One health system
The National Health and Hospitals Reform Commission (NHHRC) recently released its final report, A healthier future for all Australians. Bennett, Chair of the NHHRC, outlines the key themes behind the 123 recommendations and the recommended “one health system”, which would give the Australian Government close to total responsibility for government funding of all public health care services across the care continuum — both within and outside hospitals (→ A healthier future for all Australians: an overview of the final report of the National Health and Hospitals Reform Commission). Stoelwinder says that a federal government takeover of funding public hospital services could possibly worsen rather than solve health care governance problems (→ Final report of the National Health and Hospitals Reform Commission: will we get the health care governance reform we need?). Hickie says that an independent implementation authority, with sufficient resources and legislative power and a timeline for delivery, would have a greater chance of achieving real change (→ National health reform: it’s time for a decision). In introducing the Journal’s latest Health Care Reform series, which will include these and other articles published first online, MJA Editor Van Der Weyden says now is the time for the medical profession to present its views and recommendations, before a policy and implementation plan are ground out (→ Reforming Australian health care).
Although Staphylococcus aureus bacteraemia probably causes more deaths in Australia than occur on our roads, there is very little investigation into the causes of and preventable factors in individual episodes, say Collignon and Cruickshank (→ Staphylococcus aureus bacteraemias: time to act). In this linked editorial, they comment on research by Turnidge and colleagues (→ Staphylococcus aureus bacteraemia: a major cause of mortality in Australia and New Zealand), which found a 20% mortality rate associated with such infections. They also comment on a highly successful quality improvement project reported by Dendle and colleagues (→ Staphylococcus aureus bacteraemia as a quality indicator for hospital infection control), which found that such infections were linked particularly with intravascular catheters. Collignon and Cruickshank conclude that it is time not only to measure these life-threatening episodes much more accurately, but also to examine each case and intervene to stop further cases occurring.
Promising early days
The limited National Bowel Cancer Screening Program has already had an impact, albeit a small one, on the diagnosis of colorectal cancer (CRC) in Australia, say Ananda and colleagues. Data collected from 19 Australian hospitals revealed that 40 of 1268 cases (3.2%) of CRC had been detected via the program. Further, these cancers were detected at an earlier stage of disease, with a likely beneficial impact on survival. The researchers say that the small overall impact of the program will persist unless, and until, it is expanded to involve more age groups and until participation increases, especially among the more disadvantaged (→ Initial impact of Australia’s National Bowel Cancer Screening Program).
Women living with domestic violence have delayed leaving their home or returned home to their abusive partner out of concern for their pets, according to research conducted by Travers and colleagues. Doctors are encouraged to ask patients experiencing domestic violence whether they have pets, whether their pets are at risk of abuse, and whether they need help to keep their pets safe. The RSPCA New South Wales Safe Beds for Pets program provides emergency accommodation for pets of women and children seeking refuge from domestic violence (→ Cruelty towards the family pet: a survey of women experiencing domestic violence on the Central Coast, New South Wales).
It’s a knockout
“When I asked the ambulance officer if I had been knocked out on the field [playing rugby league], he told me I’d had a cardiac arrest . . .” John Brady’s story of his life-to-date in Inala, Queensland, was a finalist in this year’s Dr Ross Ingram Memorial Essay Competition. It’s an ironic story of competing priorities, in which the very thing that caused so much stress in his life also led to his life being saved (→ My story: balancing family, work and community). The closing date for entries in the next round of the competition is 29 January 2010 (→ The Dr Ross Ingram Memorial Essay Competition).
Teaching in Super Clinics?
The Australian Government has committed to developing 31 General Practice Super Clinics around the country, which will have the provision of high-quality education and training opportunities as one of their core objectives. In a Viewpoint, Vickery and colleagues say that a lack of time and money as well as space has been the major barrier to teaching and training in general practice, and it will only get worse with increasing numbers of medical students and increasing demand for health care services. They say that Super Clinics may provide space, but unless solutions for lack of time and money are also offered, their potentially important educational role will be limited (→ General Practice Super Clinics — how will they meet their educational objectives?).
Another time . . . another place
Herbert H Lehman
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