I Reckon This Is A Pretty Great Story!

This appeared last week and provided our good news for the week!

Australian books

The scientist who tested his revolutionary medicine on his own brain cancer: ‘It seemed worth it to give it a crack’

Richard Scolyer was one of the world’s leading melanoma researchers when he was struck with a brain tumour. Facing likely death, his team made him a guinea pig for his own medicine

Susan Chenery

Sun 3 Nov 2024 06.00 AEDT

Richard Scolyer was fully engaged in the business of living when he suddenly received a death sentence. A person more alive would be hard to find. As an endurance athlete competing across the globe, he was in peak physical condition. As one of the world’s leading pathologists on melanoma whose pioneering research has saved thousands of lives, he was in demand. At 56, Prof Richard Scolyer was flying along. His life, he says, was “rich”. And then, on the morning of 20 May 2023, he found himself losing consciousness and convulsing on the floor in a hotel room in Poland, panicking and scared.

After this grand mal seizure, he went for an MRI scan at University hospital in Krakow. It found a mass in his temporal lobe. Scolyer knew immediately it had delivered very bad news.

Having diagnosed other people with cancer many times, he knew exactly what the finding could mean. Most likely brain cancer. He knew the outcome for a high-grade glioma was “shockingly bad”. That a brain tumour is incurable, and he would have an “horrific last few months”. He descended into black despair; devastated, anxious, terrified. He cried and cried, weeping when he rang his children.

A biopsy operation performed in Sydney 12 days later would confirm the “worst of the worst”. It was an aggressive grade 4 IDH-wildtype glioblastoma – a terminal diagnosis.

“I didn’t want to die. I loved my life,” writes this year’s co-Australian of the Year in his new memoir Brainstorm. Only three weeks before the seizure he had represented Australia at the World Triathlon Multisport Championships in Ibiza. Now the certainties had been ripped away. Now his life was measured in months and weeks. Since that Saturday morning in Krakow he has been in unchartered waters.

Scolyer is remarkably optimistic for a man who did not expect to be alive when his book came out last month. But he is. “And kicking.” If somewhat cautiously. When you are attempting to revolutionise brain cancer treatment with a one-man clinical trial you can’t take anything for granted.

There is a notable absence of gravitas and ego in Scolyer. He seems humble, vulnerable. He has a way of making it feel like this conversation is the most important thing he has to do today. Which it most certainly is not.

Scolyer is the most published melanoma pathologist in the world, sent thousands of the most difficult cases each year. Soon after his own diagnosis, he decided to go public with his diagnosis as a way of keeping friends and colleagues informed, but mainly as a memory for his three kids. The news was greeted with an avalanche of messages. And now we all know what the inside of his skull looks like because his brain scans are on his social media.

For years before his brain tumour felled him on his Polish hotel room floor, Scolyer’s medical co-director at the Melanoma Institute Australia, Georgina Long (and his co-Australian of the Year), had led trials using a new class of immunotherapy drugs that had had spectacular results on patients with melanoma. “Basically what it’s doing is stimulating your body’s own immune system to recognise cancer cells and to kill them off,” Scolyer explains. They had learned the drugs were more effective if given before the tumour is taken out. In 15 years, the five-year survival rate for advanced melanoma had gone from 5% to 55%.

But while advances had been made in melanoma survival rates, the treatment for Scolyer’s aggressive glioblastoma had not changed in 20 years.

“Basically this sort of tumour spreads like tree roots that run through your brain. If you look down a microscope you can’t see where it ends,” says Scolyer. “So you can never cure it with surgery or radiation therapy. If you tried to cut the whole tumour out you wouldn’t have much brain left.”

Therapy usually focused on prolonging life with chemotherapy and radiation until palliative care and death.

From the moment she received the MRI scans from Poland, Long had been in action, consulting the Melanoma Institute’s world-leading experts and those around the world. Long had pioneered the successful use of immunotherapy for melanoma patients whose cancer had spread to the brain.

Facing up to emotional issues has turned out to be the hardest part of having cancer. Everyone around you suffers

Richard Scolyer

She and the team had been developing a plan for a radical treatment for her friend and colleague of 20 years. They would take what they had learned from immunotherapy and apply it to his cancer. It had never been tried before anywhere, was seriously risky and the stakes could not be higher – there was a 60% chance the side effects could kill him. If it caused major swelling in the brain, it could kill him within days.

They estimated there might be a 5% chance of saving his life; it might be less than 1%. To Scolyer, “it seemed worth it to give it a crack”.

Hoping the tumour did not grow bigger, he would delay the debulking surgery for as long as possible to give the drugs a chance to work. He would have a combination of three immunotherapy drugs intravenously. Fifteen days after the seizure, the first four-hour infusion began at the Mater hospital in Sydney. The second dose was delayed because of side-effects, including high temperatures, a rash and high enzymes in his liver. “I had a lot of [infusions] really close together every two weeks at the start.”

Through it all he kept running and cycling.

Twenty-eight days after Krakow, craniotomy neurosurgeon Brindha Shivalingam removed pieces of the tumour in a six-hour operation. She later admitted it had been emotional for her operating on a friend. She was careful not to take “the Richard out of Richard”.

Pathology results showed his immune cells were activated and hopefully attacking the tumour cells. “It was a phenomenal result,” Scolyer says. A possible new frontier for brain cancer.

---

Working on the book, written by journalist Garry Maddox, was “more joyful than I expected”, he says. His was a quintessentially Australian childhood, if unremarkable, in Launceston. Sport, camping, outdoors.

What is clear in the book is what an emotional journey the past 18 months have been for Scolyer.

“Facing up to emotional issues has turned out to be the hardest part of having cancer. Everyone around you suffers.”

He still cries a lot. He has cried on television. There have been setbacks, side-effects and “scanxiety” waiting for results of scans. No one, he says, who hasn’t experienced the shock and grief of having to say goodbye to yourself can hope to understand. “It drills down deep into your core and affects almost every minute of your day,” he explains.

The experience prompted a re-evaluation of his previous life and priorities. Driven, ambitious, working too hard, he was hurtling through life, travelling overseas 10 to 12 times a year to speak at conferences. “You get caught up in everyday life and you don’t necessarily think about the big-picture things. That’s changed.”

Now he knows love is what really matters: “The one thing that has really turned around is spending time with my family and valuing them. It has made me prioritise my family.”

He has received accolades and attention. But he says he would give it all back in a heartbeat to have his old life back.

It is too early to say if his world-first treatment is a success.

Every cell in his body is being studied. “Ultimately you have to do clinical trials to prove whether something works or not. We won’t know definitively until a trial has been done. The great thing though is that we’re able to generate some science by comparing my brain before the immunotherapy and afterwards. It gives some scientific hope that this is worth exploring.”

After nine infusions of the vaccine, with one more to go next month, Long has made a decision to stop the immunotherapy. At the time of writing there has been no sign of recurrence. But that doesn’t mean there wont be. “It is just waiting and watching and seeing if there is a recurrence. We will manage that if and when it happens.”

For the moment though, “I feel very delighted that this is the path we went down.”

Brainstorm by Richard Scolyer with Gary Maddox is out now ($34.99, Allen & Unwin)

Here is the link:

https://www.theguardian.com/books/2024/nov/03/brainstorm-richard-scolyer-book-interview-brain-cancer

One can only hope the good fortune continues and he remains well for many years to come – to make the story more inspirational given he has important work still to do!

David.

This Really Looks Pretty Ominous For Regional And Rural Healthcare.

This appeared last week:

Private regional hospitals, maternity and mental health services remain on a knife’s edge

Natasha Robinson

2 November, 2024

Prince of Wales Private Hospital maternity ward in Sydney is one of the private wards that has experienced declining births and revenue.

A host of regional private hospitals, maternity services and psychiatric wards are under threat of closure as a federal government review of the viability of the sector reveals the extent of declining patient numbers and massive hits to profits.

A summary of the recent Private Hospital Sector Financial HealthCheck conducted by the government showed expenditure of private hospitals increased 4.1 per cent between 2018-19 and 2021-22, but revenue only went up 2.9 per cent on average across the sector.

The report showed private hospitals were operating in 2022-23 at Earnings Before Interest, Tax and Depreciation of 4.4 per cent, down from 8.7 per cent in 2018-19.

“This is significantly below the 5 per cent threshold that represents the required free cash to reinvest in hospital services,” said Australian Private Hospitals Association CEO Brett Heffernan.

However, in the latest available financial data, the EBITDA margins of private hospitals increased in 2022-23 to an estimated figure of between 7 and 8 per cent. The government said there were positive signs of growth in admissions, and more recently indications that a number of private health insurers have offered additional funding to some private hospitals. But the review led by health department secretary Blair Comley concluded it was unable to say if private hospitals would be likely to improve profitability.

The private hospitals peak body hit out at the report, which was not published in full but only as a brief summary, as providing no way forward.

The government has established the Private Health CEO Forum to bring together leaders from private hospitals, insurers, medical groups and independent experts to develop short-term options for government consideration and to commence work on long-term reforms to strengthen the sector’s financial viability.

“We’ve all been waiting a very long time for this report only to find out what we already know,” said Mr Heffernan. “We recognise that long-term systemic reforms will be needed, but there is no escaping immediate action is essential to prevent more private hospitals from going to the wall.

“We weren’t anticipating that this report would provide a panacea, but all this suggests is continuing a conversation. We are long past the need for answers, not more discussion.”

The financial health check was called following a number of high-profit disputes between private hospitals and insurers amid disquiet in the sector that while the health insurance industry had come out of the pandemic with record profits, many hospitals were on the edge of survival and struggling to negotiate agreements with insurers that would cover rising costs. Hospitals were hit by a double whammy in recent years of declining admissions as a result of mass elective surgery cancellations, workforce shortages and very high health inflation.

Regional hospitals remain in a perilous situation, said Catholic Health Australia’s director of health policy Katharine Bassett.

“The viability of private hospitals in regional areas are of particular concern,” Dr Bassett said. “We have already witnessed the closure of many services in our regions and, without immediate intervention, more will follow. In many cases, private hospitals are the only providers of hospital care, and so their viability is crucial for the health and wellbeing of these communities.”

The HealthCheck also identified private obstetrics and in-hospital psychiatry as services of particular concern. Births in public and private hospitals declined 5.9 per cent and 4.7 per cent respectively from 2018 to 2022-23, with an average $2615 in out-of-pocket costs. Between 2015–16 and 2022–23, 9 private hospitals closed their maternity wards, and two hospitals with maternity services ceased operating.

The number of mental health services delivered by private hospitals declined about 15 per cent from 2018-19 to 2021-22. “The sector expressed concern about access to private hospital psychiatric services noting the difficulty in attracting and retaining psychiatrists prepared to work in a hospital setting,” the report said.

Private Healthcare Australia, the peak body representing health insurers, responded to the report saying it was intent on helping private hospitals survive in a way that does not push up premiums for consumers.

“It is notable (HealthCheck) found private hospitals experienced healthy profit margins in 2022-23, and that health insurance premium increases closely matched rising health fund payments to hospitals,” said PHA CEO Rachel David, who said the extent of private hospital closures had been exaggerated.

“This shows that what Australians pay for health insurance typically goes straight back out to hospitals to cover the cost of their care. This is backed by the latest data from the Australian Prudential Regulation Authority showing health funds return 88 cents to consumers from every dollar spent on premiums – the highest return of any type of insurance.”

Here is the link:

https://www.theaustralian.com.au/health/mental-health/private-regional-hospitals-maternity-and-mental-health-services-remain-on-a-knifes-edge/news-story/bd8e86fc0a8afdf9be8070ae8ce6ea8e

While this is not news to many, it is vitally important for many who live outside the capitals – and a lot of work is needed to ensure we have health equity across the “wide brown land”!

There is clearly s place for technology to help in this quest and continuing research is needed on the best ways to deploy it…

We all need to keep a watching brief on progress!

David.

The Government Still Seems To Think The myHR Is A Good Idea – And The Still Have NO Evidence It Make Any Real Positive Difference!

 It seems the Government is getting frustrated we have not all fallen in love with their myHR – and are wanting to introduce a level of compulsion to its use!

The poll below says it all – in the sense that the myHR remains plain user hostile an simply a burden for most to use!

Upload test results to My Health Record, or else? Poll results

Lynnette Hoffman

Managing Editor

• 2 Nov, 2024

Pathology and radiology companies will soon be mandated to upload all tests and scans to My Health Record – or lose out on MBS Payments, Health Minister Mark Butler told attendees at a recent digital health convention in Melbourne, promising to introduce the legislation soon.

In a Healthed poll this week, 65% of GPs expressed support for the move – but of those, 46% caveated that the government should improve the usability of My Health Record first.

What’s being proposed?

Minister Butler said all tests and scans would have to be “shared by default” in “near real time.”

“The ‘sharing by default’ framework will ensure that pathology and diagnostic imaging companies that do not upload the results of a test or scan will not get a Medicare benefit for that test or scan,” he said.

“Withhold a patient’s results and we will withhold the Medicare payment. It’s as simple as that.”

“To enable faster access, I am looking to remove the 7-day delay that prevents patients from seeing their results sooner,” Minister Butler said.

“While near real-time access will be the new standard, in some cases a clinically appropriate delay may remain if appropriate,” he added.

Widespread frustrations over My Health Record

Seventy percent of GPs in a Healthed survey last month said My Health Record was failing to achieve its objectives, with more than a third never using it to access or upload patient information at all, and many more only using it once or twice a week.

Hundreds of GPs in both Healthed surveys commented on the difficulties of searching and navigating in My Health Record, calling it clunky, slow, cumbersome and painstaking – to name a few.

Minister Butler acknowledged the woes of the system, but promised significant investment to change that, noting that “a few weeks ago, the Digital Health Agency put out a large tender to do just that: to fundamentally transform the interoperability capability of My Health Record.”

What your colleagues are saying

I support the proposal:

“This will ensure that patients’ results are readily available and prevents duplication of tests.”

“It will improve continuity of care and reduce costs of unnecessary testing.”

“So often the patient says they’ve had XYZ tests done but you cannot find them – particularly out of hours.”

“That way it’s easy for GPs to access results for new patients.”

“A good way to save time, better assist the patient and not repeat tests unnecessarily.”

“I also think that the usability of my health record should be improved, but I’m happy that the results are being uploaded because it makes them a lot easier to find than ringing several different pathology companies and then having them not give you all the results anyway.”

“It is the patients right to have access to their own health information and empowers them to make informed decisions.”

I do support the proposal, but the government should improve the useability of My Health Record first:

“MHR is a colossal time waster and needs to be scrapped or dramatically improved. Very user unfriendly.”

“Often unable to access when it is known an upload attempt has been made by the pathologist.”

“Patient confidentiality is a factor.”

“Data security in My Health Record is not proven to be comprehensive.”

“Simplifying access to results is helpful but the useability of My Health Record needs considerable improvement before it can perform this function.”

“It would improve patient care and take the onus away from the pathology company to fear litigation where there is breach of confidentiality as it would be mandated.”

I do not support the proposal:

“I do not use My Health Record for my own records and the format it uses is not very user friendly to obtain records from my patients’ hospital visits.”

“Too much Government interference.”

“There are patients who consult doctors other than their usual doctors just because they do not want them to know.”

“I do not have the confidence to know this can be done by pathology providers without significant extra administrative burden and cost.”

“I still have concerns about the confidentiality.”

“I do not find My Health Record useful, so there would be no benefit to my patients from MBS payments to pathology companies being withheld when they don’t upload results.”

“I find the idea of uploading pathology results on My Health Record absurd as patients have access to them and it increases their risk of misinterpreting results and worrying unnecessarily as they cannot understand medical jargon.”

“Pathology companies should have patient wellbeing and privacy in their best interests and shouldn’t be beholden to the government to release this information to patients in order to allow patients a rebate.”

“My Health Record is a 2 billion dollar lemon.”

“The pathology companies are already under stress to continue bulk billing for pathology services. This proposal would ultimately lead to patients being charged for the services.”

“This will increase costs to the patient who then may defer or decide against having recommended costs.”

“Many patients have opted out of My Health Record for privacy reasons. They do not want to be on a centralized database, potentially accessible by pretty much anyone and hackers!”

“Punitive measures don’t work as effective tools.”

Here is the link:

https://www.healthed.com.au/clinical_articles/upload-test-results-to-my-health-record-or-else-poll-results/

The views expressed above really only go to confirm what I have been saying since 2012! The myHR is about as useful as a “barnacle on a battleship” right now and needs a fundamental review as to where it may, if ever, be of use.  We have a stupid situation now where the damn thing exists so we are all meant to use it – just why being totally unclear!

If there was a sensible, practical, meaningful use-case I am sure it would get used so it is really up to Government to provide that use case.  Right now it just means extra work for no apparent benefit for most!

David.

Pain In Women Is Under Recognised And Under – Treated. I Wonder Why?

This appeared last week

‘Precious, princess’: Health minister warns GPs to brace for women’s pain inquiry findings

By Wendy Tuohy

November 3, 2024 — 5.00am

Victorian Health Minister Mary-Anne Thomas is warning doctors to brace themselves for the results of Australia’s first inquiry into women’s pain, saying it revealed “a misogynist view that pain is part of women’s burden”.

Thomas said she was shocked to learn what more than 13,000 women and girls who shared stories with the inquiry experienced, and that many had serious pain dismissed or were “gaslit” by being told they had mental health issues.

Women testified saying things such as, “I just want to get off the merry-go-round of antidepressants and iron infusions” prescribed for pain.

It’s prompted Thomas to warn that the findings will make difficult reading for the medical profession.

“Brace yourself for what the report is going to say about women’s experience with their primary healthcare practitioners,” Thomas said she had told the Royal Australian College of General Practitioners.

“I don’t want to blame them, but it goes to the Medicare rebates, it goes to what they’re taught and what they know and both conscious and unconscious bias that exists within the health profession.”

Thomas said some women felt they were treated as drug addicts when they asked for relief. She was challenged by researchers for suggesting misogyny may be a factor the gender-pain gap.

“‘It’s natural. Therefore, we shouldn’t do anything about it’ – that was presented back to me. I thought, ‘That’s really something’ – because cancer is also ‘natural’.”

In its submission to the 11-month inquiry, the Australian Nursing and Midwifery Federation included incidents of health workers having their own pain treated dismissively and witnessing women receiving gender-biased treatment.

It received more than 800 responses in four days to a member survey on women’s pain.

Of 89 per cent of nurses and midwives who had experienced acute pain, two-thirds felt “dismissed by health professionals”, and 53 per cent said the response was negative.

A nurse on a mixed specialty surgical ward said gynaecology patients who describe “10/10 pain” were given paracetamol as a first-line treatment to “wait and see if it helps”, while other surgical patients “are given two to three lines of analgesia charted immediately at any instance of pain”.

Another told of “multiple colleagues judging young female patients’ subjective pain scores, calling them ‘precious’, ‘princess’ or ‘overreacting’.”

Men were believed and treated sooner and often given more options. One nurse “watched a man with a carpal tunnel be written up for 20 mg of IV [intravenous] morphine, but a woman with a full reproductive system removal gets written up for only a max of 10 mg of IV morphine.

“Women are seen as if they can’t tolerate pain, or they’re weak or as, ‘You bear children, you can deal with great amounts of pain’.”

Sue Matthews, chief executive Royal Women’s Hospital and National Women’s Health Advisory Commitee

“We are treated differently and are often labelled as emotive or anxious,” she said.

The federation’s Madeline Harradence, a member of the Victorian Women’s Health Advisory Council, said nurses and midwives reported a delay in women getting care for chronic pain and getting appropriate care or treatment for very acute conditions.

“A woman who turns up in the emergency department is not believed, they’re having trouble getting in the door,” she said. “[Nurses] are constantly having to advocate for women against those gendered structures.”

Professor Sue Matthews, the Royal Women’s Hospital chief executive and inquiry co-chair, said it was heart-wrenching to hear from women at community forums, focus groups and online.

“The number one issue for women has been they felt dismissed,” said Matthews, also a member of the National Women’s Health Advisory Committee.

“One of the biggest things we’re hearing is that their pain is attributed to mental health issues or lifestyle factors, when it isn’t [due to those].

“Women are seen as if they can’t tolerate pain, or they’re weak or as, ‘You bear children, you can deal with great amounts of pain’ … It’s the invisibility of those women that’s the problem.”

Australian is behind other nations in stratifying research data by gender and including women in trials, she said. More eduction was needed to increase understanding that women’s pain is not “normal”.

That medical knowledge “doubles every 73 days” means it is very difficult for healthcare practitioners to keep up, Matthews said, and the inquiry would make recommendations about how to support them to do this.

RACGP Victorian Council chair Anita Munoz acknowledged that in parts of the medical system, “there are women who have had bad experiences of not being believed about their pain”, but said inquiries often captured historical as well as contemporary experiences.

Poor understanding of women’s pain was not just a general practice issue, but GPs faced particular challenges because patients often have multiple co-existing problems to be addressed in standard 15-minute appointments.

“GPs and patients bear the brunt of this: we have a more than 40-year-old funding system that financially punishes good GPs for spending in-depth time with patients. The patho-physiology of gynaecological issues and chronic pain is very difficult to do … in the that amount of time,” Munoz said.

‘If it achieves parity with MBS funding that would be good ... the rebate for scanning a scrotum is more than for scanning a female pelvis.’

Marilla Druitt, Royal Australian and New Zealand College of Obstetricians and Gynaecologists

“The Medicare funding system sets up GPs to fail.”

Dr Marilla Druitt, a councillor of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists and president of Pelvic Pain Victoria, said she was not at all surprised by what women told the inquiry.

The college’s submission noted “research shows that chronic pain affects a higher proportion of women and girls than men, yet women are far less likely to receive treatment”.

Druitt said it was hard to judge if the use of the term “medical misogyny” by some regarding responses to women’s pain was justified, but if it helped change longstanding women’s health funding problems it might be.

“If it achieves parity with Medicare Benefit Schedule funding that would be good. [For example] the rebate for scanning a scrotum is more than for scanning a female pelvis,” she said.

“I desperately hope that some of what we recommended is accepted.”

The inquiry is due to hand its recommendations to the Victorian Women’s Health Advisory Council by December and will be released in early 2025.

Here is the link:

https://www.smh.com.au/national/victoria/precious-princess-health-minister-warns-gps-to-brace-for-women-s-pain-inquiry-findings-20241031-p5kmsm.html

What is your theory as to why women’s pain is often minimised?

I have a feeling it is a historical carry-over from the days when men dominated the profession. Hopefully things are correcting over time (quickly).!

All suggestions contemplated!

David.

AusHealthIT Poll Number 771 – Results – 03 November 2024.

Here are the results of the poll.

Are You Expecting All Sorts Of Unexpected Problems As The 3G Telecommunications Network Is Shut Down On 28th October?

Yes                                                                             14 (38%)

No                                                                              22 (59%)

I Have No Idea                                                            1 (3%)

Total No. Of Votes: 37

A split vote, with the feeling being that we are going to handle the switch off well – as we did!

Any insights on the poll are welcome, as a comment, as usual!

Good voting turnout. 

1 of 37 who answered the poll admitted to not being sure about the answer to the question!

Again, many, many special thanks to all those who voted! 

David.

This Is Really Bad News Indeed And An Ongoing Worry!

This appeared last week:

Drug resistance

Rise of almost untreatable superbug linked to a common antibiotic

‘Surprising’ finding by Australian-led study is first recorded instance of one antibiotic causing resistance to another in a different class

Sharlotte Thou

Thu 24 Oct 2024 07.30 AEDT

The rise of an almost untreatable superbug has been linked to a common antibiotic, an Australian-led study has found.

The study – published in Nature – found that rifaximin, an antibiotic used to treat liver disease, causes resistance to another antibiotic, daptomycin.

Daptomycin is one of the few drugs that is effective against vancomycin-resistant enterococcus (VRE), a contagious bacterial infection that can cause serious reactions in hospitalised patients.

Dr Adrianna Turner, the study’s lead author, said the “really surprising” finding was the first recorded instance of an antibiotic causing resistance to one in a different class. It was previously thought that the risk of antibiotic resistance only applied to the one antibiotic.

Superbugs explained: what they are and what a post-antibiotic future could look like – video

The findings also overturned the widely held idea that rifaximin was a low-risk antibiotic.

Last month international leaders committed to decisive action on antimicrobial resistance – the development of bacteria to resist treatment. This included the aim of reducing the estimated global 4.95m deaths associated with antimicrobial resistance annually by 10 percentage points by 2030.

Turner said when bacteria became resistant to an antibiotic, “it’s a bit like gaining a new ability in a video game”.

“But when exposed to rifaximin, the VRE bacteria don’t just get one boost – they gain multiple abilities, like super-speed and super-strength, allowing them to easily defeat even the final boss, which in this case is the antibiotic daptomycin.”

Rifaximin use triggers changes in an enzyme within the bacteria, which then leads to changes in the VRE’s cell membrane, causing cross-resistance, researchers from the Doherty Institute and Austin Health found.

Turner did not rule out the possibility that other antibiotics could create resistance to antibiotics in different classes.

Researchers are now investigating whether daptomycin-resistant strains of VRE may be transmitted to other patients within the hospital.

The eight-year study involved genomic analyses of isolates from patients from Australia and Germany, and used animal models to support the hypotheses.

Turner said the findings highlighted the need for surveillance and investigation into how bacteria become antibiotic-resistant, allowing researchers to create diagnostic tests and genomic surveillance to understand the prevalence of such bacteria.

Prof Jason Kwong, from Austin Health, emphasised that rifaximin is still effective when used appropriately and those taking it to treat advanced liver disease should continue to do so.

“But we need to understand the implications going forward both when treating individual patients and from a public health perspective,” he said.

He advised clinicians treating patients with VRE who have taken rifaximin to confirm that daptomycin is working via a lab test, as its efficacy may be affected.

Kwong emphasised the importance of drug regulators considering whether the use of one drug makes another less effective when approving new drugs.

Prof Martina Sanderson-Smith, a molecular bacteriologist at the University of Wollongong, said the finding that antibiotic resistance can affect different types of antibiotics was “really concerning and interesting”.

She said the findings highlighted the difficulties in the responsible use and prescription of antibiotics, and the need to balance safety with clinical need.

“We need to better understand the possible sort of consequences of prescribing all classes of antibiotics on this idea of shared resistance across antibiotic classes, so that clinicians can make more informed decisions,” she said.

Here is the link:

https://www.theguardian.com/society/2024/oct/24/antibiotic-resistance-daptomycin-superbug-study

It is clear that some-time soon we are going to need better regulation and supervision of anti-biotic prescribing. Can’t happen soon enough I reckon!

David.

It Looks Like All Is Not OK In The Private Hospital Sector!

This appeared last week:

Ramsay calls for insurance shake-up as hospital bailout hopes sink

Michael Smith Health editor

Oct 24, 2024 – 5.37pm

Ramsay Health Care has called for health insurance funding to be automatically linked to cost inflation. The head of its Australian hospital operations said the company was prepared for a “fight” if insurers did not agree to do more to cover unexpected surges in staff wages.

Ramsay, the country’s largest private hospital group, also said it was not expecting the Albanese government to bail out struggling facilities or deliver any solutions to the sector’s crisis as it prepares to release the findings of a Department of Health review into the $22 billion sector.

The closure of a private maternity ward in Gosford on the NSW Central Coast announced this week triggered warnings on Thursday of more hospital closures unless insurers tipped more money into the system or Health Minister Mark Butler takes action to prop up loss-making facilities.

“I am not expecting solutions from the government, but I think there is a bit of pressure on [them] from the closure of maternity services like Gosford. You would imagine there would be MP pressure in some of those regions which will necessitate some thought,” Ramsay’s Australia boss Carmel Monaghan told analysts on Thursday.

“I don’t think there is a bailout coming for hospitals that aren’t doing so well. I can’t see that happening.”

While Ramsay is more profitable than other big private hospital groups, its margins are under pressure from soaring wages. Ms Monaghan told investors the company was in talks with a number of health insurers to address funding shortfalls from cost inflation. She said while there had been “some recent success” she would not rule out further disputes with insurers if they did not come to the party.

“There are quite a number of negotiations underway. I hope we don’t have to bash them up but if we have to, we will. I can’t say there won’t be a fight but if that’s what it comes to...,” she told analysts after a site inspection of Ramsay facilities in Perth.

She said Ramsay wanted “automated indexation” when health inflation was higher than expected. That model would automatically link future funding to cost inflation compared to the current system, where funding is negotiated in contract talks with each insurer.

However, health insurers said a tax hike on NSW health insurance passed by parliament on Thursday meant there was no money left to increase funding for hospitals.

“To date, health funds have provided multiple voluntary payments to private hospitals to help them survive tough financial conditions. However, the Minns government’s tax hike will cannibalise any reserves to do this in future. There is nothing left,” Rachel David, chief executive of Private Healthcare Australia, which represents health insurers, said.

Ramsay on Thursday outlined plans to expand its hospital network and invest in emergency departments and other outpatient services despite the pressure on the sector due to inflation and lacklustre patient numbers. It also said it was confident of getting more work from state governments paying for public patients to use private hospitals, although company data showed this had dropped off in the last two years.

“New South Wales have turned off the tap for a while, but they have a big waiting list … there will be pressure at some point and the pressure valve will have to be released,” Ms Monaghan said.

Ramsay is under pressure to improve its operational performance with the value of its shares down 20 per cent so far this year. The company has appointed Woolworths’ former head of supermarkets Natalie Davis as its new chief executive. She is expected to formally take on the role at the end of this year.

Some investors are disgruntled with the company’s rejection of a $20 billion takeover bid from private equity firm KKR in 2022 of $88 a share. Ramsay shares closed down 4¢ at $41.77 on Thursday, valuing the company at $9.7 billion. The stock has lost 20 per cent of its value so far this year.

“I do think the company is undervalued, given no market value being placed for Ramsay Sante, but for the market to get confident, Ramsay needs to improve operational performance,” said Blackwattle Investment Partners portfolio manager Ray David, an investor who has been calling for a change of strategy at Ramsay. Sante is the company’s European operations.

Preliminary findings of the Butler hospital review obtained by The Australian Financial Review in July revealed a government warning that some hospitals would close in the next 12 months with a shift from overnight stays to same-day procedures harming profit margins. It said the private sector was “uninvestable”.

Insurers and hospital groups had been expecting a summary of the report to be released this week, two months later than originally expected.

Michael Smith is the Health Editor for The Australian Financial Review. He is based in Sydney. Connect with Michael on Twitter. Email Michael at michael.smith@afr.com

Here is the link:

https://www.afr.com/companies/healthcare-and-fitness/ramsay-calls-for-insurance-shake-up-as-hospital-bailout-hopes-sink-20241024-p5kkzu

This is more useful information on the Private Hospital sector which, I suspect, is really struggling and needs a proper plan for co-existence with the public sector. It seems clear that both mental health and acute care are in some difficulty.

The system has always been a bit ‘Micky Mouse’ and the time has come to get it back on a sustainable footing.

A good few hard heads need to give this some careful thought! If Ramsay is struggling there will be some smaller entities in deep 'do-do'!

David.

It Will Be Interesting To See Just How Well This Key Recommendation Flies With The Docs.

This appeared last week:

25 October 2024

Here’s what’s in the scope of practice report

By

Holly Payne

The controversial review has now signed and sealed its final report, which is on its way to Health Minister Mark Butler.

Patient registration will be central to the reforms recommended by the scope of practice review in its final report, according to committee lead Professor Mark Cormack.

Speaking on a workforce panel at Rural Medicine Australia 2024, ACRRM and the RDAA’s annual conference, Professor Cormack disputed the notion that the review would promote a fragmented system.

“Our review will strongly recommend the centrality of the Strengthening Medicare policy framework and the centrality of patient registration with a [GP] practice,” he said.

“The funding, payment and other reforms that we’re proposing – and of course, we’re proposing others that have got nothing to do with payment – will be built around the centrality of Strengthening Medicare and MyMedicare.

“[It will] in many ways provide a forcing function for multidisciplinary approaches to care in the primary care sector.”

The most significant ask in the report will be on payment models.

“Payment mechanisms drive and restrict scope unnecessarily, more than any other policy setting,” Professor Cormack said.

“The work that the [Department of Health and Aged Care] … has done through the GP Incentives Review is absolutely fundamental, not only to achieving the 2032 vision for primary care, but also for enabling health professionals to work to their full scope of practice.

“Put simply: if there’s not a payment available for a healthcare worker to work at their full scope of practice … they won’t do it.”

The review of WIP and PIP payments caused a stir earlier this year, when its draft report recommended that the payments be phased out in favour of a simplified GP architecture, which itself required practices to participate in MyMedicare.

While some of the more controversial aspects were ultimately walked back in the final report, it still recommended that non-fee-for-service Commonwealth payments to general practice (i.e. block funding) should increase from 10% to 40%.

“Health professionals are far more likely to be working at full scope of practice in the context of a multidisciplinary care team in a blended payment, block payment or salaried environment than they are in fee-for-service arrangement,” Professor Cormack said.

“It’s absolutely clear cut.

“The payment mechanism drives behaviour, and there needs to be a concerted focus on addressing that.”

Professor Cormack said Aboriginal Community Controlled Healthcare Organisations were the “stand out model” for primary care.

The second consultation paper from the review, which was released in April, put forward reform options like allowing allied health professionals to write referrals to non-GP specialists directly and opening up the MBS to non-doctors.

Professor Cormack said the report will recommend a harmonisation of legislation and regulatory arrangements.

“Many of the reforms that are happening at a state-by-state level are enabled by virtue of the states having their own Drugs and Poisons Act, and the same for the Radiation Safety Act and Mental Health Act,” he said.

“At system level, we need to focus on harmonising where it makes sense and where there’s a common goal of health professionals working at full scope of practice in the context of a multidisciplinary care team.”

He also said the report would propose a formal mechanism be put in place to assess and evaluate significant changes to workforce models and scope of practice, in the same way that the PBS considers requests for new drug listings.

Rural Medicine Australia 2024 was held at Darwin Convention Centre between 24-26 October.

Here is the link:

https://www.medicalrepublic.com.au/heres-whats-in-the-scope-of-practice-report/111956

I will be interested to see just how far they (The Federal Government) get with these changes – which really look rather like a form of creeping nationalization to me – and a move to practice operation rather like that found in the NHS.

I will keep an eye out for reaction!

David.