Want to improve care in nursing homes? Mandate minimum staffing levels

The Royal Commission into aged care has begun its 18-month investigation into the quality and safety of Australia’s residential aged-care system.

Topping the list of priorities is to uncover substandard care, mistreatment and abuse, and to identify the system failures and actions that should be taken in response.

But we don’t need a royal commission to tell us the number-one thing that can improve care in nursing homes: implementing minimum staffing levels.

Based on our research from 2016, the Australian Nursing and Midwifery Federation recommends residents receive 4 hours and 18 minutes of care per day for optimal health and well-being.

It’s also important to get the right mix of staff performing for these hours and minutes. Half of the care should be provided by care workers (who undertake a short TAFE course), 30% by registered nurses (who complete a three-year bachelor degree at university), and 20% by enrolled nurses (who complete an 18-month diploma).

Nurse ratios in hospitals

It’s no surprise nurse shortages affect patient care. Nurse staffing shortfalls in hospitals have been associated with poorer patient outcomes, longer stays in hospital, and a higher risk of death within 30 days of discharge.

Poor staffing causes stress and frustration among nurses, who constantly feel rushed and unable to provide the type of care their patients deserve. This leads to greater job dissatisfaction and burnout.

One way to ensure nurse staffing levels is to implement mandatory nurse-to-patient ratios. California did this in 1999, when it mandated ratios ranging from one nurse to two patients in intensive care, to one nurse to six patients for women who had given birth.

After the ratios were implemented, the nurses’ patient loads decreased and they reported being able to provide better quality care. They also felt more job satisfaction and were less likely to burn out. Importantly, rates of complications and premature death decreased.

Minimum aged-care staffing

Seemingly small tasks in aged care can have a big impact on residents. If they don’t receive adequate assistance at meal times, for instance, they may lose weight and become malnourished. If they’re bed-bound and aren’t moved frequently enough, they’re at risk of developing painful pressure sores.

As with hospital-based care, minimum staffing ensures staff have enough time to complete these important tasks and has been associated with improvements in health outcomes for residents with multiple illnesses.

Missed or delayed care can have an enormous impact on residents. Elien Dumon/

Importantly, increasing direct care hours reduces the use of medication to manage difficult resident behaviour, allowing residents to maintain their independence.

Increasing direct nursing care also decreases the likelihood of residents being transferred to emergency departments, as their symptoms can be managed in the facility.

One key downside, however, is that the introduction of minimum staffing levels can result in a shift away from employment of registered nurses towards staff with less education and skills, as has happened in the United States.

What happens in Australia?

All Australian states and territories have legislation to determine the minimum staffing levels in hospitals to ensure patients receive timely care and close monitoring. But no such legislation exists in the aged-care sector.

The current Australian Aged Care Quality Agency standards say aged-care facilities need to be adequately staffed with appropriately skilled and qualified staff but they don’t specify what constitutes adequate.

In 2015, residents in Australian aged-care facilities received 39.8 hours of direct care per fortnight. This averaged 2.86 hours per resident per day and is significantly below the recommended 4 hours 18 minutes per day.

Our research, commissioned by the Australian Nursing and Midwifery Federation commissioned research, set out to investigate what constitutes safe levels of staffing in residential aged care.

In phase one, we tested six “profiles” for residents requiring between 2.5 and 5 hours of nursing care daily, using the de-identified data of 200 residents. We then recruited experienced registered nurses to time and record what amounted to nearly 2,000 nursing and personal care interactions in hospitals, aged care and rehabilitation facilities.

We ran the six “profiles” made up of timed care activities through seven focus groups of nurses working in aged care to determine the proportion of residents who meet each profile.

Nurses and carers want the time to provide quality care to residents. Alexander Raths/Shutterstock

Overall, we found more than 60% of aged care residents required four or more hours of care per day. This rate is likely to be similar in most aged-care facilities across the country.

The second component of our research involved surveying 3,206 staff working in aged care to determine the amount and types of care missed and the reasons why. This is care missed or delayed because of multiple demands, inadequate staffing and material resources, or communication breakdowns.

Staff believed care was being missed in all facilities, with higher levels of missed care reported in privately owned facilities (both for-profit and not-for-profit).

Unscheduled tasks such as responding to call bells and to toileting needs within five minutes were most likely to be missed – as were the social and behavioural needs of residents.

Complex care activities such as wound care, medication and end-of-life care were less likely to be missed, although there were deficits in some areas.

When asked to indicate the reasons why care was missed, the respondents cited:

  • having too few staff
  • the complexity of resident needs (for example, more residents receiving palliative care and with dementia)
  • inadequate skill mix of nursing and care work staff
  • unbalanced resident allocation (some staff having heavier workloads than others).

Beware cost saving

Many of the problems in the aged-care sector can be addressed with adequate staffing, and ensuring residents receive, at a minimum, the required 4 hours and 18 minutes of care each day. But staffing hours should not be increased by replacing nursing staff (who have clinical education and skills) with lower-skilled care workers.

(c) The Conversation Australia

Authors

  1. Research Associate, Southgate Institute for Health, Society and Equity, Flinders University

  1. Emeritus Professor Eileen Willis, Flinders University

Disclosure statement

Julie Henderson received funding from the ANMF to undertake this research

Eileen Willis received funding from the ANMF. She is a life member of the National Tertiary Education Union.

Aged Care – what we need- but will we get it?

A challenge facing the recently announced Royal Commission into Aged Care Quality and Safety will be to define “quality”.

Everyone has their own idea of what quality of care and quality of life in residential aged care may look like. The Conversation asked readers how they would want a loved one to be cared for in a residential aged care facility. What they said was similar to what surveys around the world have consistently found.

Characteristics that often appear as the basis for good quality of life include living in a home-like rather than an institutionalised environment, social connection and access to the outdoors. Good quality of care tends to focus on providing assistance that is timely and appropriate to individual needs.

 

A bleak view of aged care

A mature judgment to determine good quality requires us to recognise that many people have an instinctive and distressingly bleak view of ageing, disability, dementia and death. Some people express this as death being preferable to living in aged care, as the tweet below shows.

This doesn’t necessarily reflect an objective assessment of the actual care being delivered in residential facilities, but it does speak to the fear of losing independence, autonomy and identity.

In a survey of patients with serious illnesses hospitalised in the US, around 30% of respondents considered life in a nursing home to be a worse fate than death. Bowel and bladder incontinence and being confused all the time were two other states considered worse than death.

Aged care facilities will be the final residence for most before they die. This means the residents’ sense of futility and the notion one is simply waiting to die can and should be addressed.

 

Loose-leaf tea can make someone feel at home. Matt Seymour/Unsplash

Our reason for being is usually expressed through social connections. This a recurring theme for residents who define quality of care as whether or not residents have friendships and are allowed reciprocity with their caregivers.

A systematic review that drew together a number of studies of quality in aged care found residents were most concerned about the lack of individual autonomy and difficulty in forming relationships when in care.

Good staff

The need for positive social connections for residents extends to the relationships between staff and families. Achieving this requires staff with a positive attitude who work to build trust and involve family in their loved one’s care. They must also engage on issues that have meaning to the individuals.

Good staff should be both technically proficient and, perhaps more importantly, good with people.

Idyllic, or the way it should be?

A home-like setting – which may include having a pet and enjoying time in nature, as the Tweet below describes – may seem idyllic. However, more contemporary models of care are moving towards smaller home-like environments that accommodate fewer people and are more like a household than a large institution.

The ability to relate and personalise care to a small group of 10-12 residents is surely easier than catering to 30-60 residents. Some studies in the US have shown residents in such smaller units have an enhanced quality of life that doesn’t compromise clinical care or running costs.

This cluster-style housing still has limitations that need to be addressed. These include selecting residents who are suitable together and catering for the changing clinical and care needs of each individual.

Pets and the outdoors

Research into the value of pets in aged care has largely focused on the benefits to people living with dementia. Introducing domestic animals, typically dogs, has been shown to have positive effects on social behaviours, physical activity and overall quality of life for residents.

Pets improve quality of life for people living with dementia. from shutterstock.com

Similarly, providing accommodation where the physical environment and building promote engagement in a range of indoor and outdoor activities, and allow for both private and community spaces, is associated with a better quality of life.

Good food

Another major determinant of quality of life in residential aged care is the quality of food. This becomes even more important as people age. Providing high-quality food and enriching meal times is more challenging as many diseases such as dementia and stroke affect older people’s dentition and swallowing.

Aged care services need proactive and innovative approaches to overcome these deficits and better promote general health.

A key feature often overlooked is the cultural significance of food. Providing traditional foods to residents strengthens their feeling of belonging and identity, helping them hold on to their cultural roots and enhance their quality of life.

Safety, dignity, respect and choice

While the focus is often on preventing abuse, neglect and restrictive practices in aged care, the absence of these harmful events doesn’t equate to a positive culture. Residents want and have a right to feel safe, valued, respected and able to express and exercise choice. Positive observation of these rights is essential for quality of life.

Clinical and personal care

Time is a factor in aged care, as staff often don’t have enough time to spend with each resident. A recent ABC Four Corners investigation into quality in aged care found personal care assistants had only six minutes to help residents shower and get dressed. No wonder, then, that staff often don’t have the personal time to be able to spend with residents who need life to be a little slower, as the Facebook comment below shows.

Clinical care is another important aspect of quality aged care. A resident cannot enjoy a good quality of life if their often multiple and chronic conditions such as diabetes, heart failure and arthritis are poorly managed by their doctors and nurses.

Residents in aged care are the same as those who live in the community. They are people with the same needs and wants. The only difference is they need the community to give the time, effort and thought to achieve a better life.

(c) The Conversation Australia

Chocolate-coloured Labrador retrievers have, on average, 10% shorter lives than black or yellow Labradors,

Acording to a study we co-published today in Canine Genetics and Epidemiology. Ear infections and skin diseases are also more common in chocolate Labradors than non-chocolate Labradors.

We looked at the UK veterinary records more than 33,320 Labrador retrievers through the VetCompass program. We then extracted data on death and disease from a random sample of 2,074 (6.2%) of these dogs.

 

Some diseases were far more prevalent in chocolate dogs. The prevalence of pyo-traumatic dermatitis (sometimes called wet eczema or hot-spot) in black dogs was 1.1%, in yellow dogs it was 1.6% of but rose to 4% in chocolate dogs. Meanwhile, otitis externa (ear infection) was found in 12.8% of black dogs, 17.0% of yellow dogs and 23.4% of chocolate dogs.

Research in humans has suggested a link between inflammation and shorter life expectancy and lower quality of life. It’s possible that, by a similar process, repetitive inflammatory skin and ear infections in chocolate dogs create an immunological burden that effectively shortens their lives.

Breeding for colour, not health

Colour might not seem linked to health at first glace, but some connections between coat colour and disease in dogs are well established. The Piebald or “S” gene variants can increase the amount of white in a dog’s coat and lighten its eyes to blue, but also cause high rates of deafness in one or both ears.

 

Dogs with merle coats are popular, but prone to deafness and sight problems. Shutterstock

In another example, the Merle or “M” gene variant gives dogs a pale speckled coat and often blue eyes, but has been also linked with high rates of blindness and deafness. Rarer examples include cyclic neutropaenia (“Grey Collie Syndrome”) and colour dilution alopecia.

Even when the coat colour genes themselves are not themselves bad for dogs’ health, problems can still arise when an unusual colour becomes popular. The genes for some colours may be quite rare in the population or else hidden inside a parent of a different colour, meaning breeders may be tempted to overuse dogs they know for sure either show or hide the rare gene.

 

This is the case for our chocolate Labradors: chocolate is a recessive trait, which means both parents must carry it. Breeding chocolate puppies from this shallower gene pool carries with it additional risks of ill health and disease.

And it’s not only physical health with has surprising links to coat colour – behaviour has been linked to coat colour too. For example, there appears to be an association between coat colour and aggression in self-coloured (golden and black as distinct from roan) cocker spaniels.

Colour has been linked to temperament in cocker spaniels. Shutterstock

While it is not clear whether coat colour affects the widely prized personality of the Labrador, chocolate Labradors have different retinas to their yellow and black counterparts and retinal differences in various other breeds are thought to account for some behavioural differences in other breeds (for example in the chasing behaviour of so-called sighthounds, such as whippets, greyhounds and Afghan hounds).

The power of preference

Surprisingly, even if it turns out that the colour of Labradors doesn’t affect how they behave around us, there is some evidence that it may affect how we humans behave towards them. One study found people who look at photos of yellow and black dogs rate the yellow dogs significantly higher in agreeableness, conscientiousness and emotional stability.

Similarly, a study found pedestrians perceived pale-coloured dogs as being friendlier than dark-coloured dogs. Indeed, black dogs have been maligned by no less a figure than Winston Churchill, who referred to his own depression as a black dog. It is even possible that breeders may have selected the tan eyebrows of breeds such as Rottweilers and Kelpies because the contrast on their expressive eyebrows make their faces easier to read.

We may like dogs with high-contrast eyebrows because it’s easier to read their expressions. Shutterstock

 

But whatever our first impressions of a dog in a photograph, a dog on the street, or the new puppy we’ve just brought home, any dog owner can tell you that our relationships with our canine companions matter far more than appearances.

There are estimates that over 43,000 dogs are euthanased in shelters and pounds annually in Australia and evidence that 65% of owners report a behavioural reason for surrendering their dogs, often because the dogs have been poorly socialised, trained and managed. It is safe to say these dogs were not sent to shelters because of their colour.

 

With every generation in a breeding program, one can make only a certain number of strides. Since breeders have to take into account the many detailed traits specified in breed standards, there’s limited opportunity to also breed for traits that boost welfare and adaptability to urban environments.

Breeders could focus more on selecting for good temperament and health, but only if less attention were paid to superficial traits. After all, a dog can never be the “wrong” colour.

 

(c) The Conversation Australia.

Actor Geoffrey Rush says defamation trial makes him look like a criminal.

Oscar-winning Australian actor says front-page story published by Murdoch-owned Nationwide News made him sick to his stomach

The actor Geoffrey Rush has told a defamation trial that he was made to look like a “criminal” by a front-page story headlined “King Leer”, a story he said made him feel “sick to my stomach”.

Rush appeared on the first day of his two-week trial against Sydney’s Daily Telegraph on Monday, saying the stories had sent him into an “emotional spiral”.

“It’s been the worst 11 months of my life,” he said.

“These [articles] are the starting point of that and it only got worse. It kind of concurs with the 47th anniversary of my starting life as a professional actor, and suddenly [it] was dismantling how I felt as a person.”

The Oscar-winning actor, one of Australia’s best-known performers, is suing the newspaper over a series of articles published at the end of November and beginning of December in 2017 that alleged he behaved inappropriately during a 2015 stage production of King Lear.

Rush claims the articles defamed him by portraying him as a “pervert” and “sexual predator”.

In his opening statement Rush’s barrister, Bruce McClintock SC, said the actor would seek to prove the allegations in the stories were false, and that the Telegraph was motivated by “malice” in publishing them.

The Telegraph led its front page with the allegations against Rush story on 30 November with the headline “King Leer” and an image of the actor in character. Rush told the court the image and headline made him look like a criminal.

“Well it polluted or it dirtied the original intention of the image and converted it into what I think looked like a police lineup,” he said. “It made a madman from the theatre look like a criminal in reality.

“It was devastating, my son was home [and] Jane [his wife] was home. I could see how distressed they were which created a great deal of hurt for me. I felt as though someone had poured lead in my head. I went into a kind of, ‘this can’t be happening’, I was numb.”

Rush told the court he had pulled out of a Melbourne Theatre Company production of the Twelfth Night as a result of the claims, saying he had suffered from “sleeplessness” and “poor appetite”.

“And feeling hurt myself about the levels of distress it was creating in my son and daughter and my wife and some close friends as well,” he said.

“I was weak. I was weakening.”

Earlier the court heard that Rush and the woman at the centre of the defamation trial exchanged familiar and “affectionate” emails with one another after the alleged inappropriate behaviour had occurred.

McClintock told the court the actor denied all the allegations made against him, and accused the newspaper of deliberately seeking to “smash and destroy” Rush’s reputation.

He said the Telegraph had been desperate to publish the stories after being “gazumped” by a rival media company over allegations of misbehaviour by other Australian celebrities, including well-known television personality Don Burke.

McClintock told the court Rush had forged a reputation as one of Australia’s best-known actors over an almost 50-year career.

Rush, he said, had been a “household name” and a “national living treasure” with “no scandal attached to his name”.

“As well as giving pleasure to millions, his reputation was stellar. It could not have been higher,” McClintock said.

But the Telegraph and journalist Jonathan Moran, who McClintock described as a “gossip columnist”, had sought to “smash and destroy” Rush’s reputation in a deliberate attempt to link him to the scandal surrounding other disgraced personalities such as Don Burke and Harvey Weinstein.

“There’s no one who could read these articles and think anything other than [that] this was a straight-up, full-blown attack on my client,” McClintock said.

The woman at the centre of the allegations, Eryn-Jean Norvill, has not spoken publicly since the Telegraph published the stories, but in August the federal court heard News would seek to argue truth in its defence on the basis of her statement.

On Monday, McClintock told the court the trial would hear evidence from the director of the Lear production, Neil Armfield, as well as other cast members, that they did not witness any of the alleged inappropriate behaviour.

He said Rush believed his relationship with Norvill to be “professional and cordial”, and read out emails and text messages between the two of them which he said showed “familiarity” and “affection”.

In earlier emails Norvill thanked Rush for a positive reference, and asked him to attend her birthday. McClintock also sent an email sent after the alleged inappropriate behaviour from Norvill to Rush after he had forwarded a positive review to her.

“That was wonderful, thanks for sending through dearest daddy ‘gush’,” she wrote.

Rush appeared calm as he spoke about his early career as a young actor in Brisbane and Paris in the late nineteen seventies, and later in Sydney as a teacher at the acting school Nida where he shared a home in Kensington with “a very young” Mel Gibson.

He talked about how throughout his career he had specialised in playing “the ratbags, the fools, the conmen and the idiots and the drunks”.

He described being “disturbed” when he was presented with a list of questions from the Telegraph just after 5pm on the day before the King Leer story was published, saying he had not been told who was making the allegations.

The actor was swamped by journalists but remained silent as he entered the court wearing a navy suit and dark-blue shirt on Monday morning.

Rush’s lawyers are seeking aggravated damages against the Telegraph, and on Monday McClintock said his client had suffered “real financial hardship” and “the hurt to his feelings”.

He said Rush was earning “many millions of dollars per annum” in the years before the publications, but that in the 10-and-a-half months since the stories were published he had made only $44,000.

McClintock also accused Moran, the author of the articles, of telling “bare-faced lies” in some of the articles complained about.

Moran, who McClintock described as a “gossip columnist” will not appear during the trial.

The trial continues.

(C) Guardian Australia

Australia apologies for instututional sexual abuse

Australian Prime Minister Scott Morrison has apologised on behalf of the nation for failing and abandoning the thousands of survivors of institutional child sex abuse.

Key points:

  • The apology was a recommendation of the royal commission
  • In its final report the commission estimated the number of child victims was in the tens of thousands
  • Opposition Leader Bill Shorten also delivered an apology

In an address to Federal Parliament, Mr Morrison said there was no promise that could be made and nothing that could be done to right the wrongs of the past.

But he said the nation was now confronting a “trauma” and an “abomination” that had been hiding in plain sight for too long.

“Today, as a nation, we confront our failure to listen, to believe, and to provide justice,” he said as hundreds of people watched on from Parliament’s public galleries and Great Hall.

“To the children we failed, sorry. To the parents whose trust was betrayed and who have struggled to pick up the pieces, sorry.

“To the whistleblowers who we did not listen to, sorry.

“To the spouses, partners, wives, husbands, children, who have dealt with the consequences of the abuse, cover-ups and obstruction, sorry.

“To generations past and present, sorry.”

Mr Morrison acknowledged the “silenced voices” and “never-heard pleas of tortured souls” who were bewildered by “indifference to the unthinkable theft of their innocence”.

“I simply say, I believe you, we believe you, your country believes you,” he said.

Mr Morrison and Opposition Leader Bill Shorten both agreed to cancel Question Time in the House of Representatives on Monday out of respect for those affected by abuse.

Ms Gillard is smiling at Mr Morrison, on the sideines of the House of Representatives. Photo: Former prime minister Julia Gillard was present for the apology. (ABC News: Marco Catalano)

Shorten quotes royal commission testimony

Mr Shorten opened his apology by quoting testimony from the royal commission.

“We were treated as slaves, beaten and abused, used for their perverted desires, no love or kindness, no safety or warmth, always hungry and always frightened,” he said.

Mr Shorten acknowledged Australia had “come too late” to the apology and that there were wrongs “that cannot be made right”.

“But know that today Australia says sorry. Australia says we believe you,” he said.

“And in years to come, people will learn of your lives. They will be appalled by the suffering. They will be shocked by the cruelty.”

Former prime minister Julia Gillard, who established the royal commission in 2013, was in the Chamber to witness the apology.

After the formalities, Ms Gillard received a standing ovation and rapturous applause in the Great Hall.

There were emotional scenes as the two leaders spoke and occasional heckling from the crowd.

Among the survivors watching the apology was 96-year-old Katie, who was abused at the Sisters of Saint Joseph orphanage at Gore Hill, on Sydney’s north shore.

As one of Australia’s oldest survivors of child sexual abuse, she said the apology seemed “very sincere”.

“It was beautiful, really lovely,” Katie said.

“I’m really pleased I came, and I feel that it’s answered a lot of questions for me.

“I’m able to put a lot in the past now that I wasn’t able to before, so it’s really helped me.”

Also watching was Manny Waks, who was sexually abused by a security guard at the Yeshivah Centre in Melbourne in the 1990s.

Mr Waks, who flew in from Israel especially for the occasion, said the apology should not be the end of the matter.

“They’re words and words are important,” he said.

“[However], what’s far more important is the implementation.

“The Government and institutions cannot for a moment think they’re absolved of their obligations.”

Much work still to be done: PM

Outside Parliament, victims and survivors tied ribbons around a memorial tree and were joined by Mr Morrison, who said the pain he felt in the room “grieved his soul to the core”.

“I just hope that what we’ve done here today provides some measure of relief, but there is much work to do,” he said.

A green ribbon that says 'National Apology' is tied around a leaf on a statue of a tree. Parliament House is visible behind Photo: Survivors wrapped ribbons around a memorial tree outside Parliament House. (ABC News: Marco Catalano)

 

The national apology was a recommendation from the royal commission, which held nearly 60 public hearings and 8,000 private sessions over five years.

In its final report, the commission estimated the number of child victims in the tens of thousands, saying their abusers were “not just a few rotten apples”.

“We will never know the true number,” it read.

“Whatever the number, it is a national tragedy, perpetrated over generations within many of our most trusted institutions.”

Mr Morrison announced that the Government would also set up a museum, to collect the stories of survivors, and fund a research centre to raise awareness about child abuse.

(c) ABC  News Australia

Careful where you get your sausage from.

Naked butcher photos sees Kalkarindji residents throw out beef and sausages from NT meatworks

A butcher stands naked in a meat supplier in Kalkaringi. Photo: The photo, which emerged on Facebook, was reportedly taken at a local meat supplier (Supplied)

Meat is being dumped from stores across the remote community of Kalkarindji, the Gurindji Aboriginal Corporation says, after a photo of a naked butcher preparing sausages was uploaded to social media.

Key points:

  • Gurindji Aboriginal Corporation ‘disgusted’ after photo of naked butcher surfaces online
  • Supermarkets, school in Kalkarindji asked to dispose of meat sourced from facility
  • NT Department of Primary Industry in contact with company following incident

The photo, purportedly taken at a local meat supplier, shows a butcher handling sausages dressed in only boots and an apron, leaving his bare buttocks exposed.

Kalkarindji Traditional Owner and Gurindji Aboriginal Corporation spokesperson Rob Roy said the butcher and meat supply facility were “easily identified” by the community.

“That to me is one idiot who is treating black people of this community, Kalkarindji, very wrong and not with a lot of respect,” he said.

“To me, that’s making me think back to Vincent Lingiari, maybe that’s why he walked off the station, because he wasn’t treated fair.

“They’re just treating us like dogs.”

Mr Roy said he had asked local supermarkets to dispose of fresh beef and sausages from the meatworks.

He said it was a health and safety risk, and the community should not “eat dirty meat off their sweat”.

“I went to the main mob, our local community store, told them to empty out the shelf,” he said.

“I said the snags, the beef, I want it all chucked away and empty the fridge until further notice.

“I rang the school, spoke to the principal … and told him to dispose all of [the meat], because we’ve got a really serious situation happening here.”

Butcher fired, meat recall issued

The butcher, who has been contacted for comment, removed the photo from Facebook on Friday afternoon.

In a statement, the Arnhem Land Progress Aboriginal Corporation (ALPA), which runs a number of remote stores across the Northern Territory, including the Kalkarindji meatworks, said the man’s employment had been terminated “effective immediately”.

A handprint on a power pole at the NT community of Kalkarindji. Photo: Mr Roy said the Kalkarindji community had been “treated like dogs” (ABC News: Tristan Hooft)

“ALPA has informed three stores which were supplied by Kalkaringi Meats to remove all products from their shelves immediately pending an investigation by the Northern Territory Department of Primary Industries,” it said.

“ALPA has taken this matter very seriously and has communicated with the affected stores and has issued clear instructions to ensure any customer who returns Kalkaringi meat products that a full refund will be issued.

“ALPA does not envisage this will impact food security and we intend to secure alternative fresh meat supplies until the matter is resolved.

The Northern Territory Department of Primary Industries and Resources said it was aware of the photo and had been in contact with the company regarding the incident.

Mr Roy said the company would need to work hard to rebuild trust with the community — and needed to issue an apology.

“It’s disrespectful, it’s an utter disgrace … we don’t know how long this has been happening,” he said.

“They’re not going to hurt this community again by having an incompetent butcher or person in there processing this beef and sausages.”

The meatworks said it would not be commenting as the matter is under investigation and the appropriate authorities have been notified.

(ABC New Darwin Australia)

You can’t ‘erase’ bad memories, but you can learn ways to cope with them

The film Eternal Sunshine of the Spotless Mind pitched an interesting premise: what if we could erase unwanted memories that lead to sadness, despair, depression, or anxiety? Might this someday be possible, and do we know enough about how distressing memories are formed, stored, and retrieved to make such a therapy possible?

Cognitive behaviour therapy (CBT) is a common treatment for anxiety disorders. The basic idea of CBT is to change the fear-eliciting thoughts that underlie a client’s anxiety.

Imagine the instance where a person has a dog phobia. They are likely to believe that “all dogs are dangerous”. During CBT, the client is gradually exposed to friendly dogs to cognitively reframe their thoughts or memories into something more realistic – such as the belief “most dogs are friendly”.

CBT is one of the most scientifically supported treatments for anxiety disorders. But unfortunately, a recent US study indicates that in around 50% of patients, old fear memories resurface four years after CBT or drug treatment. Put another way, the old fear memories seem impermeable to erasure through gold-standard therapy or drug treatment.

Eternal Sunshine of the Spotless Mind was an interesting thought experiment into whether it’s better for your well-being to erase painful memories. Focus Features/Anonymous Content/ This Is That Productions/IMDb

Why distressing memories are difficult to ‘erase’

Fear memories are stored in an old part of the brain called the amygdala. The amygdala developed early in our evolutionary history because having a healthy dose of fear keeps us safe from dangerous situations that might reduce our chances of survival.

things are safe sometimes (encountering a lion in a zoo) we also need to be aware they not safe in many other circumstances (meeting a lion in the wild).

This permanent storage of a fear memory explains why relapse occurs. During therapy, a new memory – say, “most dogs are friendly” – is formed. But this new safe memory is bound to a specific context (friendly dog in the therapy room). In that context, the rational part of the brain, the prefrontal cortex, puts a brake on the amygdala and tells it not to retrieve the old fear memory.

The prefrontal cortext can put a brake (blue line) on the amygdala, if it doesn’t want it to retrieve the old memory. from shutterstock.com

But what happens when a patient encounters a new context, such as a dog in a park? By default, the brain retrieves the fear memory that “all dogs are dangerous” in any context, except the one where the new safe memory occurred. That is, old fear memories can be renewed with any change in context.

This default has helped humans survive in dangerous environments throughout our evolutionary history. However, for anxious clients whose fear is unrealistic and excessive, this default to distressing memories is likely one important basis for the high rates of anxiety relapse.

So is erasure ever possible?

There are a few instances that suggest “erasure” is sometimes possible. For example, relapse is not seen early in life with non-human animals. This may be because the brake signals from the prefrontal cortex to the amygdala mature late in development. As there are no brakes, perhaps erasure of fear memories occurs instead.

By extension, this suggests early intervention for anxiety disorder is important as children may be more resilient to relapse. However, the jury is still out on whether erasure of fear memories occurs at all in children and, if so, at what age.

It’s important to expose yourself to your fear in as many different contexts as possible. Marcus Benedix/Unsplash

So, given the high rate of relapse, is there a point to pursuing treatment at all? Absolutely! Having some respite from anxiety allows for significant moments of sunshine and improves quality of life, even if it is not eternal. In these moments, the typically anxious person might attend parties and make new friends or handle a stressful job interview successfully – things they would not have done because of excessive fear

One way to reduce the chances of relapse is to confront irrational fear at every opportunity and create new safe memories in many different contexts. Anticipating contextual factors that are trigger points for relapse, such as changing jobs or relationship break-ups, can also be adaptive. Strategies can then be used to manage the re-emergence of distressing thoughts and memories.

While erasure of negative memories may be the goal of the characters in Eternal Sunshine, the film also emphasises the importance of these memories. When processed rationally, stressful memories motivate us to make better decisions and become resilient. Being able look back on unpleasant memories without excessive distress allows us to move forward with greater wisdom and this is the ultimate goal for all therapeutic frameworks.

The Conversation

Authors

  1. Senior Lecturer in Early Childhood, Macquarie University

  2. Professor, UNSW

Academic rigour, journalistic flair

 

Vaginal mesh implant – national apology from Australian government.

Mesh implants: Government issues national apology over ‘agony and pain’ caused by device

Exclusive by national medical reporter Sophie Scott and the Specialist Reporting Team’s Alison Branley

Health Minister Greg Hunt has issued a national apology to the many women whose lives have been ruined by the debilitating effects of pelvic mesh implants.

Key points:

  • Health Minister issues national apology to mesh patients
  • Action follows patient horror stories
  • New register to be set up to track mesh devices

Speaking as he released details of the Government’s response to a Senate inquiry into vaginal mesh, Mr Hunt said he wanted to acknowledge the pain and suffering of those at the centre of the medical scandal.

“On behalf of the Australian Government, I say sorry to all of those women with the historic agony and pain that has come from mesh implantation which have led to horrific outcomes,” he said.

“My message to them is your voice has been heard, and not just heard but acted upon.”

The ABC has obtained details of the Government’s response to the inquiry, which is expected to be tabled today.

Joanne Villani Photo: Joanne Villani said she still had pain every day after having a vaginal mesh device implanted. (ABC News: Naomi Selvaratnam)

Mr Hunt said the Government would work with states and territories on setting up a voluntary national register of women who have had mesh devices and anything that went wrong.

“I would like to see it (the register) set up by the end of 2019, if not the middle of the year,” he said.

Patient groups had wanted it to be made compulsory for all health practitioners to report side-effects of any implantable device.

Mr Hunt said while his Government supported such a move, it was outside federal powers to do so.

“We will encourage the states and territories to adopt mandatory standards,” he said.

Do you know more about this story? Email Specialist.Team@abc.net.au

There’s been a mixed response from women and consumer health groups who continue to lobby for all mesh products to banned.

At the moment many items have been pulled from shelves and only select products can be used by qualified surgeons.

A vaginal mesh implant on a table. Photo: A vaginal mesh implant. (ABC News: Jerry Rickard)

Mother of two Joanne Villani said she had witnessed some reforms by regulators, but many problems she experienced more than a decade ago still persisted.

“Women are still not being believed by their doctors,” she said.

“Doctors are still implanting mesh and telling women it’s new mesh and it is the same mesh.

“I would like mesh to be banned until it’s been shown to be safe. If it’s not shown to be safe, then it should never be used again.”

Senator Derryn Hinch pushed for the Senate inquiry, calling mesh “one of the biggest medical scandals” in Australian history.

Among the other actions the Federal Government will take are:

  • Permanent Medicare payment items for the removal and treatment of pelvic mesh
  • Asking states and territories to conduct an audit of pelvic mesh

Mr Hunt said he would raise the issues with his counterparts at the next health COAG meeting.

“I would be surprised if any state or territory resisted the steps that we have taken,” he said.

“Too many women have suffered too much for too long.”

‘I’ve friends who probably won’t make it’: patient

For Ms Villani it was not that pelvic mesh stopped her being able to have intercourse with her husband, it was the broader impact it had on their relationship.

“We actually split up for quite some time. It’s nothing my husband did or thought,” she said.

“It was very hard when he felt guilty and I felt guilty. It caused strain.”

The mother-of-two left the family home for some time because of the problems mesh caused in her relationship.

She has now returned to her partner because they “just want to be together”, but said their partnership would never be the same.

Joanne Villani Photo: Joanne Villani said she had friends who also had a vaginal mesh implanted and they were “expecting to die from their complications”. (ABC News: Naomi Selvaratnam)

It is just one way Ms Villani said mesh has “totally altered my life” after her doctor suggested it to treat prolapse and incontinence following the birth of her son.

She recalled her surgeon seemed quite excited about the product at the time and believed he was on the “cutting edge” of new techniques.

“It didn’t quite work the way they expected,” she said.

“I went back to the surgeon on a number of occasions to discuss problems I was having and I was basically told it was in my head.”

Eleven years on, she said her situation had improved little.

“I have pain all the time,” she said.

“I’ll have to give up my job eventually. My financial future is also affected. I’ve been extremely depressed and anxious.”

Ms Villani said the worst part was that she was “not the only one”.

“Some women are expecting to die from their complications,” she said.

“I’ve friends who probably won’t make it.”

Patient advocates call for regulation of devices

And while Ms Villani welcomed the Government’s reforms to regulation and reporting, she said it did very little to help women who were continuing to struggle with debilitating side-effects from the product.

“I have friends who are talking about suicide. So we all need help,” she said.

“I would like to believe the Federal Government is serious about reform but what I see is a lot of this comes down to money.

“Money isn’t the issue, we are the issue.”

Patient advocates had been hoping for much tighter regulations of implantable devices, so that a scandal like pelvic mesh could not happen to other patients in the future.

Health Issues Centre chief Danny Vadasz said the Minister’s apology would provide much-needed validation to women who had long been told their problems were in their heads.

He welcomed the push for mandatory reporting, but said it relied on doctors listening to their patients.

“What we found in a lot of cases [was] women believed they had an adverse outcome but their practitioners didn’t,” Mr Vadasz said.

“You can only effectively mandate something if there’s an agreement on what constitutes an adverse result.”

He said the states and territories, to date, had not made an audit of past mesh cases a priority, but “hopefully with the Minister’s encouragement they will put this on the front burner”.

Mr Hunt said discussions were also underway to include implantable devices on the My Health record, if a patient chose.

But he said it would not be mandatory and the Government wanted to make sure that the My Health record system “was an entirely voluntary system”.

Mr Vadasz did not think the My Health record was an adequate avenue for a registry of devices because it had “sufficient problems of its own”.

“Complicating one problem by introducing the problems of another isn’t a way of coming up with an overall solution,” he said.

The Health Issues Centre was also hoping to see stricter credentialing around which surgeons were allowed to implant mesh.

“I haven’t heard anything yet that suggests there’s going to be tighter control of clinical trials that would enable a high degree of confidence in products that find their way to market,” Mr Vadasz said.

“I think people still need an explanation about why the various regulatory systems that are supposed to protect the public failed.”

(Source: ABC News Australia)

Qantas to train thousands of pilots in Australia. 18,000 have already applied.

Qantas plane at Wellcamp Airport at Toowoomba  

A new multi-million-dollar pilot training centre will be built in Toowoomba on Queensland’s Darling Downs, as part of a plan by airline giant Qantas to keep up with growing global demand and already 18,000 people have applied for positions.

The site at Toowoomba’s Wellcamp Airport will be one of two centres to be built across Australia — with the second location yet to be announced.

Earlier this year, Toowoomba and Mackay had been shortlisted among seven other regional locations, including Alice Springs, Bendigo, Busselton, Dubbo, Launceston, Tamworth and Wagga Wagga.

The $35 million academy and accommodation facility will have an initial intake of 100 pilots when it opens its doors next year, with a capacity of up to 250 pilots a year.

Picture Alan Joyce QF

Qantas chief executive Alan Joyce said enrolments will be open to domestic and international students.

“What we’re ultimately creating is a world-class pilot school for students from Australia and around the globe,” he said.

“Toowoomba will be an amazing place to learn to fly.

“It’s home to Australia’s newest airport and offers over 300 days of Queensland sunshine each year and an environment that is textbook for pilot training.”

Picture Boeing cockpit

More than 18,000 people have so far registered their interest for enrolments online.

Construction will begin next month at Wellcamp airport, and will be operational by mid-2019.

Qantas says an estimated 790,000 extra pilots will be needed globally over the next 20 years – about a third of those in the Asia Pacific – as population growth and burgeoning middle classes see more people take to the sky.

Airlines are already complaining about a shortage of pilots, with Qantas having to cut back some regional services this year because it was running short. The airline was recently granted permission to bring in up to 76 foreign pilots and flight instructors for its QantasLink arm, sparking anger from Qantas’ pilots unions.

How Have Intimate Relationships Changed Over the Years, and Where Does It Leave Us Now?

A good article worth reading.

Damon Ashworth Psychology

caleb-ekeroth-11806.jpg

I just finished reading the book ‘Modern Romance: An Investigation’ by Aziz Ansari and Eric Klinenberg and was pleasantly surprised to see such a well-researched book written predominantly by a Stand-up Comedian (with a helping hand from a Sociologist).

For those of you who don’t know Aziz, his stand-up shows typically consist of interesting observations about relationships, as does his new series ‘Master of None’:

Considering that I’d already seen and liked both his stand-up and his show, I was definitely intrigued to see his name next to a book about Modern Romance in my local bookstore. Here’s what his research found:

How Has Dating Changed?

love-1311039-1279x850

1. Distance

Back in 1932, a Sociologist named James Bossard examined 5000 consecutive marriage licences in the city of Philidelphia, USA, and looked into how close the partners had lived to each other before they married. Here’s what he found:

  • Same address – 12.64%
  • Same block…

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