Patients have had urgent operations cancelled and almost 1000 Victorian public hospital beds are closed as nurses continue industrial action.
The action has led to blockages in already stretched emergency departments, with one patient who had experienced a suspected heart attack being left unchecked for 90 minutes and nurses initially refusing to admit a 96-year-old woman to a ward.
Victorian Health Minister David Davis warned that people could die.
"There is no doubt that there is a threat to life, there is a threat and a risk to patients," he told reporters on Tuesday.
The action is part of the Australian Nursing Federation's campaign for better pay and conditions, with the union asking for an 18.5 per cent pay rise over three years and eight months and the preservation of nurse-patient ratios.
The public hospitals, backed by the state government, have taken the ANF to Fair Work Australia and applied to have the action terminated.
Some 969 beds are closed across the state, including 425 in Melbourne and 544 in country areas.
More than 311 surgeries have been cancelled since Saturday, including about 160 on Tuesday.
People have had waits of longer than 24 hours in emergency departments, including 10 with ailments such as broken bones and pneumonia at hospitals across Melbourne's southeast.
Seven patients at Dandenong Hospital and two at Monash Medical Centre waited longer than 24 hours in emergency departments. It was first time that had happened at Monash in three years.
Northern Health chief nursing officer Robynne Cooke said one patient had waited close to 40 hours on an ambulance trolley.
Category one patients, who should be operated on within 30 days, were among those whose surgeries were cancelled at Austin Hospital.
Austin Health executive director of ambulatory and nursing services, Ann Maree Keenan, said two category one and 14 category two patients had procedures cancelled on Tuesday.
One category one patient was booked in for a bladder operation to check for possible cancer and the other needed laser treatment on kidney stones, which can be extremely painful.
A spokeswoman for Mr Davis said the government had confirmed there was a further category one patient whose surgery was cancelled at Austin Hospital.
The bed closures have led to clashes between nursing staff and emergency department physicians about which patients are sick enough to be admitted to beds.
In one instance at the Austin Hospital on Monday, a patient who had suffered a suspected heart attack was left sitting in a chair unchecked for 90 minutes when they should have been hooked up to a cardiac monitor, Ms Keenan said.
At Northern Health, Ms Cooke said she had to convince the union to accept patients needing admission to wards, including an elderly woman.
"I mean, she was 96," she told the FWA hearing.
"I shouldn't to be in a position where I have to sell a patient to an ANF organiser.
"The ANF has become the bed managers for the state."
Eastern Health chief executive Alan Lilley said ambulances were experiencing long waits at hospitals, which in turn diminished their capacity to respond to emergency calls.
2011年11月15日星期二
2011年11月13日星期日
Concerns raised over €400,000 machine lying idle at Galway hospital
A €400,000 machine purchased for the urology department at University Hospital Galway over 18 months ago has “never been put into service”, consultants at the hospital have said.
Five consultants have written to Minister for Health James Reilly to raise their concerns about an extracorporeal shockwave lithotriptor (ESWL), bought for the hospital in February 2010 to treat patients with conditions such as kidney stones.
In a letter sent to the Minister at the end of last month, consultant urologists Michael Corcoran, Eamon Rogers, Killian Walsh, Syed Jaffry and Garrett Durkan said the machine had never been put into service as radiographers to facilitate the treatments were never allocated by management.
“This decision has been to the detriment of patients with stone disease in the region,” they said.
The doctors said because the ESWL treatment was not being provided, there has been an “over-reliance on invasive procedures” at the hospital, as well as delayed treatment for those in chronic pain and increased admissions to the emergency department. Some patients were also having to travel to Tallaght hospital for ESWL treatment there.
“In the meantime, an ESWL machine purchased at taxpayers’ expense, lies idle and depreciates,” they said.
The hospital is a tertiary referral centre for people with complex urological diseases and it receives referrals from Letterkenny, Sligo, Castlebar, Roscommon and Portiuncula hospitals.
The doctors said the machine had now been “cannibalised and allocated without discussion” to Merlin Park Regional Hospital for “exclusive use” by its radiology department, which already had sufficient equipment. “The background to this event is such that it warrants full investigation and due consideration,” the doctors said.
They said the decision had been made by Health Service Executive Galway clinical director David O’Keeffe, who is also a director of a private imaging company on the grounds of Merlin Park.
“It is nothing short of scandalous in the current financial times that the HSE would waste €400,000 on a piece of equipment and then render it unusable by cannibalising it for the use of a department which clearly doesn’t need it,” the doctors said.
In a statement, the HSE said the machine cost €265,000 excluding VAT. It said by the time the machine was procured, staffing at the hospital had changed, with significant reductions nursing and radiology staff numbers.
“It was not possible to provide the service from the existing staff resources as originally planned,” the statement said.
“The equipment is currently being used for interventional radiology at the Merlin Park site and the intention is to provide lithotripsy as soon as resources allow.”
Five consultants have written to Minister for Health James Reilly to raise their concerns about an extracorporeal shockwave lithotriptor (ESWL), bought for the hospital in February 2010 to treat patients with conditions such as kidney stones.
In a letter sent to the Minister at the end of last month, consultant urologists Michael Corcoran, Eamon Rogers, Killian Walsh, Syed Jaffry and Garrett Durkan said the machine had never been put into service as radiographers to facilitate the treatments were never allocated by management.
“This decision has been to the detriment of patients with stone disease in the region,” they said.
The doctors said because the ESWL treatment was not being provided, there has been an “over-reliance on invasive procedures” at the hospital, as well as delayed treatment for those in chronic pain and increased admissions to the emergency department. Some patients were also having to travel to Tallaght hospital for ESWL treatment there.
“In the meantime, an ESWL machine purchased at taxpayers’ expense, lies idle and depreciates,” they said.
The hospital is a tertiary referral centre for people with complex urological diseases and it receives referrals from Letterkenny, Sligo, Castlebar, Roscommon and Portiuncula hospitals.
The doctors said the machine had now been “cannibalised and allocated without discussion” to Merlin Park Regional Hospital for “exclusive use” by its radiology department, which already had sufficient equipment. “The background to this event is such that it warrants full investigation and due consideration,” the doctors said.
They said the decision had been made by Health Service Executive Galway clinical director David O’Keeffe, who is also a director of a private imaging company on the grounds of Merlin Park.
“It is nothing short of scandalous in the current financial times that the HSE would waste €400,000 on a piece of equipment and then render it unusable by cannibalising it for the use of a department which clearly doesn’t need it,” the doctors said.
In a statement, the HSE said the machine cost €265,000 excluding VAT. It said by the time the machine was procured, staffing at the hospital had changed, with significant reductions nursing and radiology staff numbers.
“It was not possible to provide the service from the existing staff resources as originally planned,” the statement said.
“The equipment is currently being used for interventional radiology at the Merlin Park site and the intention is to provide lithotripsy as soon as resources allow.”
2011年9月8日星期四
Lakeview offers fall health classes
Lakeview Hospital will offer several fall health classes on topics that range from from finding your way through cancer, dealing with kidney stones to understanding and deal with back pain.
Stillwater Medical Group urologist Dr. Tom Stormont and dietician Mary Miller discuss kidney stone prevention and how some stones can be treated locally with minimally invasive methods at Kidney Stone School from 6:30 to 7:30 p.m. Sept. 19 at Lakeview Hospital.
Because kidney stones can be a recurring and lifelong problem, a comprehensive approach is best to treat stone "attacks" and prevent recurrence.
Back pain hurts - physically, mentally, emotionally and sometimes even financially. From simple sprains and strains to more serious problems such as a herniated disc, St. Croix Orthopaedics' Dr. Bruce Bartie will discuss different types of back pain and the latest treatment option at the "Oh, My Aching Back" free class from 6:30 to 7:30 p.m. Sept. 20 at Lakeview Hospital.
"Finding Your Way through Cancer" is a four-week series for persons and their families dealing with a cancer diagnosis. Julie Edstrom leads the group, which meets from 7 to 8:15 p.m. on four consecutive Thursday nights Starting Sept. 22 at Lakeview Hospital.
The information is helpful to anyone experiencing the illness or a family member or loved one caring for someone facing cancer. Each week addresses an issue that most people confront at one time or another during their journey through cancer, including the new normal and making decisions.
Stillwater Medical Group urologist Dr. Tom Stormont and dietician Mary Miller discuss kidney stone prevention and how some stones can be treated locally with minimally invasive methods at Kidney Stone School from 6:30 to 7:30 p.m. Sept. 19 at Lakeview Hospital.
Because kidney stones can be a recurring and lifelong problem, a comprehensive approach is best to treat stone "attacks" and prevent recurrence.
Back pain hurts - physically, mentally, emotionally and sometimes even financially. From simple sprains and strains to more serious problems such as a herniated disc, St. Croix Orthopaedics' Dr. Bruce Bartie will discuss different types of back pain and the latest treatment option at the "Oh, My Aching Back" free class from 6:30 to 7:30 p.m. Sept. 20 at Lakeview Hospital.
"Finding Your Way through Cancer" is a four-week series for persons and their families dealing with a cancer diagnosis. Julie Edstrom leads the group, which meets from 7 to 8:15 p.m. on four consecutive Thursday nights Starting Sept. 22 at Lakeview Hospital.
The information is helpful to anyone experiencing the illness or a family member or loved one caring for someone facing cancer. Each week addresses an issue that most people confront at one time or another during their journey through cancer, including the new normal and making decisions.
2011年6月29日星期三
Kidney Stones and Calcium Supplements
Most people know that kidney stones are up there with some of those painful experiences humans can fathom, and build-up of calcium deposits is partly to blame. Meanwhile, women of a certain age are encouraged to take calcium supplements to protect their bones. With reports showing that stones are become increasingly common among American women, a link between the two becomes questionable.
As one might expect, data show that taking calcium supplements may increase the risk of kidney stones. According to a study in the July issue of the American Journal of Clinical Nutrition, post-menopausal women, the group who are especially prone to loss of bone density and the occurrence of osteoporosis, were examined.
The study consisted of 36,282 subjects who, at the start of the study, took in virtually the same amount of calcium daily (about 1,145 milligrams). They were randomly assigned to take supplements of calcium (500 milligrams) plus Vitamin D (200 international units) twice daily with meals or to take placebo pills for seven years. During that time, kidney stones developed in 830 of the women. The development of kidney stones was 17 percent more common among women taking the supplements than among those in the placebo group.
The development of kidney stones was recorded just once for each participant; recurrences were not noted, which might have affected the results.
How do I prevent kidney stones?
Drink plenty of water and do this often. In my early twenties I had a stone, and so I went to see a urologist. He told me not to drink tea or other drinks that dehydrate you and to drink more water, so that the mineral deposits don’t have as much of a chance to collect and built up. Also, it is widely known that consuming cranberry juice can help prevent urinary tract problems.
What are warning symptoms?
You should call your doctor if you have
• extreme pain in your back or side that will not go away
• blood in your urine
• fever and chills
• vomiting
• urine that smells bad or looks cloudy
• a burning feeling when you urinate
The important thing to remember is that you should always drink enough water to get your urine clear. The amount of water we need daily is different for everyone, but doctors will note that that is one way you can judge for yourself if you are hydrating yourself well.
As one might expect, data show that taking calcium supplements may increase the risk of kidney stones. According to a study in the July issue of the American Journal of Clinical Nutrition, post-menopausal women, the group who are especially prone to loss of bone density and the occurrence of osteoporosis, were examined.
The study consisted of 36,282 subjects who, at the start of the study, took in virtually the same amount of calcium daily (about 1,145 milligrams). They were randomly assigned to take supplements of calcium (500 milligrams) plus Vitamin D (200 international units) twice daily with meals or to take placebo pills for seven years. During that time, kidney stones developed in 830 of the women. The development of kidney stones was 17 percent more common among women taking the supplements than among those in the placebo group.
The development of kidney stones was recorded just once for each participant; recurrences were not noted, which might have affected the results.
How do I prevent kidney stones?
Drink plenty of water and do this often. In my early twenties I had a stone, and so I went to see a urologist. He told me not to drink tea or other drinks that dehydrate you and to drink more water, so that the mineral deposits don’t have as much of a chance to collect and built up. Also, it is widely known that consuming cranberry juice can help prevent urinary tract problems.
What are warning symptoms?
You should call your doctor if you have
• extreme pain in your back or side that will not go away
• blood in your urine
• fever and chills
• vomiting
• urine that smells bad or looks cloudy
• a burning feeling when you urinate
The important thing to remember is that you should always drink enough water to get your urine clear. The amount of water we need daily is different for everyone, but doctors will note that that is one way you can judge for yourself if you are hydrating yourself well.
2011年4月12日星期二
WHAT'S UP DOC? Learning about bladder cancer
Q: My father was diagnosed with bladder cancer. What is his prognosis?
A: Bladder cancer is the most common cancer of the urinary system, affecting over 70,000 Americans a year. In countries where the urinary form of schistosomiasis (a parasitic disease) is prevalent, the most common type of bladder cancer is squamous cell carcinoma, accounting for 75 percent of cases. However, more than 90 percent of bladder cancers in the U.S. are transitional cell cancers, and over 80 percent of these are associated with environmental exposures, most commonly tobacco use but also exposure to certain chemicals.
The classic symptom of bladder cancer is painless hematuria (blood in the urine), typically throughout the entire urine stream and often intermittent (clearing and recurring).
Hematuria can cause irritation, so some patients have urgency, frequency and/or discomfort as well. However, less than 20 percent of people with gross hematuria have bladder cancer; most have no abnormality identified (60 percent), and many others are diagnosed with urine infections, interstitial cystitis, prostatitis, kidney stones or other kidney diseases.
The prognosis and recommended treatment for bladder cancer depend on whether it invades the muscles of the bladder and/or extends beyond the bladder or has distant metastases, and this is evaluated during staging of the extent of the disease.
The first step in staging is a cystourethroscopy, where a long tube-like instrument is inserted through the urethra to directly visualize the bladder (and ureters) and to remove any tumors (called transurethral resection of bladder tumors or TURBT). Microscopic evaluation of the tumor specimens, as well as the urine, is also done.
Examination of the regional lymph nodes (N0 is no nodes, N1 is only one diseased node within the pelvis, multiple diseased nodes within the pelvis is N2 and nodes outside the pelvis N3) and evaluation for more distant metastases (such as lung, liver and bone) are also part of disease staging. However, the main factor is whether the tumor is confined to just the bladder so TURBT may be curative, or if it has progressed outside the bladder.
Although 70 percent of new transitional cell bladder cancer cases are initially classified as Ta, Tis or T1, up to 40 percent of these are later reclassified. Over half of these will recur if managed only with TURBT, and up to a quarter of these will progress through to the muscular layer or beyond to adjacent tissue or even more distant metastases, hence adjuvant therapy with treatments directly into the bladder (intravesicular) is often recommended (depending on the details of the cell type and other specifics).
The intravesicular treatments may be chemotherapy or more commonly BCG (the same bacteria as in the tuberculosis vaccine) which is used to stimulate an immune reaction to help fight the cancer.
More invasive stages may be treated with complete removal of the bladder and any adjacent affected organs, as well as chemotherapy. Radiation therapy may also be considered, sometimes to shrink the tumor before resection or sometimes in addition to chemotherapy after resection. When the bladder is removed another method to evacuate the urine is needed, sometimes a tube to a bag outside the body, or sometimes construction of a "new" bladder using a piece of intestine.
Up to 80 percent of bladder cancer patients have at least one recurrence, even though the 5-year survival rate of Ta, TIS and T1 disease is over 80 percent. The 5-year survival drops as the extent of disease increases, with a 60 percent to 80 percent 5-year survival for T2 disease, a 20 percent to 70 percent (wide variability with other factors key to a specific patient's prognosis) for T3 disease, and a less than 20 percent survival for those with T4 disease.
Even though most hematuria patients do not have bladder cancer, since early diagnosis of bladder cancer can improve outcomes, all patients with hematuria should see their health care provider to be evaluated.
A: Bladder cancer is the most common cancer of the urinary system, affecting over 70,000 Americans a year. In countries where the urinary form of schistosomiasis (a parasitic disease) is prevalent, the most common type of bladder cancer is squamous cell carcinoma, accounting for 75 percent of cases. However, more than 90 percent of bladder cancers in the U.S. are transitional cell cancers, and over 80 percent of these are associated with environmental exposures, most commonly tobacco use but also exposure to certain chemicals.
The classic symptom of bladder cancer is painless hematuria (blood in the urine), typically throughout the entire urine stream and often intermittent (clearing and recurring).
Hematuria can cause irritation, so some patients have urgency, frequency and/or discomfort as well. However, less than 20 percent of people with gross hematuria have bladder cancer; most have no abnormality identified (60 percent), and many others are diagnosed with urine infections, interstitial cystitis, prostatitis, kidney stones or other kidney diseases.
The prognosis and recommended treatment for bladder cancer depend on whether it invades the muscles of the bladder and/or extends beyond the bladder or has distant metastases, and this is evaluated during staging of the extent of the disease.
The first step in staging is a cystourethroscopy, where a long tube-like instrument is inserted through the urethra to directly visualize the bladder (and ureters) and to remove any tumors (called transurethral resection of bladder tumors or TURBT). Microscopic evaluation of the tumor specimens, as well as the urine, is also done.
Examination of the regional lymph nodes (N0 is no nodes, N1 is only one diseased node within the pelvis, multiple diseased nodes within the pelvis is N2 and nodes outside the pelvis N3) and evaluation for more distant metastases (such as lung, liver and bone) are also part of disease staging. However, the main factor is whether the tumor is confined to just the bladder so TURBT may be curative, or if it has progressed outside the bladder.
Although 70 percent of new transitional cell bladder cancer cases are initially classified as Ta, Tis or T1, up to 40 percent of these are later reclassified. Over half of these will recur if managed only with TURBT, and up to a quarter of these will progress through to the muscular layer or beyond to adjacent tissue or even more distant metastases, hence adjuvant therapy with treatments directly into the bladder (intravesicular) is often recommended (depending on the details of the cell type and other specifics).
The intravesicular treatments may be chemotherapy or more commonly BCG (the same bacteria as in the tuberculosis vaccine) which is used to stimulate an immune reaction to help fight the cancer.
More invasive stages may be treated with complete removal of the bladder and any adjacent affected organs, as well as chemotherapy. Radiation therapy may also be considered, sometimes to shrink the tumor before resection or sometimes in addition to chemotherapy after resection. When the bladder is removed another method to evacuate the urine is needed, sometimes a tube to a bag outside the body, or sometimes construction of a "new" bladder using a piece of intestine.
Up to 80 percent of bladder cancer patients have at least one recurrence, even though the 5-year survival rate of Ta, TIS and T1 disease is over 80 percent. The 5-year survival drops as the extent of disease increases, with a 60 percent to 80 percent 5-year survival for T2 disease, a 20 percent to 70 percent (wide variability with other factors key to a specific patient's prognosis) for T3 disease, and a less than 20 percent survival for those with T4 disease.
Even though most hematuria patients do not have bladder cancer, since early diagnosis of bladder cancer can improve outcomes, all patients with hematuria should see their health care provider to be evaluated.
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