Brain Tumour Survivor

The duality of workplace relations

Many of the headaches the Canberra Hospital has caused Katy Gallagher in her capacity as Health Minister (in the Stanhope government and her own) have been recurrent ones – none more concerning than workplace bullying. In 2010, the government ordered two external reviews of the hospital's obstetrics and gynaecology units amid allegations of workplace bullying and harassment. When Ms Gallagher refused to release the findings of one of those inquiries (for privacy reasons) she was accused by the ACT Liberals of trying to orchestrate a cover-up. Four years on, and Ms Gallagher is again defending her handling of bullying claims at the hospital (and in the very same units) after a review by the Royal Australian and New Zealand College of Obstetricians and Gynaecologists alleged that a toxic culture was contributing to poor patient outcomes. Quizzed on the matter during a public accounts hearing at the ACT Assembly, Ms Gallagher declined to go into specifics, but said managing poor performance and inappropriate behaviour in a hospital workplace was difficult – a view with which few will disagree.

Some of the behavioural issues referred to in the RANZCOG review appear to stem from the unrealistic work demands placed on registrars and the long hours they're expected to spend on wards, an issue of such long standing (and common) practice throughout Australia as to invite serious question as to why it is allowed to continue. Unequivocal links between fatigue and impaired judgment appear not to trouble a profession whose implied faith in the precept of trial by fire brooks no concessions whatever.

Extreme fatigue coupled with anxiety or feelings of being unable to cope in a high-pressure environment are not conducive to harmonious workplace relations. It's hardly surprising therefore that staff at a busy training hospital such as Canberra might exhibit some testiness from time to time. However, allegations of bullying, harassment and mismanagement are a ubiquitous feature of other ACT public service workplaces too. Indeed, workplace insurer Comcare gave evidence to Senate Estimate hearings last month that ACT government bureaucrats logged 3.6 mental health claims per 1000 workers in 2013-14, nearly double the 1.9 claims per 1000 workers in the federal bureaucracy. In the same period, private sector workers lodged just 0.4 claims per 1000 workers.

Why workers' compensation claims should be so high, comparatively speaking, in the ACT Public Service must concern senior bureaucrats as much as it does Comcare, which is struggling to contain mounting compensation costs. Bullying of one sort has been a long-standing feature of many workplaces. But it may be that the spike in claims has been driven not by an actual increase in the incidence of harassment but by increased awareness of the problem and the range of remedies now available. Cynics might observe that the mushrooming of legal firms specialising in compensation and personal injury has also have been a factor in the increase in bullying claims.

It follows that government departments and businesses workplaces should have policies and procedures in place to prevent bullying in the first place, and to review them regularly. On the evidence available, many senior managers – perhaps of the old-school, authoritarian type – have been slow to act. That said, bullying is not always understood for the nasty phenomenon that it is, and it can be difficult to identify and weed out perpetrators, particularly of the "kiss-up, kick-down" kind.

Bullying in the workplace is nearly always a signal of a weakness, whether of attitude, training, technique or experience, for which there should be no tolerance whatever. But just as bullies can disrupt a workplace and induce a collective anxiety, so poor performers can hobble team performance and erode morale. Trying to manage such people, particularly those who work in the public sector, is frequently to invite them to lodge a complaint or a grievance notice. As such, a zero tolerance approach towards bullying should not interfere unduly with the ability of managers to deal appropriately with poor performers. More than anyone, tribunal members adjudicating bullying claims need to be mindful of this.

http://www.brisbanetimes.com.au/comment ... 1k6r5.html

Surgeon Writes of Medicine and What Matters in the End

If evoking copious tears, even from the most stoic journalist, is the measure of deeply moving nonfiction, then “Being Mortal” wins the day.

Atul Gawande, the noted surgeon and writer, airs his personal (and professional) views on how modern medicine treats terminal illness and dying patients in barbaric ways.

The reader learns through stories of patients both young and old and descriptions of how doctors, hospitals and nursing homes fail their patients by trying to keep them safe and comfortable while denying them choice, power and their dearest wishes.

Dying is not a disease, it’s the end of life, and we all face it sooner or later. Gawande writes of his own failings and those of colleagues in presenting too many options for surgeries, therapies, medications and expecting patients to choose without ever trying to find out what’s important to them.

With the help of hospice and palliative-care nurses, he learns what questions to ask his patients and how to really listen to their answers. After he knows what their priorities are, he is better able to help them find the particular care that meets their criteria.

Often where the patient lives and the available resources, or lack thereof, determine the choices.

Interspersed with patient narratives, we learn some history of the physician-assisted suicide (or “death with dignity” if you prefer) laws now in effect in only three states: Oregon, Washington and Vermont. This past month, we learned of a young woman who moved with her husband to Oregon after being diagnosed with an inoperable brain tumor. She died peacefully in her own bed as she wished. The Oregon process is strictly regulated and so far there is little evidence of abuse. Many patients get their prescription filled and never use it. They say they feel empowered to have the option and that brings them comfort. Several countries in Europe have had these laws for years and Americans with terminal illnesses often had to go to one of the Scandinavian countries to exercise the right to die on their own terms.

While Gawande sees this as a viable option, he says there may be a better way.

“Assisted living is far harder than assisted death, but its possibilities are far greater, as well,” he writes. “… Our interventions and the risks and sacrifices they entail, are justified only if they serve the larger aims of a person’s life. When we forget that, the suffering we inflict is barbaric. When we remember it, the good we do can be breathtaking.”

The history of assisted living facilities as a step somewhere between independent living and the nursing home is littered with failures. For those who saw the PBS “Frontline” piece on assisted living residences accepting patients they weren’t able to care for and the pressure on staff to make a profit, this will come as no surprise. They’ve taken the values of medicine, Gawande says, so residents complain about boredom, loneliness and helplessness. However, the nurses who started and promoted the concept were focused on what Gawande describes as caring for the individual and his or her priorities. What a concept.

Courage is strength in the face of knowledge of what is to be feared or hoped. Wisdom is prudent strength, he writes.

“The challenge, I’ve come to see, is more fundamental than that. One has to decide whether one’s fears or one’s hopes are what should matter most.”

And that leads to the importance of having “the discussion” first with the patient and then with close relatives. It’s amazing how physicians tend to shy away from talk of dying. For them, it seems, death is the ultimate failure. Adult children fear facing the reality that life is limited and that talking about how their parents might want to spend their last days is acknowledging the end is near.

Gawande includes his father’s fatal illness, an inoperable tumor of the spine, as an example of how just listening can solve problems. His father was willing to contemplate hospice even when his mother didn’t think it necessary. A tactful nurse from the hospice agency asked just the right questions and got answers from him and blank looks from her. Still, hospice saved the things he cared about and his condition improved considerably.

In his epilogue, Gawande acknowledges, we’ve been wrong about what our job is in medicine. It is to enable well being. The questions are always the same: What is your understanding of the situation and its potential outcomes? What are your fears and what are your hopes? What are the trade-offs you are willing to make and not willing to make? And what is the course of action that best serves this understanding?

That’s the crux of the discussion. Now, we all just have to be willing to talk about it.

http://www.malibutimes.com/malibu_life/ ... 8189d.html

Woman slams dying father's treatment at Canberra Hospital

A dying elderly Canberran received such poor treatment at the Canberra Hospital during his last week of life, he begged his daughter to come and take him away.

Kambah resident Moira Smith said her father wasn't "treated like a person" during his five-day stay at the hospital and, by the end, she was determined he would leave.

She has registered a complaint with the Human Rights Commission over her father's treatment and sent a letter to Health Minister Katy Gallagher.

Ms Smith said she had been looking after her father, who suffered from chronic arthritis, for eight years before he was placed in the Goodwin retirement community in Farrer.

He was referred to Canberra Hospital in August after being diagnosed with flu and pneumonia which was present in the Goodwin community.

Yet after just a few days in Canberra Hospital, the once-enthusiastic man told his daughter, "It's all meaningless. I just want to die."

"I just cannot get it out of my head. The misery of those last few days and my helplessness to do anything about it," she said.

Ms Smith said when she arrived to check on her father he was sitting in a bare room with a improperly tied gown, without slippers, a toothbrush, a comb, soap, pyjamas or glasses.

She said his clothes had also vanished and his teeth had not been cleaned. "When I went in, he said 'Oh thank God you're here. It's awful.'" she said.

Ms Smith said her father's food arrived in tightly-sealed plastic containers he was unable to open with his arthritic hands and staff were often uninterested or unhelpful.

She said she was devastated those would be some of her last memories of her father.

"Nobody deserves to have to go through that. He lived a long life, he worked all the time, he'd been a good father to me and nobody deserved that," she said.

"Nobody saw him as a person."

Three days after her father left the hospital, he died at home.

She said her father's treatment at the Canberra Hospital had shattered her confidence in the ACT's health system, leaving her wondering what will happen when she gets old.

Health Minister Katy Gallagher said she was aware of the complaint and ACT Health was investigating it. She said in the past year, Canberra Hospital had received 4722 pieces of feedback, 70 per cent of which were positive.

Ms Gallagher said the government used feedback to promote positive system changes.

"The ACT government has been working since the start of 2014 on a detailed range of changes to the way that care is provided to patients which have been developed in line with our objectives to continually improve the quality of services we provide," she said.

http://www.smh.com.au/act-news/woman-sl ... 1kwd6.html

Can China tackle soaring cancer rates?

It's ten o'clock in the morning at the largest cancer hospital in Asia, a sprawling complex of buildings in Tianjin, a polluted city on China's eastern coast.

Dr Zhang Jing is already scrubbing up for her fourth operation of the day. She has the tired resignation of someone who knows she's in for a long shift at work.

Ten years ago, surgeons here removed tumours once or twice daily. Now they perform at least seven operations every shift.

The cancer hospital recently doubled in size but is still struggling to cope with demand.

"Even if we diagnose 50 patients every day, we cannot keep up," Dr Zhang says. "No matter where you go in this hospital, you will never find an empty bed."

Cancer rates may be falling in many Western countries but they are steadily rising in China.

Blame the effects of pollution and unhealthy habits on the country's aging citizens.

In the lobby of the Tianjin Cancer Hospital, the tension is palpable. Patients and their families jostle with one another in line as they push to make appointments.

It is a situation that is echoed in busy cancer hospitals across the country.

China has approximately 20% of the world's population, but it has 22% of new cancer cases and 27% of the world's cancer deaths.

Cancer is now the leading cause of death in China but the health ministry seems ill-equipped to deal with the problem.

There are no obvious national campaigns to educate citizens on the avoidable causes of cancer, like smoking.

The country's National Cancer Centre, which was supposed to open in 2012, doesn't even have a website.

Reliable cancer statistics are also hard to find.

In 2008, the Chinese Academy of Medical Science launched the China Cancer Registration Project, with 219 registration spots across China documenting cancer data. However, it has yielded little new information.

The project's last report was released in 2013, using data from 2010. To date, China lacks a single database tracking national cancer rates.

Cancer screening programs are virtually non-existent. The country's fragile healthcare system also means that many aren't diagnosed until it is too late.

Liver cancer is a particular problem among Chinese men, many of whom carry the hepatitis B virus.

Around 130 million people in China are believed to be carrying the hepatitis B virus and 30 million have developed a chronic hepatitis B virus.

This is a serious problem because, without regular health checks, the virus can easily morph into liver cancer. China now accounts for half of the world's cases of the disease.

In a single morning, one of the hospital's most respected doctors, Song Jing, meets 10 new patients. All of them are found to have late stage liver cancer.

When asked if it is stressful telling so many people a day that they have less than a year to live, Dr Song nodded.

"Yes, it is. For terminal patients, there's little we can do," he said.

But even patients with a good chance of recovering are afraid to mention the illness by name.

In a hospital tower devoted to breast cancer treatment, one patient - Wang Hui - admits that even there, the word "cancer" is rarely spoken out loud.

"Chinese people think that cancer is a terrible thing. Once you have it, you won't last long," she says.

Ms Wang normally commands attention in her job as a Chinese opera singer. But her cancer diagnosis has forced her into hiding. Very few know that she is sick.

Breast cancer has become increasingly common in China and is now the number one killer of Chinese women.

But like many other women, Ms Wang suffers in near-silence. Only her daughter and older sister stand next to her hospital bed, working as her faithful attendants.

"I didn't tell my colleagues or relatives because I didn't want them to worry," she says. "But when I came to the hospital, I saw so many people here with the same illness and I felt better."

Wang Hui and millions of others in China affected by cancer are beginning to accept a hard truth. This country is facing an epidemic, one that increasingly can't be hidden or ignored.

http://www.bbc.com/news/world-asia-china-29610059

Diem Brown's death sheds light on young adult cancer

The recent death of Diem Brown -- the spunky, tough-as-nails reality star and cancer advocate -- rocked the many who'd followed her long, public struggle with the disease. Brown, who was 32 and had beaten cancer twice, lost her battle when it returned a third time in the form of colon cancer and spread to her liver and lymph nodes.

Nearly 70,000 Americans aged 15 to 40 are diagnosed with cancer each year, according to the National Cancer Institute. These are critical formative years, when people are making important life choices: beginning careers, getting married and starting a family. And, because certain types of cancer and cancer treatments can cause infertility, getting sick sometimes means having to start immediately planning for an unimagined future.

Dr. Elizabeth Fino, who sees patients at the NYU Fertility Center, says young adults have to make hard choices very quickly. "Most of the cancers encountered in that age group are aggressive and need to be treated very quickly. So, in midst of having to make a lot of decisions regarding cancer, they also have to come to us and be proactive about preserving their fertility."

Fino says it can be overwhelming for young women to have to plan chemo and fertility treatments simultaneously. "With some types of aggressive breast cancers, young women also have to think about lining up a gestational carrier down the road," she says.

The overwhelming emotional, physical, social and spiritual impact of receiving a cancer diagnosis at this pivotal time in life can cause some people to want to give up. Others, like Diem Brown, choose to move through the traumatic journey by reaching out for support and getting active about finding solutions.

Some of these young people have become strong forces of cancer advocacy, using social media as a tool for raising awareness and education. Speaking out about their disease and treatment on social media, and building supportive communities is a way to make meaning out of a devastating diagnosis.

"Through blogging, writing, and social media, I've found my voice, and I've found small ways to make a difference. That's something you can do from a hospital room. It's empowering and liberating to realize that you're not just a cancer patient but you're so much more than that," leukemia survivor and New York Times wellness blogger Suleika Jaouad says.

Brown shared her cancer journey in real time with 200,000 Twitter followers, nearly 200,000 Instagram followers, and through her blog for People.com. One of her final tweets shows her will to live and her willingness to reach out for support.

http://www.cbsnews.com/news/diem-browns ... lt-cancer/

Tasmanian ambulance union warns roster changes may lead to more fatigue

There are concerns a potential change to ambulance rosters in Tasmania to combat fatigue may actually make the problem worse.

Paramedics are on four-day blocks of two 10-hour day shifts and two 14-hour night shifts.

Ambulance Tasmania is considering changing to two 12-hour day shifts and two 12-hour night shifts.

But the Health and Community Services Union's Tim Jacobson warned that instead of reducing fatigue, the change would make things worse.

"On a 14-hour shift staff get two meal breaks, so there's the capacity for those staff to rest and recuperate," he said.

"But in the 12-hour roster that's been proposed, Ambulance Tasmania has only provided for one meal break, so in our view it will actually result in increased fatigue, not reduced fatigue."

He said workers were happy with the current arrangement, despite having to work long days.

"There's absolutely no doubt that the 10-14 hour shift, while it does have very lengthy shift times, is very popular amongst paramedics."

Mr Jacobson said overtime was a big issue.

"The fundamental issue that we've had historically with fatigue on those shifts is where those shifts have been extended."

Ambulance Tasmania's chief executive Dominic Morgan moved to allay fears about the potential change.

"I struggle to understand how reducing someone's potential possibility of working a 16-hour shift would be actually made worse by only requiring them to work 12," he said.

"The most important thing to point out here is that it's not the union that has the work, health and safety responsibility, my job is to ensure that our workforce goes home safely."

Mr Morgan said shorter shifts would mean less fatigue and a safer workplace.

"My view is that not doing 14-hour night shifts improves workplace health and safety."

He agreed overtime was a problem.

"The very real likelihood, that even an hour or two hours of additional overtime sometimes occurs after these very long shifts, and then our paramedics also have to drive home," he said.

"Our staff, in some instances, could be realistically expected to be at work for 16 hours and in this day and age with our responsibilities the ambulance services decided that we can no longer support these."

He believed the 12-hour proposal was preferred as it maintained the current four days on, four days off structure.

"Certainly the advice I've received so far is that the workforce are generally more supportive of the 12-hour shift, because it preserves a four days on, four days off roster," he said.

https://au.news.yahoo.com/a/25586288/ta ... e-fatigue/

Minister's office defends health advertising splurge

Prominent television advertising promoting Health Minister Lawrence Springborg's Sunday announcement of a hospital waiting list guarantee is not promoting the government before next year's state election, Mr Springborg's office said.

However Labor questions the spirit of the health advertisements, which went to air just hours after the new policy was announced.

The Queensland Governments' Code of Conduct for government Advertising says "there should be no advertising within six months of the scheduled date for an election unless there is an urgent emerging issue."

The 2015 Queensland election has not yet been called, but is likely to be called in mid-to-late March 2015.

Queensland Government advertising statistics show the government spent more than $36 million on advertising - $36,831,579 - in 2013-14.

The department of Treasury and Trade was the Queensland Government's biggest advertiser - $13,470,337 - more than a third of the total government advertising bill.

Health is the second biggest advertiser, spending $9,088,918.

Of this, more than $8.7 million is allocated to "health campaigns', while $353,975 is spent on general advertising.

The new "Wait Time Guarantee" advertisements would be paid for health department funding for the 2014-15 year.

Shadow health spokeswoman Jo Ann Miller said it was clear the advertising was not "within the spirit of government advertising."

"It is quite clear that they have broken the standard and that it is certainly not within the spirit of what the people of Queensland should expect from the government," she said.

"People know that the election is due in March next year and they would rather that this money be spent on front-line services, rather than on promoting the LNP."

Ms Miller said the advertising should be spent by the LNP's party organisation.

"It should not be taxpayer's money used to promote the LNP itself."

This was rejected by a spokesman for Health Minister Lawrence Springborg who said the advertising highlighted a major change in health policy and was not "election" advertising.

"There is no election," the spokesman said.

"We have got to tell people how it works – and what we have done is gradually reducing our waiting list times – and now is the time where we can tell people that we can do a 'Wait Time Guarantee'," he said.

"Because we are getting it (waiting times) to zero and what we want is those (hospital boards) to hold it at zero."

People's rights have changed under the Queensland health system, the minister's spokesman said.

"You will be seen within your set times," he said.

"Once you have seen the specialist – and you have been put on the waiting list – you will be seen in 30 days if your case is urgent, or 90 days if you are semi-urgent," he said.

"Now that has changed dramatically and we need to tell people."

The spokesman said the state government was spending less on advertising that the previous Labor government.

However Labor's advertising spend in 2011-12 - its last full year in office - was $30,287,825, more than $6 million below the LNP state government spend in 2013-14.

That figure can be calculated here.

The minister's spokesman said the health advertising was separate to the Queensland Government's "Strong Choices" advertising campaign.

He said the new "Wait Time Guarantee" advertising was part of a series of health promotional advertisements that had been prepared, linked to explaining problems in Queensland Health.

"We are in the process of making a series of ads about GP's not EDs," he said.

"To tell people that if you have a sniffle you don't go to the ED, you go to the GP.

"And we tell them that because at the moment we have a problem there."

He said 30 per cent of people going to emergency departments should go the GP, Queensland Health's research shows.

He said similar advertising has been run in Western Australia.

The spokesman said the new "Wait Time Guarantee" advertising was funded by Queensland Health.

"People have never had access to that, so we want to explain what the hell it is."

The spokesman said it had nothing to do with next year's election.

"The fact is that we have made this announcement and we can't not tell people about it," he said.

"That would be inviting a bloody mess. And one thing we are trying to avoid in Queensland Health is bloody messes."

http://www.brisbanetimes.com.au/queensl ... 1sbdx.html

Hope for new brain cancer treatment

Australian researchers will conduct a world-first trial of a potential therapy for glioblastoma, the most aggressive form of brain cancer.

The trial will test a treatment resulting from major discoveries by a team of scientists from Brisbane and Melbourne.

"It really is a home grown study," said Dr Bryan Day from the QIMR Berghofer medical research institute in Brisbane.

Glioblastoma is very difficult to treat and is almost always fatal, killing about 1,000 Australians every year, he said.

"Brain cancer has really been put in the too hard basket for a long time."

Dr Day said the therapy for treating this type of cancer have not changed in decades.

"There have been a lot of incremental gains.

"But still the mainstay of the treatment is surgery and then radiation and chemotherapy, which has been around for 60 years."

The trial by QIMR Berghofer and Melbourne's Ludwig Institute for Cancer Research will involve 20 to 40 patients.

They will be treated at the Royal Brisbane and Women's Hospital and the Austin Hospital in Melbourne.

The development of the clinical drug, KB004, is a result of a discovery the scientists made over two decades ago.

"The treatment involves an antibody that targets a cancer protein on the surface of tumour cells," Dr Day said.

"The protein - EphA3 - was discovered by QIMR Berghofer scientist Professor Andrew Boyd in 1992."

Prof Boyd also created an antibody that has been shown to specifically target cancer cells which express EphA3.

The antibody has been adapted for human use by an American biotech company to create the clinical drug.

A trial of this same drug is underway in leukaemia patients.

The upcoming glioblastoma trial will be the first test of the drug against solid tumours, as opposed to blood cancers.

https://au.news.yahoo.com/thewest/a/256 ... treatment/

Standing desk delivers health benefits

FROM the canopy of printouts to the undergrowth of stuck-down reminders, this desk is a fragile ecosystem that not so much sustains life as consumes it.

If my body was ever a temple, it is now a crumbling ruin, slumped in an office chair behind two computer screens and a bubbling stream of news. In the open plan, pro forma, white and grey of the modern ­office environment, work inevitably involves hours and hours of sitting. That’s simply not good for your health.

For the first time, Australia’s physical activity guidelines include the risks of doing the exact opposite: remaining sedentary.

It’s not just failing to get your recommended 2½ to five hours of moderate-intensity activity each week — or 75 to 150 minutes of the really hard stuff. Sedentary behaviour carries its own health risks.

And that is why, one fateful day, and with the support of my similarly shackled podmates, I decided it was time to take a stand. It was time to stand for something — well, everything really. It was time to trial a standing desk.

DAY ONE

THE problem with such a finely balanced deskscape is that to introduce a new component requires careful thought. Everyone will have different requirements, whether it be your height, your space or the number of monitors you have. Having chosen a raw timber, two-tiered Bystander desk, with that glorious smell and feel of a carpenter’s workbench, blending into the environment was never going to be possible.

I decide the desk should face a glass wall so people don’t knock it flying. I reorganise my piles of paper. I dance with the phone and monitor cables. I chuckle, comparing this experience to Kramer’s “levels” in that Seinfeld episode. But something else is starting to concern me: ­people can see me up here: the bur­eau chief, other journos, advertising people, the IT guys with whom I never discussed this trial. I have no idea what I am doing but, as a man, I must now project a degree of ­industrious confidence. Thankfully they don’t notice that by midafternoon my feet are so sore I slip off my shoes.

DAY TWO

TODAY I have ditched my hard-heeled shoes in favour of work-issue bushfire boots and already it feels better. It’s a strange thing, standing. I don’t know what to do with my feet: sometimes I go all akimbo; sometimes I make a figure four; too often I wiggle my hips and thrust about, trying to find the right position.

I put my headphones on and someone suggests I look like a club DJ. This prompts me to reorganise the desk for the umpteenth time, again thinking about how I work, what I need, what I do and what people see.

It has been too easy for me to slump in my office chair, half-hidden, supposedly multi-tasking yet ignoring reminders to go for a walk, stretch or hit the gym.

Up here, bizarrely, I am working harder. With little more than my phone, iPad, notebook and PC, and in full view of the world, I tend to focus. Maybe that is because relaxing up here is almost impossible. (Can anyone sleep while standing?)

By the time the first full day is over, my knees, hamstrings, back and shoulders are sore.

DAY THREE

AFTER a busy morning at home, and surprisingly stiff for someone who did nothing the day before, I arrive at work to discover I still have a standing desk. Gah. This is also the day, of all days, that I split another pair of pants getting out of the car.

After checking myself out in the bathroom mirror — still overweight but not noticeably split — I resume my position. This desk makes me selfconscious but also self-aware: seems I am lifting my forearms to get a clean strike on the keyboard, which in turn shifts my shoulders back, while I also tilt my hips to alleviate pressure on my lower back. Sitting becomes the exception rather than the rule, the thing I do to take a break.

If I keep this up, I can see benefits for both productivity and posture. Unlike some who have trialled standing desks, I don’t predict rapid weight loss, though it may play a part in my longer-term plans.

And, hey, if some ink-stained heffalump in the gym asks whether I lift, at least now I can say, “Yeah bro, 95kg.” That’s 95kg, eight hours a day, five days a week.

MORE than a fortnight has passed since the Bystander came into my work life. This standing desk has been accepted by the herd — in fact, my podmates are now discussing when, not if, they too will rise up. Those few days of sore legs, crushed feet and a stiff back have passed — if there is pain now it generally means I’m doing something wrong, although a standing mat would make things easier. I feel tighter, taller, more aware of my posture, which in turn seems to make me more conscious of things such as diet, fluid intake and the need for exercise. For you, that’s obviously all anecdotal, so some experts have looked at the evidence and believe sitting can be deadly.

Emmanuel Stamatakis, from the Charles Perkins Centre at the University of Sydney, says that for each hour of daily sitting you swap for an hour doing even light activity, your risk of death is reduced by up to 5 per cent. Swap it for walking or more intense activity and that reduction jumps to 12 per cent to 14 per cent.

“It is absolutely imperative to find ways to incorporate some sort of movement into the daily office routine, even if only of a light intensity,” Stamatakis says.

“I believe in 20 to 30 years we will look back and be horrified that we imposed so many hours of sitting on our workers, just so they can make a living.”

http://www.theaustralian.com.au/executi ... 7137568716

Lady Cilento Hospital opens at South Brisbane

The new $1.2 billion Lady Cilento Children's Hospital officially opened its doors on Saturday morning, while at the same time Brisbane's existing two children's hospitals closed theirs.

In between those doors went a fleet of nine ambulances, transferring almost 100 sick children to their new beds.

Among them was 12-year-old Bryson Morrison, who could not be happier about his new digs, apart from a games system he had not yet been able to figure out.

Bryson, who has been hospitalised for about 2½ weeks after being diagnosed with leaukemia, was one of 98 children moved into the new Lady Cilento Children's Hospital on Saturday.

He had been transported from the Royal Children's Hospital at Herston, which along with the Mater Children's Hospital at South Brisbane, were closed on Saturday.

Children's Health Queensland executive director of nursing Shelley Nowlan said that came with mixed emotions.

"It is a little bit sad (to leave), but at the same time there is elation," she said.

"We've had two generations of paediatric nursing workforce, clinical workforce, and our operational workforces come together."

The new facility, in the existing Mater hospital precinct at South Brisbane, has 359 beds, which was 25 per cent more than the two closed hospitals combined.

Children's Health Queensland chief executive Peter Steer said there were 98 movements of "some very, very sick" children over an eight-hour period on Saturday.

"There's something special about paediatric care and I think we've seen that today," he said.

"We've seen some children who have taken a tough journey but they've had a great attitude and the parents have been very understanding and very supportive when these things are another stress in what's obviously a pretty distressing time for families."

Dr Steed said the "state-of-the-art" hospital could offer every paediatric specialist service, with the exception of paediatric cardiac transplants, which, in Australia, can only be performed in Melbourne.

"But literally every other high quality subspecialty service will be offered under one roof," he said.

"This is a great opportunity for Queensland and particularly for parents who've got children with complex or chronic diseases to have all their services under one roof and not fragmented as they have been across the city."

The former Labor government's decision to build the LCCH came under fire during the 2012 state election campaign, when then-de facto opposition leader Campbell Newman publicly slammed the planned RCH closure, saying the as yet unnamed LCCH would "not achieved what is required".

But Dr Steed said the concerns that had been raised in the past had been addressed.

"The Royal Children's Hospital has served the Brisbane community for 136 years and it's understandable that lots of staff and the community will in fact be very, very sad about an extraordinary institution that served the community so well," he said.

"We've done our very best to … communicate to all stakeholders and the broader community, about the advantages of bringing these services and consolidating them under one roof.

"…This is a great opportunity to provide state-of-the-art, truly family-focused environment for children and their families in desperate need."

Up in the oncology ward, Bryson – a keen cricket fan – was stoked with the view of the Gabba from his new 10th floor room.

"It's really new and it just got built, I think, so that's a bit of history," he said.

Of more interest to Bryson, though, was the entertainment system that hung over his bed.

"I'm learning how to work it along the way," he said.

Bryson's mother, Rosa Morrison, travelled with her son from the RCH to the LCCH on Saturday morning.

Mrs Morrison said she was impressed with the new facility.

"It's really nice and new, and it's beautiful out in the family rooms," she said.

"(The move) went really smoothly. We came across at about 10 o'clock as we were here within 15 minutes and straight up into the room."

The Morrisons, from Logan, expected to remain at the LCCH until early 2015.

While Mrs Morrison will sleep in her son's room, if not at home in Logan, nearby accommodation for families from regional areas was sadly lacking.

Dr Steed said a new Ronald McDonald House would be open across the road from the LCCH in March 2016.

In the meantime, Dr Steed said families would still have access to accommodation near the old RCH, in the Royal Brisbane and Women's Hospital precinct, with regular transport between Herston and South Brisbane.

http://www.smh.com.au/queensland/lady-c ... 1wsoe.html

Smoking Ban In Sydney's Martin Place May Spread To Other Public Spaces In The CBD

A plan for a 12-month smoking ban at Sydney’s Marin Place next year may lead to further areas of the CBD becoming smoke-free.

The City of Sydney will vote on the year-long trial ban – proposed by Liberal councillor Christine Forster – at the next council meeting on 8 December, with a full-time ranger allocated to enforce the restriction if it is approved, the Daily Telegraph reports.

“If it is successful I would look at a motion to expand the ban to Pitt St Mall,” Forster said.

Forster, said other Australian cities had successfully banned smoking in heavily trafficked public spaces.

Forster, sister of prime minister Tony Abbott, said she believes the council will take a subtle approach to enforcement, instead of issuing a bunch of on-the-spot fines.

“I think it will be gently enforced by the ranger advising people they cannot smoke in Martin Place and by appropriate ‘no smoking’ signage,” she said.

Depending on the time of day, between 3% and 8% of people in Martin Place were found to be smoking, according to a survey of more than 750 people conducted last month. The survey revealed there were around 1400 people in Martin Place at 1pm on a typical weekday.

NSW law already disallows smoking at bus stops, taxi ranks and within 4 metres of an entrance to a public building. From July 2015 these restrictions will apply to cafes, clubs, hotels and restaurants. Offenders may be issued fines of up to $550.

In November, NSW national parks outlawed smoking in a number of popular parks, with offenders facing a $300 fine. The ban applies to almost all areas of NSW national parks and reserves, including picnic areas, campgrounds, accommodations, beaches, lookouts, walking tracks, and on national park roads.

Melbourne City Council held a similar trial outlawing smoking in a small area of the CBD.

http://www.businessinsider.com.au/smoki ... bd-2014-12

One in 10 surgery deaths due to flawed care or injury caused by treatment

More than one in 10 deaths during or after surgery involved flawed care or serious injury caused by the treatment, a national audit has found.

The Australian and New Zealand Audits of Surgical Mortality shows delays in treatment or decisions by surgeons to perform futile surgeries are still the most common problems linked to surgical deaths.

But surgery also appears to be getting a little safer, with the audit, which covers almost every surgery death in Australia, finding fewer faults with the medical care provided to patients than it has in the past.

Audit chair Guy Maddern said of the deaths where there were concerns, about 5 per cent involved serious adverse events that were likely to have contributed to the person's death.

In about 8 per cent of cases, the audit found some area of care could have been delivered better.

"These are the sorts of deaths where it was a difficult surgery, and instead of going straight to an operation, maybe additional X-rays and imaging should have been pursued, or maybe the skill set of the team that was operating could have been more appropriate," he said.

"Sometimes, of course, the result would have been exactly the same."

Professor Maddern said some surgeons, particularly in general surgery, orthopaedics, and, to a lesser extent, neurosurgery, still needed to work on deciding not to proceed with surgeries where the risks outweighed the benefits.

"People are thinking a little bit longer and harder about whether an operation is really going to alter the outcome," he said. "These are the types of cases where you know before you begin that it is not going to end well."

However, in some areas with many patients with complex conditions, things were just more likely to go wrong.

The report, which includes data from nearly 18,600 deaths over five years, found in 2013 the decision to operate was the most common reason a death was reviewed.

Overall, delays in treatment, linked to issues such as patients needing to be transferred or surgeons delaying the decision to operate, were still the most common problem, and in about 26 per cent of the deaths no surgery was performed.

Between 2009 and 2013, the report shows a decrease in the proportion of patients who died with serious infection causing sepsis from 12 per cent to 9 per cent, while significant post-operative bleeding decreased from 12 per cent to 11 per cent. Serious adverse events halved from 6 per cent of deaths in 2009 to 3 per cent in 2013.

Every public hospital now participates in the audit, along with all private hospitals in every state except NSW. However, Professor Maddern said he was pleased NSW private hospitals had agreed to participate in future.

Doctors are now provided with regular case studies from the audit, in which de-identified information about the death is provided, so they can learn from any mistakes.

"What we are seeing is an overall decrease in deaths associated with surgical care, which may be due to many things, and we think the audit is helping," he said. "It's making people think twice."

Professor Guy Maddern's tips on protecting yourself in surgery

1. If you are away from a major hospital, get yourself to one. A particular problem, Professor Maddern says, exists when rural patients resist transfers to major hospitals because they don't want to leave their families.

2. Lose weight and don't smoke.The proportion of deaths where obesity was a factor increased slightly this year. "An operation done on a thin person relative to a fat person can have a completely different outcome," Professor Maddern says. This is particularly important for older people, who have the most operations.

3. Go to a hospital that performs a lot of the type of surgery you are going to have, particularly if it is complex. Remember, practice makes perfect.

http://www.smh.com.au/national/health/o ... 1z5y1.html

[Great advice]

Third of hospitals don’t record visitor complaints – that’s unacceptable

fter the scandals of Mid Staffordshire, Winterbourne and Morecambe Bay, the health and care system promised to get better at listening to and addressing reports of poor care, negligence and abuse.

As chief executive of Healthwatch England, the consumer champion for health and social care, I have been watching their progress intently, in particular around the complaints system and the drive to inject a real sense of compassion into how people are dealt with when failed by the system.

To see how they are getting on, we submitted a freedom of information request to every hospital trust in England and asked them to share details of their complaints process. We found there is still huge variation.

The most startling finding, however, was the attitude of hospitals towards complaints raised by those who witness poor care, rather than experiencing it themselves.

Of the 164 trusts we contacted, we received responses from 123, with one in three saying they don’t record complaints made by third parties. Only 30 were able to provide us with enough information to suggest they were dealing with these sorts of complaints in the right way.

Many of the trusts stated incorrectly that they could not investigate complaints unless the patient’s permission was secured. While we would not expect a hospital to share confidential information with a stranger, there is nothing in the rules that says an incident reported by a third party shouldn’t be properly investigated just like any other.

It’s perhaps time that government revisited and clarified the rules around complaints, underpinning the principle that everyone has the right to complain about poor care backed up by proper penalties and fines for those that fail to up their game.

All complaints, no matter how minor, or indeed who makes them, should be recorded and submitted to a central repository so we can track performance. This goes for social care complaints as well.

Just measuring the number of complaints isn’t enough. Every hospital, GP surgery and care home in the country should be required to report on how it has used complaints to drive improvement.

When hospitals do listen, and take action, complaints can lead to positive change. In Rotherham, for example, when two members of the public got into a lift at the local hospital and were asked by a member of staff to escort a lost-looking patient back to his bed, they were outraged. The man had been let outside to smoke a cigarette but the doctors and nurses hadn’t given him any shoes or proper clothes to put on. After getting nowhere with the hospital, the two women took their complaint to their local Healthwatch, which was able to apply some pressure. The hospital agreed to review the CCTV footage and has now implemented new policies around which patients are allowed out, and the checks that need to happen first.

It is worth noting that where hospitals do record third-party concerns, they account for about a fifth of the overall number of complaints. To ignore them risks a huge number of incidents going under the radar, but also wastes a huge learning opportunity to improve services and ensure that everyone receives a compassionate response when they experience or witness poor care.

It is important to remember that complaints aren’t case files; they are real-life stories of what happens when things go wrong in health and social care. Without injecting this sense of compassion into how all such incidents are dealt with, no matter how efficient the system becomes, it will continue to fail to deliver what people need.

It’s time for the system to stop hiding behind red tape and legal loopholes and get serious about complaints.

http://www.theguardian.com/healthcare-n ... erformance

Health system under new attack over its bed count numbers

The beleaguered NSW health system has come under renewed attack with allegations that its bed count includes people sleeping in their own homes, parents staying with sick children and patients being moved between hospitals.

One in 10 hospital bed categories are for "virtual beds", which are defined in a policy directive obtained by NSW Labor as the category to be used when there are no physical beds in the hospital.

They can also be used as "the second or third establishment of the same physical bed".

People taking up "virtual beds" include those on the "hospital in the home" program, mental health, aged and disability patients participating in social day programs, those using mobile beds within a vehicle and relatives staying with patients.

NSW opposition health spokesman Walt Secord said the inclusion of virtual beds was "a glorified paper exercise" designed to create the impression of actual beds.

"The word 'virtual' is, to my mind, a bed that doesn't exist," Mr Secord said.

Health Minister Jillian Skinner claimed in February that NSW was on track to make 1390 additional beds available by March 2015.

According to its annual report, NSW had 21,268 beds in 2013-14, an increase of 576 beds from five years previously.

But there has been a reduction in the number of beds available for admissions from the emergency department, and most of the increase has been met by "other hospital beds", such as day services, and "other beds", such as hospital in the home.

Ms Skinner said on Sunday that she had increased transparency since becoming health minister by separating beds into a range of categories.

This had also helped hospitals to manage patient flow and plan for changes in demand.

"In Opposition, I was highly critical of Labor for lumping beds that were available for transferring patients from the emergency department and other beds, which were not, into one count," she said.

A spokeswoman for NSW Health said hospital in the home was a "nationally recognised and highly valuable service modality" which saved patients from being admitted to hospital.

It was only counted as a hospital bed while that service was provided, she said.

But Mr Secord said Labor would introduce a more comprehensive breakdown of the classifications if it won government.

"When Mrs Skinner says there are record numbers of hospital beds, she's giving the wrong impression that they are genuine hospital beds," Mr Secord said.

"It is no wonder the health system is under pressure and people are waiting in emergency departments for hospital beds."

Fewer than 50 per cent of patients in some western Sydney hospitals were being treated within four hours of arriving at emergency departments, according to hospital quarterly data released on Thursday.

NSW Australian Medical Association president Saxon Smith said it was unclear how many hospital beds had been added to the system under the Coalition, but whatever increase there had been was not adequate to cater to the demand.

"We will be calling for commitment to increased bed numbers so that a target of 85 per cent bed occupancy at 5pm allows for surge capacity in the hospital system and minimises bed block.

"This will help ED patient flow, ambulance offloading and patient care."

But he said virtual beds were created to capture data "in the intersection between hospital and hospital-in-home programs" rather than to inflate delivery of promised bed numbers.

The guidelines surrounding virtual beds are contained in a NSW Health policy directive that was reviewed in 2012 and a NSW Health document on bed type codes.

http://www.canberratimes.com.au/nsw/hea ... 220el.html

Patient satisfaction lags in Sydney's west

Hospitals across NSW have been given a nod of approval from most patients but people in western Sydney aren't so happy.

The majority of the 35,000 people surveyed by the Bureau of Health Information rated the health system positively.

More than 90 per cent of patients were happy with the information they received before going to hospital and in relation to their discharge medication.

A majority said they could understand answers from doctors and that their care was well-organised, the Patients Perspectives report released on Wednesday shows.

People in northern and southern NSW appear to be most happy.

However, the responses of people in western Sydney fell below the NSW average across most categories.

The Australian Medical Association says this could reflect the fact that hospitals in the west and southwest of Sydney are seeing more patients.

"This is impacting not only on patient experience but ... on hospitals' ability to meet targets for emergency department performance," AMA NSW president Saxon Smith said.

Westmead Hospital's emergency department had seen an increase in urgent triage patients more than three times the state average.

"This build-up of patient numbers has been happening year-on-year in NSW and western Sydney hospitals are copping the brunt of it," Dr Smith said.

http://www.9news.com.au/health/2014/12/ ... ney-s-west