Hope Alexander MPH

Posts Tagged ‘treatment’

Hope will be in Adelaide this week, arriving Monday 26 April, departing early Saturday morning.

Beyond Evidence on Reducing Health Inequities: What works, why and how

27th – 28th of April 2010

National Wine Centre of Australia
Corner Botanic and Hackney Roads, Adelaide

This will be the Final Policy Event for National Health and Medical Research Council funded Australian Health Inequities Program.

The aims of the Symposium are to:

1. Present research-based examples of Policies and Programs that were designed to intervene on the social determinants of health inequities

2. Contribute to debates about the ways in which policy makers can build social determinants of health inequities perspectives into programs inside and outside of government

3. Compare progress in the uptake of social determinants of health inequities perspectives in Australia and other countries

4. Consider how social determinants of health can contribute to the Council of Australian Governments (COAG) goal of Closing the Gap.

Hope is attending the Anaesthetists Expert Working Party meeting.

Date
Thursday 15th April 2010

Agenda

10.00  Welcome and overview of meeting objectives – Linda MacPherson

10.10  Summary of results Kirsten Armstrong

10.30  Facilitated discussion:

• Feedback on report

• Identification of recommendations – Lorraine Acheson

12.15  Next steps and close – Linda Macpherson

Hope has been invited to research and write an article about pelvic neuropathy for virtualmedicalcentre.com

For Debate

Vertebroplasty for painful acute osteoporotic vertebral fractures: recent Medical Journal of Australia editorial is not relevant to the patient group that we treat with vertebroplasty

William A Clark, Terrence H Diamond, H Patrick McNeil, Peter N Gonski, Glen P Schlaphoff and John C Rouse MJA 2010; 192 (6): 334-337(see link below)

Abstract

We use vertebroplasty for patients with the most severe pain caused by osteoporotic vertebral fractures less than 6 weeks old, and have observed dramatic pain relief in this acute setting.

A recent editorial in the Journal, written by the authors of two recent vertebroplasty trials, suggested that vertebroplasty is not an effective therapy for acute osteoporotic vertebral fractures.

The trials described in the editorial sampled a very different patient cohort to the one that we treat with vertebroplasty.

Our clinical experience and most of the published literature relating to the benefits of vertebroplasty are in striking contrast to the opinions presented in that editorial.

©The Medical Journal of Australia 2010 www.mja.com.au

Vertebroplasty for painful acute osteoporotic vertebral fractures: recent Medical Journal of Australia editorial is not relevant to the patient group that we treat with vertebroplasty
William A Clark, Terrence H Diamond, H Patrick McNeil, Peter N Gonski, Glen P Schlaphoff and John C Rouse.
Med J Aust 2010; 192 (6): 334-337.
http://www.mja.com.au/public/issues/192_06_150310/cla11439_fm.html

Invited editorial presents an accurate summary of the results of two randomised placebo-controlled trials of vertebroplasty
Rachelle Buchbinder, Richard H Osborne and David Kallmes.
Med J Aust 2010; 192 (6): 338-341.
http://www.mja.com.au/public/issues/192_06_150310/buc10020_fm.html

The Consumers Health Forum-nominated consumer representative on the Medical Services Advisory Committee panel reviewing Vertebroplasty, has asked for comments on consumer issues around treatments such as Vertebroplasty (or injection of bone cement into diseased vertebrae such as osteoporotic fractures).

She is keen to ensure that all consumer issues relating to potential Medicare funding for this procedure are considered in the evaluation.

The Question:
Are we aware of any consumer issues relating to the current treatment and management of painful vertebral compression fracture as a consequence of osteoporosis or vertebral malignant tumours?

In a letter to the editor of the Medical Journal of Australia (MJA 2010; 192 (3): 174-17) Paul J Graziotti states that “Vertebroplasty appears no better than placebo for painful osteoporotic spinal fractures, and has potential to cause harm”.

Some years earlier Vertebroplasty was described as “a promising but as yet unproven intervention for painful osteoporotic spinal fractures” by Rachelle Buchbinder and Richard H Osborne (MJA 2006; 185 (7): 351-352). It was further claimed that “Medicare funding could jeopardise the research needed to establish the benefits and risks of this procedure”.

I read elsewhere that the “slurry” they inject into the bones, can leak out and cause even more problems. Therefore I would suggest caution to anyone who may be contemplating this procedure … as yet the evidence is not available.

The Response:
I would be very wary of suggesting that this procedure be funded by Medicare until there is some strong evidence that it works, and does not cause further harm. The way I read it, the evidence is just not there, and the possibility of damage and the “potential to cause harm” has already been established.

Further information about treatment for osteoporotic vertebral fractures can be found on The Health Report ABC National Radio web site here:
http://www.abc.net.au/rn/healthreport/stories/2009/2647587.htm

Western Australians will be able to make important decisions regarding their future medical treatment and lifestyle choices, under new legislation which takes effect today.

Ministerial Media Statement from Kim Hames, Deputy Premier; Health; Indigenous Affairs can be viewed here:

http://www.mediastatements.wa.gov.au/Pages/Results.aspx?ItemId=133128

Government of Western Australia Department of Health Advance Health Directives information and forms can be viewed here:

http://www.health.wa.gov.au/advancehealthdirective/home/

The below article is a guest column written by Hope, that was published in the “Medical Forum WA”  magazine, Western Australia’s Independent Monthly for Health Professionals December, 2009 edition. Her article is on Page 17 and the orginal article can be accessed at http://www.medicalhub.com.au/component/option,com_docman/task,doc_download/gid,174/Itemid,228/

The GP-patient relationship is an imperfect science, with many GPs finding it hard to diagnose properly if information is not articulated correctly or withheld. Conversely, some seniors believe GPs need to take a different approach when dealing with this growing demographic in WA.

So what do seniors want from their GP? To be listened to, taken seriously and to be able to enjoy a partnership with their health provider. I believe this leads to more productive consultations and a positive outcome for both doctor and patient.

Many seniors (like me) have at least one chronic condition, some have more. This does not necessarily mean we are ill or incapacitated. Seniors need support and information, including access to resources so that we are better able to ‘self manage’ our condition in partnership with our health providers.

Having gained weight and body fat after cancer treatment I do not want to be told “it is because you are menopausal”, “because you have had children”, “it is in your family”, or worse still “go to Jenny Craig”. It is more useful to be referred to a dietician and an exercise physiologist. In this way a plan can be drawn up to achieve my goal, that is, to manage my weight, to keep fit, to reduce the risk of other medical conditions, and reduce the risk of the cancer recurring.

With the help of my GP I can set my health goals, draft an action plan, and take responsibility for my continuing wellness.

What doctors can do to make the journey easier:

1. Suggest the patient brings all medication they are taking to the consultation. An on-going review can minimise errors such as a patient taking the same drug by another name, continuing to take medication if no longer required and confusion.
2. Ask the patient to write down a list of questions to ask the doctor, and copy the answers given by the doctor.
3. Offer the patient a print-out of all medications they are taking, the reason for taking it and dosage – including any known drug reactions. Seniors often put this list on their fridge, so in an emergency ambulance officers have access to this vital information.
4. If a doctor is uncomfortable discussing a particular issue, e.g. sexuality, refer the patient to someone who is not. Many patients have difficulties in this area because of surgery, chemotherapy and other procedures.
5. Suggest the patient request a long consultation if there are several issues to be discussed, or else make two consultations. If these are bulk-billed (for pensioners) this could perhaps save time for both doctor and patient.

And what will the doctors stand to gain? Patients who are using the knowledge and support offered to better manage their health and such conditions they may have. This may result in fewer and shorter visits, more time spent achieving positive outcomes than having to listen to the same old sad story. Many seniors are ‘experts on their own condition’ and do have a wealth of experience in coping – but we do need the relevant up-to-date information the doctor can provide.

Hope Alexander

December 2009

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