News in brief: Financial burden of eczema needs NDIS support; Mohs in the elderly may be appropriate; Hospitals must act on staff psychological wellbeing

Wednesday, 1 Jun 2022

Financial burden of eczema needs NDIS support

The Eczema Association of Australasia (EAA) has highlighted the financial burden of living with eczema and called on government bodies to provide more support through the National Disability Insurance Scheme (NDIS).

The Association said members spend up to $7,000 a year treating their condition including skin care measures, time off work, health care visits and complementary medicine.

“Many of our members struggle to pay for expensive treatments and the constant re-purchasing of moisturisers and pain relief, and if they can’t afford it, they attempt to just live with the pain – which significantly impacts people’s mental health and wellbeing – a cost that is far greater than any,” EAA President Cheryl Talent said.

Complicating the situation is the long wait list to see a dermatologist at a public hospital – especially given Australia has one of the highest incidence of eczema in the world.

In an ABC news report, dermatologist Dr Deshan Sebaratnam said there was a need for both more dermatology training positions to grow the specialist workforce as well as upskilling of GPs.

Mohs in the elderly may be appropriate

The functional status and living environment of elderly people impact the decision to proceed with Mohs surgery for keratinocyte cancers, research suggests.

A US study of 1,184 patients >85 years referred for Mohs surgery found the common reasons to proceed were patient desire for a high cure rate, good to excellent patient functional status, and high-risk tumour histology.

Patients who underwent Mohs were more likely to have lesions on their face and ears than patients who underwent alternate treatment including electrodessication and curettage, photodynamic therapy, excision, topical chemotherapy, and cryotherapy.

“Compared with living with a spouse or partner, living in a nursing home was associated with greater tumour size (relative difference, 0.41 cm; 95% CI, 0.21-0.61 cm) and defect size (relative difference, 0.57 cm; 95% CI, 0.21-0.94 cm.”

“These findings suggest that advancing age and loss of social support may be associated with tumour neglect and growth,” the study authors said.

“Tumour removal in this group may preserve quality of life that may otherwise diminish owing to tumour-associated symptoms (eg, bleeding or painful nonhealing lesions), functional loss, or social embarrassment leading to withdrawal.”

Read more in JAMA Dermatology

Hospitals must act on staff psychological wellbeing

Hospitals and other employers must take “proactive and meaningful steps” to care for the mental health and wellbeing of workers, a leading medical indemnity provider says.

The warning from Avant Mutual follows a decision last month by the High Court, which found in favour of a public prosecutor who sued her former employer for failing to protect her from workplace trauma.

She was ultimately awarded significant damages.

“The decision is a sad reminder to employers that they cannot adopt a ‘wait and see’ approach where the work of their employees inherently involves psychosocial hazards,” said Avant senior solicitor Frances Thomas.

She suggested employers conduct health and safety risk assessments to identify challenging situations, including violent, angry or distressed patients and extremely high workloads.

It was also likely that many staff had seen their mental health impacted through COVID-19, adding to the need for workplace health and safety systems to be agile and proactive, Ms Thomas added.

“We recommend that all practices have systems in place to manage psychosocial hazards,” she said.

AMA vice president Dr Chris Moy said more protections were needed, calling on all states and territories to enact legislation making hospital boards directly and explicitly responsible for the psychosocial wellbeing of their staff.

Laws that did so were currently only in place in South Australia, he said.

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