differently
and that opens up a wealth of
possibilities. For instance, if
someone’s in really chronic pain
they have a cascade of protective reactions and we start to
unpick some of those and work
out which ones may not be really needed.
“In that process the person
gets much more movement and
feels much more like herself. So
the pain, instead of being allconsuming, starts to move out
of central focus. People come
to me with chronic pain but
rather than discussing pain we
talk about what they’d like to be
able to do or what they are having trouble doing, so that pain is
no longer the central part of the
discussion.
Contact Janet Auret
on 6629 1589; fax 6629 1670.
Book: Healing the Heart and Mind with Mindfulness
By Malcolm Huxter, Routledge www.routledge.com
(Also available at amazon.com)
B
uddhist practitioner and
Lismore clinical psychologist Malcolm Huxter has written
a practical book that provides
strategies using mindfulness
to manage stress, anxiety and
depression, and cultivate psychological wellbeing.
In a unique blend of Eastern
and Western wisdom, Malcolm
uses his extraordinary depth of
knowledge to outline how the
Buddha’s four applications of mindfulness
can provide a pathway
to psychological wellbeing and how this
can be used personally or in a healthcare
setting.
Malcolm’s sincere
and easy to digest approach is a must read
for therapists and others who
wish to understand the roots of
mindfulness and how it’s related
to wisdom, compassion and ethical behaviour.
Included are chapters on purpose, meditation, mindfulness
of thoughts, emotions, reactive cyclic
patterns and how to
break free from them,
presence, practice and
aspirations for the
future. The practices
are clearly explained
and supported by real life stories.
Being aware that mindfulness and
meditation are simple but not
easy, Malcolm guides the reader
from the basics of mindfulness
and meditation through to the
more refined aspects.
Also provided are a number of different exercises and
guided meditations which can be
streamed or downloaded online.
Through examples and practical applications, Malcolm does
an excellent job of integrating
the Buddhist understanding of
our human condition and its use
of mindfulness with the modern cognitive and behavioural
psychology practiced today. For
the reader who is ready, this is a
life-changing book.
29
Professional training for the health sector
T
he Northern Rivers Social
Development Council
(NRSDC) has been delivering
community services in Northern
NSW for more than 40 years, but
it’s not well known that NRSDC
also provides professional development and training in the health
services and community sectors.
NRSDC’s Training Coordinator Gabe Morahan said customised in-house training can
be organised to meet particular
training needs.
“Through partnering with
experts in the field, we can save
managers considerable time,
money and stress. We take on all
the administrative tasks involved
in running your staff training,”
said Gabe.
NRSDC offers expertise in
sourcing trainers, marketing
courses, finding venues and
administrating the delivery of
courses to help your staff access
relevant and well-designed training.
NRSDC’s in-house training
service delivers a range of innova-
tion and its staff. All professional
development training sessions are
interactive, based on adult learning principles and are facilitated
by experienced trainers.
Training can be delivered
anywhere across the Northern
Rivers. Contact our Training
Coordinator at training@nrsdc.
org.au or call 02 6620 1810 or
0439 137 207.
tive, creative and flexible training
programs and is a cost effective
solution for small businesses and
organisations.
“One of the important aspects
of any organisation is the ability
to change and adapt as the people
you work with change and adapt
so that you can ensure that you
are meeting their needs. We are
responsive in our program and
will often place training on our
calendar due to specific requests
from our audience. People might
see a particular training on our
calendar and then request that
we offer it as an in-house training
specific to their organisation. We
are happy to do that and have a
lot of experience doing it,” Gabe
explained.
The NRSDC training program
is a expanding component of its
core business. NRSDC’s diverse
range of in-house professional
development training can be
tailored to suit the strengths, challenges and needs of your organisa-
Greenmeadows campaigns against antibiotic resistance
A
general practice in Port
Macquarie has joined with
NPS MedicineWise to create
awareness around the overuse of
antibiotics.
In June, Greenmeadows
Medical Centre staff wore purple
NPS t-shirts labelled Antibiotic
Resistance Fighter to get the
conversation going with patients
about the 29 million antibiotic
prescriptions written in Australia
each year.
The Centre’s NPS MedicineWise clinical services specialist
Lesley Burrett explained that a
lot of prescriptions given out for
antibiotics were unnecessary.
“We know that resistance to
antibiotics is a world wide problem,” said Lesley.
In the general community
there is a mistaken perception
that antibiotics are a cure all,
despite their lack of effectiveness
30
From left: pharmacist Lesley Burrett; Dr Tetyana Seppi, Dr Anthony
Wan, Dr Madeleine Holloway, Dr Nevenka Stancevic, Dr Julia
Edmund, Dr Robert Clarke and Dr Chris Timms
against viruses such as those
causing the common cold.
Community members can
help tackle the problem of antibiotic resistance by not expecting
antibiotics when they present
with virus and only taking antibiotics which are prescribed.
Due to the overuse of antibiotics, infections that were
once easy to treat are becoming
untreatable, a worrying development.
Greenmeadows’ GP, Dr Robert Clarke said that while infections were a common presentation, it was important to work
out the type of infection and the
best treatment for that infection,
which might not be antibiotics.
Coraki Health
One building
starts soon
N
orthern NSW Local
Health District
has awarded the building
contract for the new
$4 millionCoraki Health
One facility. Woollam
Constructions has been
awarded the contract and
has already taken control
of the site.
“The awarding of the
building contract is a major
milestone for the construction of the Coraki Health
One facility, and marks
several years of community
consultation” NNSW LHD
Chief Executive Wayne
Jones said.
Ms Lynne Weir, Executive Director Richmond
Clarence Health Service
Group paid tribute to
the Coraki Health One
Community Reference
Group who have worked
with the NNSWLHD and
the community since this
announcement and she
thanked them for their
involvement and their continued contributions.
“The Health One facility
will meet the primary and
community health care
needs of the residents of
Coraki and surrounding
area now and into the
future, Mr Jones said.”
Grey power and equity
A
re we set for a period of
inter-generational warfare?
It’s probably too early to say but
certainly the seeds of war are
there and the ground is fertile.
Intergenerational clashes are
quite common in history as
the young wrestle control from
the old. But this time it’s a little
different. That large bulge in our
population that comprises the
baby-boomers is in the process
of retiring.
And in democratic western
countries they have the numbers
to swing elections should they
choose to do so. The question
is: will they use their political
power in a democracy to skew
policy making to their own
benefit - and to the detriment
of those who are younger? The
answer is “yes”. In fact it’s already
happening.
Baby boomers are flexing
their ageing muscles in the ballot
box and it is leading to serious
inequities. If it continues then
tensions are likely to rise.
The Brexit is a clear example
of grey power. While the vote
was reasonably close there
was a clear divide between the
attitudes of the young and the
elderly.
We know from surveys that
young people in the UK were
overwhelmingly pro-European
while older Britons were not.
Only 36 per cent of those
aged 18 to 24 bothered to vote
compared with 80 per cent for
those over 65.
The combination of their
greater numbers and the fact
that older people tend to be
more politically active, turned
the vote. Many young Britons
now feel their future has been
compromised and are blaming
their parents. But it doesn’t
stop there.
In the European Union there
are 130 million pensioners and
if they decided to act together
to protect their interests they
Entitlements paid
to the elderly
are skyrocketing
forcing even
higher levels of US
government debt
could determine the outcome
of any election. The same power
dynamics exist in the US and
Australia.
Even if the elderly do not
rally in excited mobs, they have
a power that makes politicians
tread very carefully. Everyone
agrees that pensions in the EU
are far too generous but with the
exception of Greece no country
has seriously cut pensioner benefits despite calls for austerity
and huge budget deficits.
In the US many city municipalities are going broke because
of overly generous pension
schemes granted to their baby
boomer employees. Entitlements paid to the elderly are
skyrocketing forcing even higher
levels of US government debt.
In Australia those aged 65
and over are the fastest growing
population segment. They represent 15 per cent of the population and will grow to more than
25 per cent by mid-century. As a
proportion of the voting population they will be even larger.
Eighty per cent of those 65
and over are on a full or part age
pension and this is not expected
to change. The elderly also put
greater demands on the health
system. Cutting the health
budget is a risky proposition. In
addition the elderly have a firm
grasp on the nation’s wealth,
mainly through real estate and
superannuation investments.
Meanwhile the young are
finding it almost impossible to
enter the housing market with
first home buyers at record lows.
They are also being forced to pay
handsomely for their education
and accumulating large debts.
Climate change too is an
intergenerational issue. Babyboomers have won handsomely
from strong economic growth
over the past thirty years but the
cost of this growth in terms of
climate change will be borne by
finance
David
Tomlinson
younger generations. In addition
the job market today for young
people is extremely difficult – a
far cry from the job stability
baby boomers enjoyed.
Despite this there have been
serious calls for cuts to unemployment benefits while leaving
generous tax concessions to the
elderly untouched. Trying to
change all this will be difficult in
a democratic country.
Now none of this might
matter much if we had strong
economic growth and more
importantly, strong productivity
growth. But over the next few
years, even decades perhaps,
economic growth in developed
countries is expected to be modest, even stagnant.
Trying to be more equitable when the economic pie is
shrinking will be a challenge.
But something will have to
give in terms of reducing intergenerational inequity.
If not, things could get interesting.
31
Spending on palliative med services jumps
O
ver the past five years,
MBS payments for all
palliative medicine specialist
services increased by almost
80%.
In 2014-15, 13,000 patients
received an MBS-subsidised
palliative medicine specialist
service, with around 71,500 of
these services provided nationally at a cost of $5.3 million
paid in benefits, according to an
Australian Institute of Health &
Welfare (AIHW) report.
The report, Palliative care
services in Australia 2016, shows
that palliative care hospitalisations increased by 11% from
55,983 in 2009-10 to 62,164 in
2013-14, but accounted for less
than 1 in 100 of all hospitalisations for both public and private
hospitals.
“As the Australian population
grows and people live longer, the
demand for palliative care services will increase,” said AIHW
spokesman Tim Beard.
“These services provide relief
from pain and other distressing symptoms for people who
are dying. Such services are in
New allied health
building at SCU, Coffs
Southern Cross University Vice Chancellor Professor Peter Lee,
federal Member for Cowper Luke Hartsuyker, Coffs Harbour City
Council Mayor Denise Knight and Chamber of Commerce President
George Cecato.
S
outhern Cross University
has welcomed a $12 million investment from the Coalition government for stage one
of a new allied health building at
the Coffs Harbour campus.
Vice Chancellor Professor
Peter Lee said it was fantastic
news for Coffs Harbour.
“This is an exciting day for the
University and the Coffs Harbour community. This investment will enable us to proceed
with stage one of our allied
health building, paving the way
for new courses and facilities for
students and the community,”
Professor Lee said.
32
“We will introduce degrees in
speech pathology and occupational therapy and establish the
SCU Health Clinic, an innovative model of providing community care and professional
experience for our students.”
Professor David Lynch, head
of the Coffs Harbour campus,
said the concept for the allied
health building was well-developed.
“We are shovel-ready for this
project. The funding will enable
us to complete stage one and we
will continue to look for funding
opportunities to complete the
additional stages.”
increasing demand as patterns of
disease at the end of life change.
“An increasing proportion of
Australians are suffering from
chronic illnesses, and people
are therefore more likely to die
from chronic illnesses and make
use of palliative care services,”
he said.
The most common principal
diagnosis for palliative care
hospitalisations was cancer
(53%), which accounted for 1
in 25 (4%) of all cancer-related
hospitalisations.
Palliative care-related hospitalisations also accounted for
nearly one-third (30%) of all
hospitalisations with a principal
diagnosis of pancreatic cancer,
followed by lung cancer (29%)
and liver cancer (20%).
New RACGP President
T
asmanian GP, Dr
Bastian Seidel, has been
announced as President-elect
of The Royal Australian College of General Practitioners
(RACGP).
Dr Seidel, who will take
over the role from current
RACGP President Dr Frank
R Jones in September, has
vowed to build on the RACGP’s growing public profile
to ensure general practice
remains at the heart of public
dialogue on health.
“I am absolutely delighted
and honoured to have been
elected by our members to
this important role and look
forward to making a positive
impact on behalf of Australia’s general practitioners, our
college and our patients,” he
said.
“With general practice
funding increasingly under
briefs
Folic acid in bread
paying off
Mandatory fortification of
bread with folic acid and
iodine, introduced here
in 2009, has resulted in
improved health outcomes,
particularly for teenagers
and Aboriginal and Torres
Strait Islander women,
according to a report from
Dr Bastian Seidel
threat the role of the RACGP
in representing and communicating the interests of
members and patients has
never been more important.”
Dr Seidel praised incumbent RACGP president Dr
Frank R Jones for his achievements.
“I will endeavour to be as
passionate and vocal in advocating for primary healthcare
as Dr Jones but he will be
hard act to follow.”
the Australian Institute of
Health and Welfare.
The report shows that
there was a significant
(14.4%) overall decrease
in the rate of neural tube
defects (NTDs) in Australia
following fortification.
However among teenagers,
the rate of NTDs decreased
even more, by almost
55%, and for Aboriginal
and Torres Strait Islander
women, the rate of NTDs
decreased by 74%.
Across the road and
over the mountain
‘
I’d prefer a new edition of the
Spanish inquisition or a dentist to be drilling…’ Remember
Rex Harrison in that old musical
My Fair Lady?
It rings true with my childhood memory of the dentist in
1958, those early experiences
leaving me with an irrational fear
of dental work. The slow speed
drill was actually pedalled by a
huge dentist on a bicycle stool
as he gouged my dental pulp. He
threatened me one day with a
horse gag if I could not keep my
mouth open.
Then- progress - he had
electricity. It didn’t help much.
Maybe it was worse as he was
not distracted by pedalling and
could apply his evil pressure
faster. I must admit, I feel much
more relaxed these days, because my lovely dentist has the
nitrous oxide option.
Early in my career, I was a
busy GP anaesthetist. I know
something of nitrous oxide and
have administered a lot of this
analgesic gas to unconscious
patients, during lengthy operations, as a total respiratory replacement for inert atmospheric
nitrogen. To the anaesthetist,
the floating, twirling, flowmeter
bobbins gave constant re-assurance of the necessary 25% oxygen additive. Nitrous oxide must
be considered an amazingly safe
agent to use, so much so that
dentists can use it without the
presence of an anaesthetist.
In the conscious patient
this ‘laughing gas’ can enable
happy sensations, but dosage to
response is vital and the dentist
told me that some people can
become panicky or disoriented.
It’s not for everyone.
One day recently at the
dentist’s, the nurse told me of
her uncle who was in pain with a
terminal illness. Did I know how
to get some medicinal cannabis
for him? She had been asked and
wanted to help if possible.
Articles in the local paper
refer to the Nimbin Hemp
Embassy so I suggested she start
there.
It did however arouse my curiosity and I asked some friends
whom I thought might be in the
know. ‘No problem really,’ I was
told. ‘You can buy it openly in
the computer repair shop’. That
was a surprise.
Next time in town, I wanted to
verify this, except my computer
was working quite well, denying
me an excuse to shop. I went in
anyway. To my surprise, there
was large sign advertising the
sale of CBD oil. The young man
behind the counter was very
helpful and said it was almost
legal because the oil did not contain THC, though expensive at
$280 for a small bottle. He even
gave me his card.
I was telling a friend about the
whole confusing issue and she
replied with a parable. A tourist in an Islamabad restaurant
ordered the chicken. Examination of the dish revealed it to be
suspiciously mammalian and
when questioned as to if it was
truly chicken, the waiter replied,
‘Ah Sir, but it is nearly chicken’.
So, it seems that maybe ‘oils
ain’t oils’ and further research
was needed. According to my
Apple Mac (the one not needing
repairs) trials done at Kings
College in London showed that
10mg of THC (tetrahydrocannabinol) caused psychological
and behavioural differences but
600 mg of CBD (Cannabidiol)
did not cause these effects rather it relieved pain, improved
sleep, controlled fitting and
enabled a sense of relaxation.
THC, something any GP
knows, accentuates psychosis.
According to the researchers
these effects are ameliorated by
CBD. It will be interesting to
see the results of trials already
underway with the NSW Government. In the meantime I have
heard a fair amount of anecdotes
that people who believe the
early claims are already voting
with their feet. Suffering does
not wait.
At my next dental appointment, I told the nurse the news
that it might be available across
the road but she told me she
had already taken my advice
and gone over the mountain to
Nimbin. She reported that the
Hemp Embassy was very helpful
and a nice hippy had directed
her downstairs. ‘Just go through
the green door’.
‘It was quite crowded in there,’
she reported as I started to relax
for the dreaded filling, ‘full of
straight people from Brisbane’.
light airs
David
Miller
The young man
said it was almost
legal because the
oil did not contain
THC, though
expensive at $280
for a small bottle
Editor’s note: The Australian
parliament passed national laws
paving the way for the use of
medicinal cannabis by people with
painful and chronic illness earlier
this year. Under the new scheme,
patients with a valid prescription
can possess and use medicinal
cannabis products manufactured
from cannabis legally cultivated in
Australia, provided the supply has
been authorised under the Therapeutic Goods Act. The changes
put medical cannabis in the same
category as restricted medicinal
drugs such as morphine.
33
Dying: A Memoir
Cory Taylor
Text $27.00
C
learly, Cory Taylor was
alive when she penned this
insightful and elegantly presented book, but as the title indicates
she was certainly not well, having
been diagnosed with terminal,
melanoma-related brain cancer.
“Cancer strikes at random,”
she notes, pragmatically. “If you
don’t die of cancer you die of
something else, because death is
a law of nature.”
Quite so, but it is the way one’s
death occurs, and to an extent
why, that guides her musings, if
that is not too light a term.
For instance, what if she
had been more vigilant about
checking her skin, “because if I
had been, I would have picked
up that first melanoma before it
turned bad, and saved myself a
lot of heartache.”
Another ponderable entails
a near-death experience when
a teenager’s speeding car had
brake failure, ran a red light and
ploughed into her parked vehicle a split second after she had
stepped out.
A bystander said she had been
a millimeter away from losing
her legs.
Now, aged 60, house-bound,
weighing “less than the neighbour’s retriever” and coping with
a terminal diagnosis, she writes,
“So many times I’ve wondered
what might have happened to
me if I had lost my legs, or even
just my right one, where my first
melanoma appeared two or three
years later.
“If I’d just been a second
slower stepping away from the
car, I might not be dying now. I’d
be legless, of course, but still in
good health.”
Yet this is much more than a
catalogue of what-ifs, tempting as
it may be “to envy the life of the
alternative me” who looked like
settling permanently in Paris, or
becoming an expert in the constitutional history of NSW when
studying at Oxford.
Rather, it is a clear analysis of
the dying process and another
important contribution to the
debate about drug assisted euthanasia. In the latter regard, Taylor,
a highly regarded writer (of the
acclaimed novels Me and Mr
Booker, and My Beautiful Enemy)
book
review
Robin
Osborne
echoes the views of longtime MS
sufferer and North Coast author
Gillian Mears who died recently.
She wonders if medicos’ aversion of assisted dying “might
stem from a more general
belief… that death represents a
form of failure… (and) can be
banished from our consciousness
altogether.”
An attendee of Exit meetings,
she possesses drugs bought
online from China, kept in a
vacuum-sealed bag in a secret
place, along with a suicide note,
and contemplates the ease with
which she could end her life.
No doubt swallowing a fatal
dose and never waking up would
be preferable to facing a “lingering and gruesome demise”. Yet
she hesitates, mindful of the
emotional impact on those
“unfortunate enough to discover
my corpse.”
It worries her that the death
certificate would list ‘suicide’ as
the cause of death, “with everything that the term implies these
days: mental angst, hopelessness,
weakness, the lingering whiff of
criminality - a far cry from, say,
the Japanese tradition of seppuku,
or suicide for honour’s sake [her
husband Shin is Japanese].
“The fact that cancer was
actually my killer would be lost
to posterity, as would be the fact
that I am not, by any fair measure, mad.”
Taylor’s mother was also a supporter of assisted dying, but by
the time she was lost to dementia
“had left it too late to put theory
into practice.” So was her father,
an airline pilot whose erratic lifestyle dragged the family across
the world, who suggested sailing
out into the Pacific and drowning
himself. He even asked his wife
to buy a half share and to crew
for him.
In one of her flashes of humour, Taylor writes, “Maybe they
should have sailed off into the
sunset never to return; instead
they lived on and died badly.”
She is determined not to share
this fate, so keeps her stock of
drugs while engaging the help of
a valued palliative care team that
includes volunteer biographers
who record patients’ stories and
present a bound copy of the
finished product to the families
of the dying.
It hardly seems necessary to
extend this service to an author
whose memoir offers as much
insight and reflection as anyone
could deliver in just 150 pages.
Cory Taylor died on July 5 ‘peacefully, at home and surrounded by
friends’.
CVD rate falls by one-third
T
here have been good gains
in the health of the Australian population, with the overall
burden of disease and injury reducing between 2003 and 2011.
According to the Australian
Burden of Disease Study: Impact
and causes of illness and death in
Australia 2011, released by the
Australian Institute of Health
and Welfare (AIHW), there was
a 10% fall in the total fatal and
non-fatal components combined.
“This was mainly due to a 15%
34
fall in fatal burden - in other
words people are not losing as
many years from dying prematurely as before - but there was
also a 4% fall in the non-fatal
burden,” said AIHW spokeswoman and report co-author Dr
Lynelle Moon.
Among all the disease groups,
the largest fall in the fatal burden
was seen in cardiovascular diseases, where rates fell by nearly
one-third.
“We found that chronic diseas-
es such as cancer, cardiovascular
diseases, mental and substance
use disorders, and musculoskel-
etal conditions still dominate in
terms of total burden, along with
injury,” Dr Moon said.
“In fact, these 5 disease groups
combined, accounted for around
two-thirds of the total disease
burden-69% in males and 62%
in females. In terms of non-fatal
burden only, mental and substance use disorders along with
musculoskeletal conditions had
the greatest impact, accounting
for nearly one-half of the total
non-fatal burden between them.”
Increasing Cardiovascular Fitness
with High Intensity Interval Training
W
hile there is nothing
new about the use of
High Intensity Interval
Training (HIIT) to
improve the performance of elite
athletes, could the
same principle be
applied to someone
who is overweight
and sedentary?
And indeed, HIIT would
be ideal for busy unfit people
who often cite a lack of time as
the reason for not participating
in exercise.
Canadian study
A recent small study under
researcher Professor Martin
Gibala at McMaster’s University
in Ontario, Canada, investigated
whether sprint interval training (SIT) was a time efficient
strategy to improve insulin
sensitivity and other indicators
of cardio-metabolic health to
the same extent as traditional
moderate intensity continuous
training (MICT).
The exercise component
The SIT involved 3x20 second
‘all out’ sprints (~ 500W)
interspersed with 2
minutes of cycling
at 50W, whereas
MICT involved
Andrew
45 minutes of
Binns
continuous cycling
at ~70% maximal
heart rate (~110W).
Both protocols involved a 2
minute warm up and a 3 minute
cool down.
The major novel finding from
the study was that 12 weeks of
SIT in previously inactive men
improved insulin sensitivity,
cardio-respiratory fitness and
skeletal muscle mitochondrial
content to the same extent as
MICT. This was despite a fivefold lower exercise volume and
training time commitment.
Sedentary
Lifestyle
reduced aerobic capacity
reduced mitochondrial number
Ageing
insulin resistance and diabetes
cardiovascular disease (CVD)
Similarly effective
SIT involved 1 minute of
intense intermittent exercise
within a time commitment of 10
mins per session whereas MICT
consisted of 50 minutes of
http://tinyurl.com/jflwl5c
continuous exercise at moderate pace. There was a similar
In the study, SIT involved 1
19% improvement in V02 peak
minute of intense stationafter 12 weeks of SIT
ary cycle exercises
and MICT which
within a 10 minute
compares favourably
Look out for stairs
time commitment.
with the typical
to climb and
In contrast, MICT
change reported afascend as quickly
involved 50 minter several months
as possible
utes of continuous
of traditional endurexercise per session.
ance training.
The study went over 12
So, how could these
weeks with sessions three times
findings be used to give advice
weekly.
to people in everyday life?
Despite the association beThere are many ways a version
tween low amounts of physical
of this type of activity could be
activity and an increased risk
incorporated into the lives of
of many chronic diseases, the
even the most sedentary people.
prevalence of physical inactivFor example, look out for stairs
ity is higher than that of all
to climb and ascend as quickly
other modifiable risk factors for
as possible. If cycling, look for
cardiovascular disease.
With a minimum time
commitment, we can
wake up those sleeping
mitochondria, lose fat,
improve insulin sensitivity
& cardiovascular fitness
Aerobic,
Resistance
and HIIT
Excercise
increased aerobic
capacity
increased resistance
to fatigue
increased endurance
increased fitness
reduced risk for
diabetes
reduced risk for CVD
steep hills rather than flatter
ground. Adding some resistance
training may also help to build
muscle strength.
Exercise & heart risk
One word of caution: there is
always the risk of a major heart
event with training whether
intense or moderate. A large
Norwegian study of people who
had already had a heart event
were put through high intensity
training and moderate intensity
exercise in a cardiovascular
rehabilitation setting.
http://circ.ahajournals.org/
content/126/12/1436.full
Among the 4,846 patients,
a total of 175,820 exercise
sessions lasting ≈1 hour were recorded, distributed on 129,456
hours of moderate-intensity exercise and 46,364 hours of highintensity exercise. Overall, the
incidences included one cardiac
arrest with fatal outcome during
moderate-intensity exercise and
two non-fatal cardiac arrests
Continued page 35
35
Health&Lifestyle
Making connections through art
H
ealthSpeak visits artist
Lorraine Abernethy at
her Bilambil Heights home. A
vibrant woman with an infectious enthusiasm for all things
creative, it’s clear Lorraine’s passion for art has been lifelong.
“I was born in Armidale and
came here when I was six. My
mother was a painter and my
grandmother taught me to sew
and knit and crochet. The artist
brings out several of her ‘soul
dolls’ for me to look at. These
are soft form dolls created to
represent where a person is
at in their life. They can be an
archetype – dolls that contain a
person's inner wisdom and their
personal medicine which may
be accessed at any time.
Lorraine explained that these
soul dolls reference play when
she was a little girl and used to
like making dolls’ clothes.
“Art is a place of refuge for
me, you can enjoy your own
space and I got a lot of praise as
a child in relation to doing stuff,
so that shapes you too,” said
Lorraine.
Lorraine studied art when her
children began school and then
focused on art exhibitions and
teaching.
A series of challenging losses
in her life – a divorce, the death
of a partner, and the death of
her eldest son– became a path
on which Lorraine became
equipped to teach more holistically, with more awareness and
understanding.
“This doll is one of about
thirteen I’ve made, a ‘Mother’,
she’s pregnant with ideas and
creativity and has a soft tummy,
She’s also a winter doll, a good
time to incubate ideas.”
Lorraine uses the dolls in her
Art as Healing Workshops and
as one art form offered at weekly
workshops she runs for people
with mental illness; workshops
she’s run now for 14 years.
The dolls came out of Lorraine’s training in transpersonal
art therapy which focuses on
36
self-realisation and facilitates
personal growth, giving a sense
of meaning to the participant.
“The product [artwork] is
something that you are moving
along towards, but the journey
is so much more important, and
hence the healing aspect and the
curiosity about life and what it
brings up for you…I encourage
people to look within at their
own inner journey as well as
their outer journey. I like the
analogy of being Alice jumping
down the rabbit hole and you
don’t know where you are going
or who you will meet,” Lorraine
said.
Lorraine enjoys her Tuesday Connections workshops
for those with mental illness
auspiced by On Track because
she never knows who’s going to
turn up.
“The participants might
be dealing with physical and
mental disabilities and I learnt
a long time ago that you don’t
the focus of getting into something they enjoy.
“Doing something
creative helps to still
the mind and helps
Lorraine Abernethy
reduce their stress or
at her home in
anxiety. It can also
Bilambil Heights
with some of her
help them to become
soul dolls
more mindful.
“I find people start sharing their stories, too, because
they feel safe. There might be
someone new in the group feeling a bit vulnerable and sharing
can help them relax.”
Because Lorraine has been
leading the group for so long,
for a lot of the participants
it’s like their home, ongoing,
safe and with a strong sense of
family.
She says working with
participants whose ages are
from 25 through to 70s is very
different from working with
her art students in more formal
workshops.
“In the Connections workshops it’s always a bit of a
struggle to do an art project. My
come in with a big plan. I always
role is about supporting them as
have painting and drawing maa facilitator, walking with them.
terials and then I broaden it by
You can help to direct them on
offering some mosaic work. For
some things, but if they don’t
example, making mosaic cut out
want to go there, that's OK. It’s
hearts or other wooden shapes.
not like art school where you
“We did a project
have to complete an art
where we created
project, it’s very flexmosaic around
ible.”
a garden bed
Some very
years ago.
There might be
talented people
I also got
someone new in the
have been
the guys
group feeling a bit
through the
to paint
vulnerable and sharing
Connections
can help them relax
tables with
art workshops.
colourful
“Several young
images like a
people who come
mural, which was
regularly, they’re
then sealed, and now
very talented and I have
we’ve just stripped the tables
sold a lot of their work at the
back and painted them white,
art exhibitions we have had. As
ready to redo them again. We’ve
an artist, it gives one a sense of
also created some murals on the
self worth to have your work
outside of the building.”
purchased and acquired. A
Feedback from her On Track
reinforcement of what you are
groups informs Lorraine that
doing.
people like the quiet atmo“Another young person is
sphere, being with others and
Continued page 39
Health&Lifestyle
Coffee: why you can enjoy it every day
I
s coffee part of your lifestyle? bean, while the espresso drinkDoes the first cup of coffee in ers enjoy the Arabica, with just
the morning make you feel norhalf the caffeine. Go over the
mal? Do you get the odd muscle 400g mark (about four cups of
twitch with your fourth cup of
espresso) and you may be enterthe day, or a headache
ing serious diuretic terriif you go without it?
tory, with leaching of
Welcome to a select
minerals and water
band of coffee
soluble vitamins,
drinkers called the
perhaps gastritis
Chris
Ingall
majority. You are,
and anxiety, and in
along with the 46%
the long run osteoof Australians who
porosis.
drink coffee, and the
Many drinkers mix
38% of Australians who drink
it up, having an espresso if one
tea, up for a stimulant.
is handy and drinking Instant
You are more likely to be pro- when it isn’t. Stopping by the
ductive in the hour or so after
local coffee shop on the way to
your flat white, less irritable and work, lashing out and buying an
more relaxed; in the long run
espresso machine for the office
less likely to succumb to cirand even going out for a break
rhosis from your alcohol intake, between patients are all ways we
have a better cup, the pressure
and at lower risk of Parkinson’s
disease, renal and gall stones. So extracting flavour and the short
marriage between water and
go ahead and have one or two,
roasted, ground bean minimisand maybe even three, but four
may be stretching it.
ing bitterness. Perfect really.
It is not only caffeine which
The time of day is what gets
exerts positive effects, but other me, with nadirs occurring regualkaloids and substances in the
larly at ten in the morning and
bean, such as clorogenic acid
two thirty in the afternoon. I
and caffeic acid (type 2 diabetes have my latter coffee just before
protection) and kahweol and
I put my head down (yes even
cafestrol (some cancers and
if the waiting room is full) for a
inflammation). Caffeine helps
ten-minute nap, and waken as
performance before
fresh as, well, a daisy.
exercise, and
I understand the
possibly muscle
science behind
recovery after,
this is the
The bean has been with
especially
coffee takes
us for many centuries,
with water
about fifteen
and has allegedly excited
goats, birds and donkeys
and some
minutes to
along the way to its
glucose. Go
kick in, which
discovery
the lycra latte!
is about the
Having said
time I wake.
that, the studies
The sleep lowers
are mainly metamy adenosine levels
analyses, and we need
then the coffee binds the
some good controlled studies
molecule’s receptor, ensuring
of lower doses of coffee for
about an hour of energetic clarity. A coffee nap, no less!
ordinary drinkers.
Here on the North Coast
If you are one of the two
we are blessed
thirds of coffee sippers who
drink Instant you can have up to with many
fine producers
five cups, as that gives you the
of coffee, and
estimated maximum 400g caffeine for the day, but you will be have our pick
drinking the inferior Robusta
of plantation
or shade coffee, the latter existwith civilisation from its begining in a rainforest environment
nings in Ethiopia to its spread
and arguably making a gentler,
across the planet today. We are a
more flavoursome brew. Higher lowly 42nd in the world per capaltitudes and hotter climes exert ita consumption, so we need to
the plant to infuse the bean
get cracking and lift our game.
with more caffeine, which is by
Our patients will thank us!
the way an insecticide which
protects the leaves. Our lower,
milder terroir gives a naturally
lower level of caffeine, which I
prefer.
So what to tell our
patients? If they
notice gastrointestinal sympIt is not only caffeine
toms at either
which exerts positive
effects, but other alkaloids
end soon after
and substances in the
imbibing,
bean,
such as clorogenic
caffeine may
acid
and caffeic acid
be the culprit.
Irritable bowel
syndrome, heartburn and a sensation
of oesophageal reflux
are not uncommon, so advise
them accordingly. Sometimes
an adjustment in dose is all
that’s needed. A maximum
of 400g each day and 200g
if pregnant is a good
rule of thumb, and
the vast majority of people
will enjoy
their coffee
untroubled.
The bean
has been with
us for many centuries, and has
allegedly excited
goats, birds and
donkeys along the
way to its discovery, so it has
married
well
37
Health&Lifestyle
Caffeine in soft drinks and energy drinks:
Health implications for children
M
depression. Studies are now
ost parents wouldn’t
linking consumption of caffeindream of giving their
kids a mug of coffee, but might
ated and energy drinks with the
routinely serve soft
rise in childhood obesity.
drinks containing
Soft drinks and energy
caffeine. A stimudrinks generally
By Anna Huddy
lant that affects
include a massive
Program Coordinator
children and adults
dose of sugar. This
– Healthy Eating
similarly, caffeine is
can result in a tenActive Living Team,
NNSWLHD
naturally produced
dency not to eat or
in the leaves and
drink better sources
seeds of many plants. It
of nutrition which can
is defined as a drug because it
result in significant implicastimulates the central nervous
tions for weight gain, but also
system. At lower levels it can
importantly for malnutrition. A
enhance alertness and make
variety of nutrient rich foods are print ‘‘Consumption should
not exceed one can per day”, yet
people feel more energetic.
vital for growing children and
they are sold in a four-pack.
These principal effects may be
young people.
There is no Acceptable Daily
seen as beneficial in moderate
Alarmingly, in 2013 the
Intake
for caffeine. However, a
doses for adults, but what about American Association of Poison
literature
search by the Expert
the effects for children? The
Control Centres reported the
Working
Group
of Food Stanquestion, which has become a
highest number by far (879)
dards
Australia
New
Zealand
matter of research and consider- of energy drink overdoses in
(Oct
2014)
provides
evidence
able debate is, how does this
children aged 5 or under. Many
of
increased
anxiety
levels
in
affect their health?
countries have banned the sale
children
at
doses
of
about
3
Caffeine is a drug with no
of energy drinks to minors due
mg of caffeine per kilogram
nutritional value. Sugar, also
to energy drink related deaths
of bodyweight per day. This
addictive, contains nothing but
and other adverse effects,
equates to a caffeine
kilojoules. The combination of
yet such a ban
dose of 95 mg per
has not been
caffeine and sugar, along with
day (two cans
imposed in
a few other ingredients such as
Children
hooked
on
of cola) for
Australia.
guarana, theobromine, theophcaffeine
can
suffer
children aged
The Austraylline, taurine, ginseng, amino
withdrawal
symptoms
5-12 years and
acids and vitamins, typically
lian Medical
such as headache,
about 210 mg
make up the highly marketed
Association
sleeplessness, irritability
per
day (three
products called ‘energy drinks’.
has backed
and depression
cups
of instant
For more than 30 years caffeine
calls to ban
coffee)
for adults.
consumed by children in the
this type of
In
2010
the
form of soft drinks and energy
drink.
American
Academy
drinks, has skyrocketed. Since
For adolescents
of Paediatrics recommended
energy drinks were introduced
and young adults, mixing
that
children not consume
into the Australian market
energy drinks with alcohol
drinks
with caffeine loads
about 15 years ago there have
increases the potential harm as
greater
than 50mg/serve. The
been several poisonings in
the caffeine can mask the effects
Australian
Food Standards
young children as a result of acof intoxication, making the
Code
(AFSC)
states that energy
cidentally consuming them.
consumer feel more alert and
drinks
must
contain
no more
Caffeine added to sugary
less drunk (CHOICE article).
than
32mg
of
caffeine
per
drinks disrupts neural developMixing energy drinks with
100ml.
However,
most
250ml
ment and increases anxiety,
alcohol increases dehydration.
bottles
of
energy
drinks
have
leading to abnormalities in
A 16 -year-old Australian girl
about
the
same
amount
of
cafbehaviour and socialisation.
died in 2002 after consuming
feine
as
an
espresso
shot
and
Children hooked on cafthree cans of a branded pre-mix
many energy drinks contain 2 to
feine can suffer withdrawal
of soda, vodka and guarana in
3 times the amount of caffeine
symptoms such as headache,
just over an hour. The preas in cola soft drinks (CHOICE
sleeplessness, irritability and
mixed can states in very small
38
article 2014). Thankfully the
AFSC states that energy drinks
must also carry the warning
label, "Contains Caffeine, Not
Recommended for Children,
Pregnant or Lactating Women
and Individuals Sensitive to
Caffeine”.
The key to the problem with
caffeinated food and drinks
loaded with sugar is not the
individual dose but the effect
on long-term, continuous
consumption. There is currently
no health policy or even public
awareness about limitations of
caffeine for children and adolescents. This leaves the responsibility to parents who must
monitor their children’s intake
– difficult to do with so many
sources of caffeinated beverages
and foods now readily available
and skilfully marketed.
Write for
HealthSpeak
Are you interested in
writing an article for our
new Health & Lifestyle
section?
We’d love to hear from
you. Get in touch with
Editor Janet Grist on
[email protected]
From page 36
very talented with cartoons
and has a strong sense of purpose in what he does.”
And it's not just young
people, several of the elders
have created stunning works
of art as well.
The Connections participants are often mostly men,
which Lorraine said is a bit
unusual for a creative group.
“I’m often amazed at how
many men come to Connections where we may have
conversations that lead to
more internal things, such as
loneliness, or the difficulty
of living with an illness.” The
participants have a range of
mental health disorders such
as bipolar, schizophrenia,
anxiety, depression etc.
Although her Connections
clients sometimes ask to be
taught art, Lorraine prefers to
engage them more gently.
“There is a great art move-
ment called Outsider Art. This
is artwork created by people
who live on the margins of
life with little or no formal
art training. Like Outsider
Art, I don’t teach art to these
people. Formal training can
stifle a person. I’ll show
them a few technical ways to
approach something if they
wish, but it’s so important to
engage them in being creative,
allowing their individual
creativity to have an outlet,
whatever that strength is.”
Lorraine and her artist husband Ian Tremewen recently
spent a couple of months in
The Maldives as Artists in
Residence, creating and teaching art to visitors and locals.
Find out more about
Lorraine’s art classes,
workshops, exhibitions and
view her work at: www.
goldcoastartclasseswork
shopsnorthernnsw.com
From page 35
Check CV health first
The results of this study
concluded that the risk of a
cardiovascular event is low after
both high-intensity exercise and
moderate-intensity exercise.
Considering the significant
cardiovascular adaptations
associated with high-intensity
exercise, such exercise is worth
considering for patients with
coronary heart disease as well as
those who are healthy but sedentary. However, there should
be an appropriate cardiovascular
check up first.
So maybe there is a message here for all of us? With a
minimum time commitment,
we can wake up those sleeping
mitochondria, lose fat, improve
insulin sensitivity and cardiovascular fitness. And there are no
time excuses about fitting this
activity into a busy schedule.
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39

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