H
August 2017
Midwifery Feature + Boosting midwifery education in a virtual world + Understanding pathology in pregnancy + Embracing a career as a Credentialled Diabetes Educator + ANU study reveals costs of maternal health
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HealthTimes - August 2017 | Page 31
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AMH Children’s Dosing Companion 2017 Release Available Now
The AMH Children’s Dosing Companion is Australia’s national independent dosing guide for prescribing and administering medicines to children from birth to 18 years with evidence-based, peer-reviewed and up-to-date information.The July 2017 release extends the number of monographs included to almost 400 drugs. Available now in print or online. Go to www.amh.net.au
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online.jcu.edu.au HealthTimes - August 2017 | Page 03
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August 2017 We hope you enjoy perusing the range of opportunities included in this Issue. If you are interested in pursuing any of these opportunities, please contact the advertiser directly via the contact details provided. If you have any queries about our publication or would like to receive our publication, please email us at contact@healthtimes.com.au DISTRIBUTION 46,300
Advertiser list Aspen Medical Australian Medicine Handbook Bendigo Health CCM Recruitment International Cleveland Clinic Abu Dhabi DC Conferences
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Royal Flying Doctor Service
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SkinScience Australia Smart Salary SunSuper Victoria University
Next Publication: Mental Health feature Publication Date:
Monday 25th September 2017
Colour Artwork Deadline: Monday 18th September 2017
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HealthTimes - August 2017 | Page 05
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COSMETIC INJECTABLES We provide students with a programme that leads to real opportunities and excellent understanding of Aesthetic procedures. This is a three day post graduate certificate workshop. Our trainers and staff provide students with knowledge and ongoing support vital to success in this field. On completion each delegate will be competent in the delivery of basic techniques of Botulinum Toxin and Dermal Fillers. Expand your clinical skills as a healthcare professional. Enjoy additional income by offering rewarding treatments that can improve clients self esteem. Upcoming workshops: (Melbourne)
11, 12 & 13 September 2017 23, 24 & 25 October 2017 27, 28 & 29 November 2017
PLATELET RICH PLASMA WORKSHOP (PRP) Ideal for Doctors & Registered Nurses working in anti-ageing, rejuvenation & aesthetics. Workshop Objectives: • Understand the principles of PRP and its use in clinical settings • Indications and contraindications • How to conduct a comprehensive patient history & assessment • How and when to use PRP for cosmetic applications (Skin & Hair Rejuvenation) 1 Day Certified Workshop Upcoming dates: Friday 20th October 2017 (Melbourne) Friday 24th November 2017 Visit www.aesthetictrainingaustralia.com for more information, call 1300 817 524 or email ata@skinscience.co Finance available through Maccredit.
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HealthTimes - August 2017 | Page 07
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Paediatric Nurses DUBAI
Nursing and Allied Health vacancies are now available for experienced paediatric and neonatal professionals in a new, purposely designed children’s hospital in the luxurious Dubai. The speciality hospital is a dedicated referral centre comprising of six Centres of Excellence - Cardiac, Renal, Mental Health, Neurology, Criical Care and Cancer/Blood Disorder. The state of the art, 200 bed hospital caters for all medical, surgical and outpaient needs. Health Professionals with a minimum 2 years current paediatric experience are encouraged to apply today!
Hospital Presentaaon & Interviews in Australia & New Zealand this September: Auckland 15 Sydney 18 Melbourne 20 Brisbane 22 Nurses, Physios, Occupaaonal & Speech Therapists are encouraged to apply. Skype interviews can also be arranged for those located in other ciaes. Working as part of a highly skilled, internaional team, you will receive a compeiive salariy paid tax free, generous accommodaion allowance, relocaion assistance and flights to/from your contract. Living in Dubai also offers unique cultural experiences, travel opportuniies and an acive social life within large expatriate communiies where you are sure to make lifelong friendships.
Contact CCM today raquel@ccmrecruitment.com.au dawn@ccmrecruitment.com.au AUS Free Call 1800 818 844 NZ Free Call 0800 700 839
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CARING FOR THE CRITICALLY ILL CHILD: WORKSHOP ROYAL PRINCE ALFRED HOSPITAL SYDNEY- NOVEMBER 2 & 3, 2017 For more information and to book tickets go to: http://bit.do/CritIllChild
Enquiries: Contact HealthTimes 1300 306 582 Contact@healthtimes.com.au
Focusing on the clinical skills that are required and essential for the recognition and emergency management of the seriously ill infant and young child.
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HealthTimes - August 2017 | Page 09
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ANU study reveals costs of maternal health
N
ew research from The Australian National University (ANU) has for the first time identified and quantified the factors pushing up maternal health costs in the New South Wales public hospital system, paving the way for better health policy. In the first study of its kind in Australia, actuarial research techniques have been applied to the public hospital costs of women during their pregnancy to just after the birth of a child, providing a new and more precise picture of what is driving costs. Dr Jananie William from the ANU College of Business and Economics looked at hundreds of factors and found that the biggest costs are incurred by mode of birth delivery (caesarean versus vaginal delivery), diabetes, adverse births, smoking status, private health insurance and where a patient lives.
“With the new information, policy makers can consider health interventions in areas which drive costs, such as cessation programs for smokers, which could result in a better health outcome for the woman and a reduced cost to the system,” Dr William said. Dr William found a caesarean birth costs 92 per cent more than a vaginal birth, at an average cost of $11,500, in the NSW public
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hospital system. “We found that the mode of delivery is by far the biggest driver of costs, with women who have a caesarean delivery costing almost twice as much as women who have vaginal deliveries, which cost on average $5,700.” Adverse birth events such as premature births and stillbirth cost eight per cent more than women who have full term births. The average cost of full term births was $7,200. “We found that a woman with gestational diabetes had no significant impact on hospital costs whereas a pregnant woman with preexisting diabetes cost 12 per cent more than women who do not have diabetes” she said. “This could indicate that we are dealing with gestational diabetes very well but we need to consider our practices for other forms of the condition”. Dr William has also conducted similar research into out-of-hospital costs, which include costs of post-natal depression, and will focus future research on the interaction between public and private maternal health systems. Her paper has been published in the international journal: Annals of Actuarial Science.
For more articles visit Healthtimes.com.au
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1-4 May 2018 | Crown Promenade Melbourne www.dcconferences.com.au/nnec2018
Conference themes of interest are: • Creating and supporting change in education and learning • Innovative educational programs • Student engagement initiatives
Abstracts are now open and will be closing 22 November 2017
• Collaborative health education projects • Supporting vulnerable groups through education (such as children, refugees, Aboriginal and Torres Strait Islanders)
Gain up to 20 CPD Points
Sponsorship & Exhibition opportunities are available
Stay up to date with the latest conference news, complete an Expression of Interest
www.dcconferences.com.au/nnec2018 HealthTimes - August 2017 | Page 11
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Recruiting Mental Health Nurses for one of the largest public health services in New Zealand. Positions are available in inpatient, community and forensic services.
Benefits: • Financial assistance with flights to/within New Zealand and accommodation on arrival (conditions apply) • Competitive salary • Affordable living
Shane King: AU free phone 1800 123 900 shanek@genevahealth.com
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Registered Nurses – Critical Care Unit Are you looking for a new challenge? We are currently seeking experienced Critical Care Registered Nurses to join our dynamic multidisciplinary team of staff. Our organisation is soon to expand with the opening of two 32 bed Inpatient Units, a new Emergency Department, Endoscopy Suites and the regions first Cardiac Catherisation Laboratory in the latter part of 2017. Our Critical Care Unit has 14 beds which support intensive care, coronary care and surgical high dependency type patients. This is a terrific opportunity to join a progressive health service which values person-centred care. For further information please contact Simone Redpath, NUM on telephone (03) 5173 8326. The successful applicant will be required to apply for and satisfactorily obtain a National Police Check. Applications Close: 11th September 2017
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Mental Health Nursing Positions Hornsby Kuring Gai Mental Health Service (HKMHS) is a dynamic mental health service, part of the Northern Sydney Local Health District located in an area of natural beauty with surrounding national parks but close to all the attractions Sydney has to offer. The Inpatient Service has undergone expansion and redevelopment to include a Psychiatric Emergency Care Centre, a Mental Health Intensive Care unit and an Adult Mental Health Inpatient Unit, all in modern purpose built facilities. The Community Service has a number of teams with a variety of opportunities across the Assertive Outreach Team, the Acute Care Team and the Wahroonga Rehabilitation Service. Current vacancies include: • Clinical Nurse Specialists Level 2 • Registered Nurses • Enrolled Endorsed Nurses HKMHS as part of Northern Sydney Local Health District is committed to supporting staff in salary packaging, education support and professional development. Why don’t you call today to hear more about these exciting career opportunities! Anne Bajuk (Inpatient Services Manager) Telephone: 0422 001 221 - Email: Anne.bajuk@health.nsw.gov.au Elisabeth Manning (Community Services Manager) Telephone: 0477 735 162 - Email: Elisabeth.manning@health.nsw.gov.au https://facebook.com/nslhd.mhda http://www.nslhd.health.nsw.gov.au/ We look forward to welcoming you into our friendly and supportive team!
HealthTimes - August 2017 | Page 13
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Helping to make a difference truly is the greatest reward Nat Luxton is a Registered Nurse (RN)/ midwife who has been registered with the Rural Locum Assistance Program (Rural LAP) since 2011. She first heard about Rural LAP through their program administrator, Aspen Medical, and wanted to help alleviate the pressure of taking leave in rural and remote locations around Australia. “I loved the idea of being able to go to smaller places and know I was genuinely helping them out. Travel and meeting new people were a bonus. I had worked in a few country hospitals so I had an idea as to what to expect - a new experience with the opportunity to meet truly lovely people”. Nat was initially overwhelmed by the Rural LAP credentialing process due it’s the complexity but realised the significance of robust and thorough screening. “Rural LAP needs to know that they are sending qualified locums capable of doing what they say they can. It’s about safety, so I fully respect that.” Nat has emergency nursing, neonatal nurseries, birthing suite and postnatal experience which has contributed to the 250 hours of nursing and 250 hours of midwifery experience required to be Rural LAP locum. “Once credentialed, getting placements was easy. You receive a job opportunity via email, respond to the request and the Rural LAP team will let you know if you have been successful. From there, the lovely travel and logistics coordinator arranges your travel and
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accommodation so there is little for you to do other than plan what to pack and what to do whilst in a new town.” Nat has worked for numerous healthcare services with Rural LAP including Corowa, Hilston, Temora, Tocumwal, Wagga Wagga and Wallaroo. “Most of these places I had never heard of so it is always interesting looking up where I am heading to. My first placement was in Tocumwal, on the NSW/Victorian boarder. “Wagga ED was a particular favourite. The staff made me feel so incredibly welcome and supported every time I was there. They appreciated the assistance so they seem do what they can to make you feel welcome. The Rural LAP team is also wonderfully supportive, especially if there is a problem during the placement.” Nat believes that helping to make a difference truly is the greatest reward. “Rural LAP offers rewards and incentives but I do not discuss them. The real reward is being able to genuinely help a community just by being there.” Nat has completed over 30 locum placements with Rural LAP since 2011 and is currently in South Australia completing another two week placement in a remote location. “I would absolutely work with Rural LAP again. I definitely recommend the program to others but only to those I think are clinically competent to do the job.”
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DID YOU KNOW? Bendigo Health is currently recruiting midwives in our brand new world class facility. Each year our maternity services welcome more than 1,300 babies.
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Women’s and Children’s Services in the new Bendigo
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Registered Midwife
www.bendigohealth.org.au/careers
HealthTimes - August 2017 | Page 15
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DOUBLE YOUR JOB OPTIONS
STUDY A DOUBLE DEGREE IN MIDWIFERY/NURSING Options. What a great thing to have when you’re entering the job market. VU’s Bachelor of Midwifery and Nursing gives you just that with the ability to choose a career as a nurse or midwife. Or both. And placement opportunities with the Western Hospital Network will build your skills and confidence in real hospital settings so you graduate job ready.
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VU responds to maternity care challenges with innovative dual degree
A
s the health profiles of women having babies continue to change, the complexity of the care requirements undertaken by midwives is increasing, prompting a surge of interest in Victoria University’s innovative dual degree in midwifery and nursing. While there are distinct differences between the midwifery and nursing professions, there are also numerous shared commonalities in both knowledge and practice that complement each other. “Women having babies today are generally older, and there has been a change in their health profile,” says Victoria University’s Professor and Head of Program, Nursing and Midwifery, Dr Sharon Andrew. The dual degree prepares midwives to meet the current challenges in maternity care. The course was developed in direct response to feedback about the current challenges in maternity care, and its impact on the knowledge and skill requirement of midwives. Essentially, the dual degree prepares graduates to become work-ready to practice as midwives or nurses in Australian healthcare settings, through theory, practice and six clinical placements. Victoria University is an early adopter of virtual simulation technology, enabling students in all four years of the dual degree to practice midwifery and nursing decision-making and critical thinking through interactive computer based technology. “We lead the way in the use of groups of simulated patients from culturally and linguistically diverse backgrounds in order to reflect the diversity of the Australian population,” says Professor Andrew. Students benefit directly from the diversity of the group, learning to effectively
communicate with a broad range of patients, managing cultural and language sensitivities while effectively tending to their patients’ health requirements. The degree has seen numerous advancements in its self-directed learning lab, the result being a cutting-edge facility, providing students with plenty of opportunity to improve their skills. “Midwifery and nursing educators are seconded from one of our clinical partners and this provides students with current clinical knowledge,” says Professor Andrew. Students at Victoria University have access to extensive current research, with Professor Andrew, along with Professor of Midwifery, Dr Mary Carolyn-Olah and Professor of Mental Health Dr Terence McCann, all bringing their research to the classroom. “Studying our Bachelor of Midwifery/ Bachelor of Nursing you’ll learn the practical skills for each profession – and the healthcare knowledge for both,” says Professor Andrew. In addition to having access to state-of-theart practical learning facilities, students learn how to understand their patients’ unique health needs in the delivery of midwifery and nursing care. The dual degree in midwifery and nursing is an ideal choice for anyone wanting a career that directly benefits the health of their community, while enjoying the innovative and cutting-edge facilities offered through Victoria University. “Midwives and nurses can work in many settings and the dual degree gives the graduating student additional flexibility in choosing where they want to work,” says Professor Andrew.
HealthTimes - August 2017 | Page 17
Boosting midwifery education in a virtual world
M
idwifery students are using virtual reality to study neonatal resuscitation. In a learning environment that sits between the classroom and real life, second year midwifery students at the University of Newcastle (UON) are the first in the world to explore emergency neonatal resuscitation in a virtual scenario. In a collaboration between the School of Nursing and Midwifery and the university’s Innovation Team, students are using Samsung GearVR headsets coupled with a smartphone app. The cutting-edge technology transports students into a virtual birthing room where they are confronted with a time-critical resuscitation scenario in either a practice or test mode. Midwifery lecturer and co-project leader Jessica Williams, a former Maitland Hospital nurse and midwife, says the technology places students in a simulated real-world environment with an ill baby, its family, hospital staff, and medical equipment. “Everything that you see in the scenario is comparative to the real world environment, so everything is in the correct proportions, things are in the correct locations, the right equipment is there,” she says. “We wanted to try and mimic the sort of real life experience that students would actually be confronted with out on their placements.” In the virtual reality scenario, midwifery students must first prepare for the birth of the baby before moving through a series of stages
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and using elements, such as the Apgar score and the ISBAR framework. “It starts with getting everything they need set up on the trolley. When the baby is born, it just appears on the trolley,” she says. “You can tell straight away from looking at it, that it’s not doing so good - it’s colouring is really poor and it’s not moving and it’s just laying there. “So then students have to progress through the steps that we would do in the real world environment - calling for help and interacting with other health professionals as they come into the room, setting up the right equipment, and putting an oxygen mask on. “It reaches a stage in the scenario where they have to progress to doing CPR, and eventually they do manage to save the baby once they’ve gone through all of the steps that are necessary.” With figures showing 15 per cent of births in Australia and New Zealand require resuscitation, Ms Williams says the technology is designed to help students feel comfortable and confident in applying their skills in an emergency environment. “What we do know from the evidence is that when health practitioners are stressed in emergency medical situations, their reaction time is slower, they are more likely to make mistakes, and they therefore put patient safety at risk,” she says. “So if this is one method that can help improve confidence and lower stress and really
trial and use of the technology in the clinical environment. Ms Williams says incorporating virtual reality into the classroom, as an addition to and not a replacement for hands-on practice, is the way of the future. “It’s being able to have these blended learning environments where students get a mix of learning methods - face to face, hands on, and utilising technology,” she says. “It also means that it appeals to people who have different styles and ways of learning. It gives a whole other dimension to learning, and I think that in 10 years’ time this is going to be something used across all universities - using virtual reality in some form when it comes to teaching and learning, particularly in the clinical types of degrees. “The possibilities are endless with what you can really create and mimic using virtual reality.”
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Completing medical school was a tough assignment, but with OUM’s unique curriculum and continued support, I graduated as a culturally, worldly, more rounded doctor.” Dr Paris-James Pearce
RN to MD
Make the dream of becoming a doctor a reality, earn your MD at Oceania University of Medicine. n Attractive fee structure for our Graduate Entry Program. n Over 200 students currently enrolled and over 50 graduates in Australia, New Zealand, Samoa and USA. n Home-based Pre-Clinical Study under top international medical school scholars, using world leading Pre-Clinical, 24/7 online delivery techniques. n Clinical Rotations can be performed locally, Interstate or Internationally. n Receive personalised attention from an Academic Advisor. n OUM Graduates are eligible to sit the AMC exam or NZREX.
Applications are now open for courses starting in January and July - No age restrictions
OCEANIA UNIVERSITY OF MEDICINE INTERNATIONALLY ACCREDITED For information visit www.RN2MD.org or 1300 665 343
HealthTimes - August 2017 | Page 19
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cement some of those important principles, that will be enormously beneficial.” For her PhD, Ms Williams is conducting a trial to understand whether multiple methods of learning, including hands-on practical learning plus virtual reality practice, will improve midwifery students’ competence in neonatal resuscitation. “We are going to be using some biometric sensor equipment that students will wear and it’s going to monitor their heart rate and their rest rate and their skin temperature, and all of those physiological markers that can’t be falsified. “We’re hoping that if students are reporting better confidence by having access to multiple ways of learning about neonatal resuscitation, that they’ll also demonstrate lower levels of stress when they are actually practising that out in the real world.” The university is exploring a range of other scenarios for virtual reality learning for students, and is also investigating partnerships for the
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Unique Career Opportunities Join a great Australian icon. Working with the Royal Flying Doctor Service (RFDS) you will be joining a team of dedicated professionals providing health care to people living and working in rural and remote Australia.
Alice Springs, NT • Mental Health Clinicians Unique opportunities are now available for the above roles to work in a diverse and rewarding environment delivering mental health services to communities outside of Alice Springs. Please visit our website for more details.
Port Augusta, SA • Medical Practitioner An exciting opportunity to join a team of dedicated health professionals at our Port Augusta Base. Our Medical Practitioners deliver a range of clinical primary care and aeromedical services. You will be an AHPRA registered General Practitioner, fellowship with RACGP, ACRRM or equivalent with comprehensive experience in primary care are essential.
Adelaide & Port Augusta, SA • Flight Nurses RFDS flight nurses are at the forefront in delivery of aeromedical health services, providing primary response, intensive care, obstetric and trauma services, including emergency retrievals, as part of our high performance aeromedical team. If you are keen to move your career into an organisation that makes a real difference to all Australians, apply now. For further details please visit our website at: www.flyingdoctor.org.au The Royal Flying Doctor Service is an Equal Opportunity Employer.
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HealthTimes - August 2017 | Page 21
Embracing a career as a Credentialled Diabetes Educator
B
ernie Maynard began her career in neurosurgical nursing before moving into emergency nursing, where she spent 17 years. Seeking a change, Bernie then took the leap into primary health care as a practice nurse, and began work at The Lake Munmorah Doctors’ Surgery. It was here Bernie recognised the need for a diabetes service, and embarked on a plan to establish a nurse-led diabetes clinic. “We have a large cohort of patients with diabetes, and diabetes services were hard to access promptly, so I approached my practice manager and GPs and discussed setting up a nurse-led diabetes clinic for our patients,” she says.
Diabetes Australia statistics show about 1.7 million Australians have diabetes, including 1.2 million people with diagnosed diabetes, and an estimated 500,000 people with undiagnosed type 2 diabetes. There are three main types of diabetes type 1, type 2, and gestational diabetes. This serious complex condition is the fastest growing condition in Australia, with more than 280 people developing diabetes each day. Bernie completed the Graduate Certificate of Diabetes Education in 2013, and became credentialled with the Australian Diabetes Educators Association in 2014 after completing 1800 hours of clinical practice. As a Credentialled Diabetes Educator, Bernie’s position involves all aspects of diabetes education and management - educating the newly diagnosed patient about the condition and self-management, and ongoing education and management of patients with established
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diabetes to improve their glycaemic control and quality of life. The position also covers insulin initiation and titration, supporting families and carers of patients with diabetes, and advising GPs about better management options for their patients. Bernie runs two clinics a week focused on helping patients to manage their type 1 and type 2 diabetes and pre-diabetes. “Patients have their blood tests done prior to their appointment. When they come in to see me, a care plan is completed which focuses on all aspects of diabetes management and reducing risk of complications,” she says. “It also encompasses their other health issues or comorbidities and addresses preventative or screening health, for example their immunisation status, current electrocardiogram and women’s health - mammograms, pap tests. “I spend time addressing the patient’s main concerns with their diabetes management and working with them to devise smart goals and strategies to improve their glycaemic control and sense of wellbeing. “I also provide referrals to other allied health professionals, for example dietitians and exercise physiologists, as required. The patient’s GP will then come in and we will discuss best management for the patient, for example change in medication, and often congratulate the patients on their self-management achievements. “If insulin is recommended for the patient, I provide education for this and then work with the patient outside clinic hours either by phone or email to titrate their dose as required. “I see my patients formally in the clinic every three or six months depending on their glycaemic control and informally as required.” The clinics have been a major success, helping around 450 patients to improve their
HT-708-010471/2PG FULL COLOUR CMYK PDF Seeking Registered Midwives To provide and co-ordinate quality care for women and neonates on a Part Time/Full Time basis. Prerequisites: AHPRA Registration, Minimum 1 years’ post grad experience, Self-motivated, proficient in communication and organisational and time management, basic patient management knowledge.
About GV Health - We are located in Shepparton, Central Victoria. Two hours’ north of Melbourne close to snowfields, rivers, lakes, wineries and the arts. We enjoy glorious weather, lifestyle, and the sports and attractions of a major regional city. What’s in it for you? - Salary Packaging, Social Club, Discount Gym/Pool Membership, Mentoring Programs, Supportive Culture, Reward and Recognition, Employee Assistance Programs, Professional Development Opportunities, Competitive Remuneration, Paid Maternity and Paternity Leave. To apply visit our website www.gvhealth.org.au Confidential Questions? Contact Carmel Brophy, Midwifery NUM – (03) 5832 2596 / carmel.brophy@gvhealth.org.au If you want to make a real difference and work with great people, come and join us!
exercise. Bernie was recently recognised for her outstanding contribution to the nursing profession when she was named a finalist in the 2017 HESTA Australian Nursing and Midwifery Awards. She hopes her nomination will encourage other practice nurses to establish nurse-led clinics. Helping people to manage their diabetes is rewarding work, Bernie says. “It is a challenging condition and everyone’s diabetes experience is different. Not only are you dealing with the physical side of diabetes but also the social, emotional and psychological aspects as well,” she says. “The management of diabetes is evolving all the time which makes it so interesting. I would encourage all nurses to give a go. There are not enough of us to go around!”
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health outcomes, and leading to a significant reduction in the number of patients referred to public hospital outpatient clinics and endocrinologists. Bernie says diabetes clinics offer numerous benefits to people living with diabetes. “They provide the patients with focused education using best practice guidelines, and it gives them the tools, knowledge and support they require,” she says. “Any changes to management happens on the day and patients are closely followed up. Patients are comfortable coming here because it is a familiar environment and familiar people looking after them.” Bernie provides education days and evening sessions featuring free screenings, and she also established the Heart Foundation Munmorah Movers walking group in 2016. The group meets three times a week, with Bernie encouraging local residents and patients to step up to regular
Understanding pathology in pregnancy
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ore than 300,000 babies are born each year in Australia. Pathology is an integral part of diagnosis and patient care in pregnancy, offering a range of pathology tests throughout the first, second and third trimesters. Dr Ellen Maxwell, Medical Director and Director of Haematology at Melbourne Pathology and an ambassador for Pathology Awareness Australia, says the support and expertise of the broader pathology community is crucial to providing rapid, reliable and quality results. “Pathologists are there at the start, guiding appropriate testing, meeting the patient to procure tissue samples, monitoring quality of analysis, using specialist interpretive skills to make the diagnosis, to define the prognosis and communicate this to the multidisciplinary teams of management, and finally there to follow the success of treatment through relevant monitoring,” she says. Advances in pathology have resulted in reduced maternal and neonatal morbidity and mortality. From an understanding of the prevention of Rhesus disease through to the recognition of potential infectious and genetic risk, pathology is instrumental in providing screening and monitoring tests to reduce harm to women and their babies. Dr Maxwell says genetic testing has had
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a significant impact on all disciplines of pathology. “Prenatal screening for common genetic errors is the perfect example of how an advance in science can have such a clinical impact, can be adopted so readily and embraced so thoroughly by both patients and doctors,” she says. “Not only has this allowed enhanced accuracy of prediction of conditions like Downs syndrome, but it has reduced the invasiveness and associated complications of testing, as well as providing a rapid result earlier in pregnancy. “In such a short period of time, the advancement in technology has become increasingly financially attainable.” Australia has 1,800 pathologists and 35,000 people working in pathology, including roles that range from medical scientists to lab technicians and collectors. While technological change is sometimes perceived as a threat to job security, Dr Maxwell says it’s imperative to increase affordability, accessibility, reliability and rapid turnaround of results. “The analysers will get smaller, the machines will get faster, the amount of blood needed to test will reduce and digital technologies will likely replace the microscope and allow greater freedom from the barrier of geographic isolation,” she says.
Pathology tests in pregnancy Trimester 1 - from six to eight weeks Women are offered several blood tests to confirm a pregnancy. A full blood examination will check for possible iron deficiency and thalassaemia risk. A ferritin level may be included and is more sensitive than the full blood alone to determine reduced iron stores. A blood group will determine not just the ABO group but more importantly identify individuals with a Rhesus negative blood type who should be offered prophylactic therapy during pregnancy to prevent one of the causes of pregnancy loss and newborn jaundice (haemolytic disease of the fetus and newborn). Women are also screened for infectious disease exposure or immunity including HIV, and Hepatitis B and C which can put babies at risk of future liver disease, if not treated. Testing for antibodies to rubella and chicken pox is conducted as exposure to these viruses during pregnancy can cause birth defects if a woman is not immune.
A woman can also talk to her doctor about whether testing for chlamydia, syphilis, thyroid disease and vitamin D is necessary. After 10 weeks Combined first trimester screening usually takes place between the 10th and 14th week of the pregnancy to determine the chance of the pregnancy being affected by certain chromosomal abnormalities such as Down syndrome (trisomy 21), Edwards syndrome (trisomy 18) or Patau syndrome (trisomy 13). This combines information obtained by an ultrasound and blood tests. The ultrasound is performed between the 11th and 13th weeks, predominantly to assess nuchal translucency, the thickness of the fold at the back of the baby’s neck. Together with the maternal age, weight, gestation and maternal blood test results (free beta-human chorionic gonadotrophin, pregnancyassociated plasma protein-A) obtained between the 9th and 13th weeks of the pregnancy, the chance of a baby affected by these abnormalities is determined. Further blood tests are available where parents have close blood relatives carrying other genetic disorders. Trimester 2: 15-17 weeks’ pregnancy Multiple Marker Screening or Maternal Serum Screening involves a blood test that looks for both Down syndrome, Edwards syndrome and neural tube defects such as spina bifida and anencephaly, in which the skull does not form properly.
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“But people will still be imperative for human oversight of result quality, for individualisation of interpretation and have direct relevance to patient care. “In the future, we aspire to greater integration of the clinical detail from the total medical health record, information from all participants in patient care, that will maximise quality use of pathology and maximise wellbeing for the community.”
708-01068-04 3pg_1 1PG FULL COLOUR CMYK PDF The screen looks for four chemicals in the blood alpha-feto protein, unconjugated estriol, free beta hCG and dimeric inhibin A. Again, these results are combined with the nuchal translucency results and other information about the pregnancy to assess the chance of a fetus having abnormalities. All tests have limitations and may not be diagnostic alone.
The full blood examination is usually repeated towards the end of the second trimester, looking for the development of iron deficiency anaemia, which is extremely high in pregnancy, as well as to check the platelet count which may sometimes fall as a result of pregnancy complications. Rhesus negative women will also have their antibody status checked prior to receiving their first dose of anti-D at 28 weeks.
Non-invasive prenatal testing Other tests Non-invasive prenatal testing (NIPT) can offer better accuracy in detecting chromosomal abnormalities. This tests fetal DNA that is released normally into the mother’s blood. Testing is recommended between 11 and 16 weeks and may be carried out after a woman has had the nuchal translucency test or following the results of other blood tests. Tests such as amniocentesis or chorionic villus sampling (CVS) are also available. These are more invasive so carry a risk of miscarriage, making NIPT a potentially safer option. Amniocentesis tests fetal cells in the amniotic fluid and CVS tests cells taken directly from the placenta. Trimester 3: 24-28 weeks’ pregnancy Between three and eight per cent of women get gestational diabetes between the 24th and 28th week of pregnancy, sometimes earlier. It usually goes away after the baby is born. A glucose tolerance test uses three blood samples - the first sample is taken before a standardised glucose drink is consumed, the second sample one hour after, and the third sample two hours after the glucose load. A pathology laboratory compares results from all samples to see if they indicate gestational diabetes. The condition can be managed with lifestyle changes, monitoring blood glucose levels and sometimes medication.
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Pregnant women may also be tested for Group B Streptococci (GBS) bacteria via a vaginal or anorectal swab at 35-37 weeks. These bacteria occur naturally in some women and are usually not harmful, however if passed on to a newborn in the birth canal, the baby can become very ill. Pregnant women carrying these bacteria can be offered antibiotic treatment during labour as a measure to help protect a baby from becoming infected. Women may also be offered pathology tests if they fall ill while pregnant or if they are in a high-risk group – particularly during the early stages of pregnancy. Certain conditions can affect the unborn baby such as cytomegalovirus (CMV), toxoplasmosis and herpes simplex virus (HSV) and pathology can diagnose these conditions so that steps can be taken to protect mother and baby.
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