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Papers by Michele Levinson

Internal Medicine Journal, 2009

An audit at a private tertiary hospital showed low rates of assessment and treatment of osteoporo... more An audit at a private tertiary hospital showed low rates of assessment and treatment of osteoporosis in minimal trauma patients of hip fracture. A survey sent to all doctors involved in hip fracture care to establish medical beliefs about effective management of osteoporosis in minimal trauma hip fracture patients showed a lack of ownership for investigation and beliefs influencing treatment choices. Understanding the barriers to the translation of evidence into practice is vital to improve patient care.

We sit at a phase in human development when life expectancy is greater than ever before. In class... more We sit at a phase in human development when life expectancy is greater than ever before. In classical Rome life expectancy was a mere 28 years for an adult, in Medieval Britain it had risen slightly to 30 years, and by the early 20th century 31 years. These figures were predominantly due to high infant mortality, and thanks to recent advances in science and medical technology, we have seen the greatest increases in life expectancy in the past century.

The Medical Journal of Australia, 2014

Age and Ageing, 2014

There are few certainties in life-death is one of them. Yet death is often thought of today as th... more There are few certainties in life-death is one of them. Yet death is often thought of today as the 'loss of the battle' against illness, where in traditional societies it was the natural, meaningful, end to life. Medical knowledge and technologies have extended the possibilities of medical care and increased our life span. People living in most developed countries today can expect to survive to an advanced age and die in hospital rather than at home as in the past. Owing to these and other historical, cultural and social factors, our views on death have been skewed. Medical technology provides an arsenal of weapons to launch against death and the 'war against disease' has entrenched itself in medical philosophy. We now primarily experience death through the lens of a camera. Representations of 'death as spectacle' distort our perceptions and leave us ill-prepared for the reality. Additionally, death as a natural consequence of life has become much less visible than it was in the past due to our longer life expectancies and lack of infectious disease. The continued thrust for treatment, wedded with a failure to recognise the dying process, can rob individuals of a peaceful, dignified death. Progress being made in Advance Care Planning and palliative care is limited by the existing paradigm of death as a 'foe to be conquered'. It is time for a shift in this paradigm.

Resuscitation, 2011

Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in... more Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study. Design and Setting: A point prevalence design conducted at 10 hospitals, comprising of private and public, secondary and tertiary referral, ICU equipped, metropolitan and regional settings. Patients: All inpatients were eligible except intensive care and psychiatric patients. Measurement and main results: On a single day consenting inpatients in each hospital had a single set of vital signs obtained, their observation chart reviewed and followed up for MET activations, unplanned ICU admissions, cardiac arrests and 30 and 60 day mortality. Of 2199 eligible patients, 1688 (76.76%) were assessed, 175 (7.95%) refused consent and 336 (15.28%) were unavailable. Access to patients was refused in some wards despite ethics approval. Data collection required 2 student nurses approximately 14 min per patient assessment. Conclusion: In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients.

Internal Medicine Journal, 2014

Background: Within Australian hospitals, cardiac and respiratory arrests result in a resuscitatio... more Background: Within Australian hospitals, cardiac and respiratory arrests result in a resuscitation attempt unless the patient is documented as not for resuscitation.

Heart, Lung and Circulation, 2011

Methods: Pilot prospective cohort study. Primary outcome measure: Change in HRQoL scores between ... more Methods: Pilot prospective cohort study. Primary outcome measure: Change in HRQoL scores between baseline and three months following cardiac surgery

Heart, Lung and Circulation, 2011

To explore what quality of life means to octogenarians following cardiac surgery.

Australasian Journal of Dermatology, 2012

Reported is the case of a 17-year old male with sacroiliitis confirmed by magnetic resonance imag... more Reported is the case of a 17-year old male with sacroiliitis confirmed by magnetic resonance imaging (MRI) while undergoing isotretinoin treatment for acne vulgaris. The cessation of isotretinoin and symptomatic treatment resolved the symptoms within 6 weeks, with no signs of sacroiliitis on repeat MRI 10 months later. The temporal association of disease onset and commencement of isotretinoin along with rapid recovery on withdrawal supports the role of isotretinoin in this case.

The Medical journal of Australia, Jan 4, 2014

Cardiopulmonary resuscitation (CPR) is the default treatment in hospital unless there is a decisi... more Cardiopulmonary resuscitation (CPR) is the default treatment in hospital unless there is a decision to the contrary and this is documented in the patient record. The outcome of CPR in older chronically ill patients is very poor and discharge home is unlikely. Fewer not-for-resuscitation (NFR) orders are written than there are patients who would not benefit from CPR. NFR orders appear to be a marker of death, rather than the result of informed discussion about end-of-life care. There is a legal and ethical framework for the consideration of the suitability of CPR. Discussions about CPR are challenging, and uncertainty is introduced because of the lack of consensus around futility, the emotionally charged nature of the topic, misconceptions about the success of CPR and the failure to recognise that not offering CPR will allow a peaceful and supported death. Discussion around CPR can be misconstrued as a need for consent. A focus on patient and family involvement may result in an expec...

Internal Medicine Journal, 2009

An audit at a private tertiary hospital showed low rates of assessment and treatment of osteoporo... more An audit at a private tertiary hospital showed low rates of assessment and treatment of osteoporosis in minimal trauma patients of hip fracture. A survey sent to all doctors involved in hip fracture care to establish medical beliefs about effective management of osteoporosis in minimal trauma hip fracture patients showed a lack of ownership for investigation and beliefs influencing treatment choices. Understanding the barriers to the translation of evidence into practice is vital to improve patient care.

We sit at a phase in human development when life expectancy is greater than ever before. In class... more We sit at a phase in human development when life expectancy is greater than ever before. In classical Rome life expectancy was a mere 28 years for an adult, in Medieval Britain it had risen slightly to 30 years, and by the early 20th century 31 years. These figures were predominantly due to high infant mortality, and thanks to recent advances in science and medical technology, we have seen the greatest increases in life expectancy in the past century.

The Medical Journal of Australia, 2014

Age and Ageing, 2014

There are few certainties in life-death is one of them. Yet death is often thought of today as th... more There are few certainties in life-death is one of them. Yet death is often thought of today as the 'loss of the battle' against illness, where in traditional societies it was the natural, meaningful, end to life. Medical knowledge and technologies have extended the possibilities of medical care and increased our life span. People living in most developed countries today can expect to survive to an advanced age and die in hospital rather than at home as in the past. Owing to these and other historical, cultural and social factors, our views on death have been skewed. Medical technology provides an arsenal of weapons to launch against death and the 'war against disease' has entrenched itself in medical philosophy. We now primarily experience death through the lens of a camera. Representations of 'death as spectacle' distort our perceptions and leave us ill-prepared for the reality. Additionally, death as a natural consequence of life has become much less visible than it was in the past due to our longer life expectancies and lack of infectious disease. The continued thrust for treatment, wedded with a failure to recognise the dying process, can rob individuals of a peaceful, dignified death. Progress being made in Advance Care Planning and palliative care is limited by the existing paradigm of death as a 'foe to be conquered'. It is time for a shift in this paradigm.

Resuscitation, 2011

Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in... more Objective: The RESCUE study examined the prevalence of patients at risk of a medical emergency in acute care settings by assessing the prevalence of cases where patients fulfil the hospital-specific criteria for MET activation. This article will detail the study methodology including the ethics applications and approvals process, organisational preparation, research staff training, tools for data collection, as well as barriers encountered during the conduct of the study. Design and Setting: A point prevalence design conducted at 10 hospitals, comprising of private and public, secondary and tertiary referral, ICU equipped, metropolitan and regional settings. Patients: All inpatients were eligible except intensive care and psychiatric patients. Measurement and main results: On a single day consenting inpatients in each hospital had a single set of vital signs obtained, their observation chart reviewed and followed up for MET activations, unplanned ICU admissions, cardiac arrests and 30 and 60 day mortality. Of 2199 eligible patients, 1688 (76.76%) were assessed, 175 (7.95%) refused consent and 336 (15.28%) were unavailable. Access to patients was refused in some wards despite ethics approval. Data collection required 2 student nurses approximately 14 min per patient assessment. Conclusion: In conducting a large multi-site point prevalence study, critical organisational processes were shown to influence the access to patients. This study demonstrated the impact of variation in Human Research Ethics Committee interpretations of protocols on consenting processes and the importance of communication and leadership at ward level to promote access to patients.

Internal Medicine Journal, 2014

Background: Within Australian hospitals, cardiac and respiratory arrests result in a resuscitatio... more Background: Within Australian hospitals, cardiac and respiratory arrests result in a resuscitation attempt unless the patient is documented as not for resuscitation.

Heart, Lung and Circulation, 2011

Methods: Pilot prospective cohort study. Primary outcome measure: Change in HRQoL scores between ... more Methods: Pilot prospective cohort study. Primary outcome measure: Change in HRQoL scores between baseline and three months following cardiac surgery

Heart, Lung and Circulation, 2011

To explore what quality of life means to octogenarians following cardiac surgery.

Australasian Journal of Dermatology, 2012

Reported is the case of a 17-year old male with sacroiliitis confirmed by magnetic resonance imag... more Reported is the case of a 17-year old male with sacroiliitis confirmed by magnetic resonance imaging (MRI) while undergoing isotretinoin treatment for acne vulgaris. The cessation of isotretinoin and symptomatic treatment resolved the symptoms within 6 weeks, with no signs of sacroiliitis on repeat MRI 10 months later. The temporal association of disease onset and commencement of isotretinoin along with rapid recovery on withdrawal supports the role of isotretinoin in this case.

The Medical journal of Australia, Jan 4, 2014

Cardiopulmonary resuscitation (CPR) is the default treatment in hospital unless there is a decisi... more Cardiopulmonary resuscitation (CPR) is the default treatment in hospital unless there is a decision to the contrary and this is documented in the patient record. The outcome of CPR in older chronically ill patients is very poor and discharge home is unlikely. Fewer not-for-resuscitation (NFR) orders are written than there are patients who would not benefit from CPR. NFR orders appear to be a marker of death, rather than the result of informed discussion about end-of-life care. There is a legal and ethical framework for the consideration of the suitability of CPR. Discussions about CPR are challenging, and uncertainty is introduced because of the lack of consensus around futility, the emotionally charged nature of the topic, misconceptions about the success of CPR and the failure to recognise that not offering CPR will allow a peaceful and supported death. Discussion around CPR can be misconstrued as a need for consent. A focus on patient and family involvement may result in an expec...