Again, in the last week, I have come across a few reports and news items which are worth passing on.
These include first:
Electronic antibiotic stewardship—reduced consumption of broad-spectrum antibiotics using a computerized antimicrobial approval system in a hospital setting
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1 Victorian Infectious Diseases Service, The Royal Melbourne Hospital, Parkville, Vic. 3050, Australia 2 Department of Medicine, Centre for Clinical Research Excellence in Infectious Diseases, University of Melbourne, Parkville, Vic. 3050, Australia 3 Clinical Pharmacology and Therapeutics Department, The Royal Melbourne Hospital, Parkville, Vic. 3050, Australia 4 The Nossal Institute for Global Health, University of Melbourne, Parkville, Vic. 3010, Australia
Objectives: Antibiotic stewardship is important, but the ideal strategy for providing stewardship in a hospital setting is unknown. A practical, sustainable and transferable strategy is needed. This study evaluates the impact of a novel computerized antimicrobial approval system on antibiotic-prescribing behaviour in a hospital. Effects on drug consumption, antibiotic resistance patterns of local bacteria and patient outcomes were monitored.
Methods: The study was conducted at a tertiary referral teaching hospital in Melbourne, Australia. The system was deployed in January 2005 and guided the use of 28 restricted antimicrobials. Data were collected over 7 years: 5 years before and 2 years after deployment. Uptake of the system was evaluated using an in-built audit trail. Drug utilization was prospectively monitored using pharmacy data (as defined daily doses per 1000 bed-days) and analysed via time-series analysis with segmental linear regression. Antibiograms of local bacteria were prospectively evaluated. In-hospital mortality and length of stay for patients with Gram-negative bacteraemia were also reported.
Results: Between 250 and 300 approvals were registered per month during 2006. The gradients in the use of third- and fourth-generation cephalosporins (+0.52, –0.05, –0.39; P <> glycopeptides (+0.27, –0.53; P = 0.09), carbapenems (+0.12, –0.24; P = 0.21), aminoglycosides (+0.15, –0.27; P <>P = 0.08) all fell after deployment, while extended-spectrum penicillin use increased. Trends in increased susceptibility of Staphylococcus aureus to methicillin and improved susceptibility of Pseudomonas spp. to many antibiotics were observed. No increase in adverse outcomes for patients with Gram-negative bacteraemia was observed.
Conclusions: The system was successfully adopted and significant changes in antimicrobial usage were demonstrated.
More here:
http://dx.doi.org/10.1093/jac/dkn218
or
http://jac.oxfordjournals.org/cgi/content/abstract/dkn218v1
This is a nice demonstration of how a focussed decision support system can improve the quality of prescribing (and reduce costs almost certainly) while having no negative impact on the clinical outcomes. Antibiotic selection in very sick patients is always a matter for the experts and having a supportive expert system makes very good sense.
Second we have:
ID theft hits $1bn: ABS
Karen Dearne | July 01, 2008
AUSTRALIANS lost almost $1 billion to fraud and scams last year, according to the Australian Bureau of Statistics' first survey of personal fraud.
More than 800,000 fell victim in some way to at least one instance of fraud, representing 5 per cent of the population aged 15 and older. Of those, 453,100 lost money, incurring a combined financial loss of $977 million. The median loss was $450.
Identity fraud accounted for 499,500 victims, with 77 per cent of these reporting fraudulent transactions on their credit or bank cards.
All victims of credit or bank card fraud incurred a financial loss: 25 per cent lost less than $100; 26 per cent lost between $101 and $500; and 3 per cent lost more than $10,000.
The remaining 23 per cent suffered identity theft, involving unauthorised use of their personal details. These people reported forged documents had been used to conduct business, open accounts or take out loans illegally in their name.
More here:
http://www.australianit.news.com.au/story/0,24897,23952995-15306,00.html
These figures seem very high I must say – but on the basis that they are close to reality one has to wonder why there is not more public concern. The impact of this level of fraud on trust of systems (be they banking systems or e-Health systems) must be significant and not helpful I fear.
Third we have:
Victoria's health software ready
Monday, June 30, 2008; Posted: 06:48 PM
Jun 30, 2008 (The Australian Financial Review - ABIX via COMTEX) -- Victoria's Department of Human Services is about to implement new software for the management of patient medical information in the state's hospitals. The rollout is part of the $A360m HealthSmart project.
More here:
http://www.tradingmarkets.com/.site/news/Stock%20News/1725320/
The full article is available here:
This is a very optimistic read on the progress of HealthSmart. One can only hope it turns out the the adoption of the clinical solutions do actually progress rapidly. I for one am happy to watch and wait to see actually implementation and go-lives occur.
Fourth we have:
Mobile phone a 'life-saver'
Louisa Hearn
June 30, 2008
Most of us would dial triple 0 for help in a life and death situation. Now our mobiles can also issue life-saving CPR instructions thanks to a new animated download launched by the Red Cross on Sunday.
The technology, jointly developed Tasmanian company Multi-Ed Medical and mobile networking giant Ericsson, is an animated program with an audio voiceover that gives a detailed overview of steps required for CPR.
Available through any Australian mobile phone service, the animation will can be viewed on any handset capable of displaying 176 x 144 pixel video content in the 3GPP file format.
More here
http://www.smh.com.au/news/technology/mobile-phone-a-lifesaver/2008/06/29/1214677836696.html
The instructions are downloadable:
“The CPR animation costs $3 and can be purchased directly from the Red Cross website or by texting 'CPR' to 19 951 515.”
It is always good to see innovative use of new technology. I think it should be downloaded before the event – hardly would like to be texting for instructions with the collapsed patient in front of me! I am not sure availability should not be funded nationally so it is free for all those with appropriate mobiles.
Fifth we have:
Flying doctors spend $2.7m on bush health records
30 June 2008 03:57 PM
The Royal Flying Doctor Service (RFDS) has entered into a five-year AU$2.7m contract with IBA Health to create a standardised system for its electronic health records.
The new system will help the Service's health professionals with its 12,000 annual clinical appointments across regional Australia.
Clinicians will be able to remotely access a patient's medical history, including allergies, immunisation records and current medications, via the internet-based system, and update the information during check-ups.
In time, it is hoped the system will also be accessible in aircraft. The RFDS Queensland operations are already using Telstra Next G to achieve this.
Some areas the RFDS visits don't have internet access. For these places, the RFDS will work together with IBA to develop a customised system which will allow "briefcasing" of medical records — taking files that are needed on laptops and synchronising them with the system when the clinician again has an internet connection.
More here:
This looks like a very useful ‘shared record’ initiative. I hope someone has planned evaluations of the clinical impact as part of the implementation. The devil I am sure will be in the detail of which information is shared, how privacy and confidentiality is handled and so on.
A detail press release is here:
http://www.ibahealth.com/html/isoft_to_provide_emr_for_royal_flying_doctor_service.cfm
iSOFT to provide EMR for Royal Flying Doctor Service
It is interesting to note this project was an initiative of the previous Government in election mode!
Flying Doctors to access medical records
October 3, 2007 - 2:47PM
The Royal Flying Doctor Service (RFDS) will have ready access to the medical records of more than 750,000 residents in remote Australia under a new project backed by the federal government.
Communications Minister Helen Coonan said the federal government would provide $2.7 million towards the eHealth for Remote Australia project.
The project will give RFDS and other authorised health professionals mobile access to medical histories, allergy, immunisation, current medications and other health information, Senator Coonan said.
"The funding will enable health professionals from the RFDS to provide better health care for people in rural and remote Australia," Senator Coonan said.
"The RFDS will have the right information available for the right person, in the right place at the right time to enable assessment to be made during flight and preparations to be made on the ground to receive the patient."
More here
Sixth we have:
Students slice into virtual patients
Nick Miller
June 30, 2008
A WORLD-FIRST surgery simulator, invented by the CSIRO and Melbourne University, allows medical students to practice operations with unprecedented realism.
The simulator lets students "feel" bone and flesh under their virtual drill while using force-feedback pens. It also enables them to see the operation through a 3-D microscope showing a live, animated model of the anatomy they are operating on.
"There have been other computer simulators, but when it's just a mouse melting away the bone you don't feel part of it, you don't get that true connection," said Professor Stephen O'Leary, a senior surgeon at the Royal Victorian Eye and Ear Hospital, who worked to develop the machine. "This brings engagement and realism to the process."
It was also valuable, he said, to be able to stop and "rewind" an operation to show a student what went wrong. It was a great learning tool that would save time and hone the skills of Australia's trainee surgeons, he said. In the future it could even be programmed with scans from an individual patient, so a surgeon could practice before an operation.
More here:
This sounds like fantastic stuff. Good to see such expertise exists in Australia and is being used to do such important stuff. Operating on the middle-ear – which the simulator trains for – is very difficult and the chance of permanent damage is high. Maximum preparation before approaching the real patient is a very good thing.
Last we have our slightly technical note for the week:
A requiem for Windows XP
We remember the pros, and a few cons, of the most popular version of Windows to date
InfoWorld staff (InfoWorld) 02/07/2008 08:07:30
Despite an outpouring of demand -- including more than 210,000 people who signed InfoWorld's "Save XP" petition, Microsoft held firm and Monday discontinued sales of XP in most cases. So, we bid adieu to Windows XP.
Sure, any copies of XP in use will continue to run, so the venerable operating system isn't leaving us entirely. And enterprises, small businesses, and some consumers will still be able to install XP as a "downgrade" to Windows Vista Business or Ultimate. And until February 1, 2009, system builders will be able to install XP on "white box" PCs they assemble, which also ironically includes Apple Macs that are bundled with Parallels Desktop or VMware Fusion by resellers such as MacMall and CDW. Finally, low-cost, low-power desktops and laptops such as the Asus Eee PC can ship with Windows XP until 2010.
But it is the end of an era nonetheless.
In response to XP's passing, several InfoWorld editors and contributors shared their memories of XP.
More here:
http://www.computerworld.com.au/index.php?id=1065455962&eid=-255
We all resist change and I must say the transition to Vista is hardly transparent and a number of aspects of Vista are just plain annoying. However, it does do all that XP does – and more – with greater – if not perfect – safety and reliability. Sadly this is all as the cost of needing massively increased resources in terms of memory etc. A simpler, cleaner and less flashy Vista would have been more satisfactory from my perspective – so I plan to stick to the familiar XP for as long as it is supported – which is at least the next 4-5 years.
By then there will be a better Vista (whatever it is called) and a better MacOS I am sure!
More next week.
David.
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