News in brief: Melbourne to get second mobile stroke unit; NPS MedicineWise calls for review on its funding; No need to speed to surgery over subdural haematoma 

9 May 2022

Melbourne to get second mobile stroke unit

A second Mobile Stroke Unit (MSU) could join Melbourne’s roads following a $12 million investment from the Victorian Government.

The additional ambulance, announced in the state’s 2022–23 budget, will cover south-east Melbourne, ensuring stroke patients “get the urgent care they need without delay”.

It follows the success of the first MSU which has treated over 6,000 patients since launching in 2017, and 1,920 in 2020–21.  alone.

The mobile unit allows clinicians to deliver CT scans and thrombolytic medications outside a hospital, leading to shorter wait times and better outcomes, the Ambulance Victoria Annual Report 2020–21 stated.

“More than half of patients seen by the MSU were diagnosed with either stroke or a transient ischaemic attack.”

“Our data shows 18 per cent of patients receiving thrombolysis on the MSU were treated within the first 60 minutes (known as the ‘Golden Hour’) from the onset of stroke, compared to 1.5 per cent in hospital.”

A second unit was under consideration when the report was released, with Ambulance Victoria suggesting it would allow for “significant improvements, and the inclusion of an improved CT scanner would reduce intervention times”.

NPS MedicineWise calls for review on its funding

The future of NPS MedicineWise is under a cloud because the service has lost almost its entire Federal Government funding, its CEO says.

It follows the federal budget announcement back in March that the NPS would no longer receive uncontested funding to promote quality use of medicines, a cut of around $25 million annually.

The money will instead go to the Australian Commission on Safety and Quality in Health Care (ACSQHC), which will also take over the service’s website and the MedicineInsight dataset and.

The Practice Review letters sent to doctors comparing their prescribing of PBS-listed medicines with others in their specialty are also now expected to come from the commission.

NPS MedicineWise CEO Katherine Burchfield says the decision is a mistake.

“We are disappointed and concerned with what this means for Australia at a time when quality and safe use of medicines is listed as a national health priority,” she says.

“While there is no doubt that the ACSQHC has a key role to play in quality use of medicines, and has strong capabilities and networks, it performs a different role and function in the health system to that of NPS MedicineWise.”

“The two organisations should work together, using their different strengths and levers, to enact change.”

She said the service had contacted Minister for Health Greg Hunt to request he reconsider.

No need to speed to surgery over subdural haematoma 

An aggressive approach of surgery over initial conservative treatment for traumatic acute subdural haematoma is not associated with better functional outcomes.

An international study of 1,407 patients with acute subdural haematoma found 24% were managed with acute surgical evacuation either by craniotomy in (73%) or decompressive craniectomy (27%). Delayed decompressive craniectomy or craniotomy after initial conservative treatment occurred in 11% patients.

The study showed wide variability in the management approach depending on the centre, as demonstrated by the percentage of patients who underwent acute surgery ranging from 5·6% to 51·5%.

Centre preference for acute surgery over initial conservative treatment was not associated with improvements in functional outcome at six months.

The study concluded that where a neurosurgeon sees no clear superiority for acute surgery over conservative treatment, initial conservative treatment might be considered.

Read more in The Lancet Neurology


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