bluuebunny/crossref_metadata_2025 huggingface dataset:
Factoring Information into Returns
Authors: Easley David , Hvidkjaer Soeren , O’Hara Maureen
Published: February 2010

We examine the potential profits of trading on a measure of private information (PIN) in a stock. A zero-investment portfolio that is size-neutral but long in high PIN stocks and short in low PIN stocks earns a significant abnormal return. The Fama-French, momentum, and liquidity factors do not explain this return. However, significant covariation in returns exists among high PIN stocks and among low PIN stocks, suggesting that PIN might proxy for an underlying factor. We create a PIN factor as the monthly return on the zero-investment portfolio above and show that it is successful in explaining returns to independent PIN-size portfolios. We also show that it is robust to inclusion of the Pástor-Stambaugh liquidity factor and the Amihud illiquidity factor. We argue that information remains an important determinant of asset returns even in the presence of these additional factors.
The Impact of the Euro on Equity Markets
Authors: Cappiello Lorenzo , Kadareja Arjan , Manganelli Simone
Published: February 2010

This paper investigates whether comovements between euro area equity returns at national and industry level changed after the introduction of the euro. By adopting a regression quantile-based methodology, we find that after 1999 the degree of comovements among euro area national equity markets was augmented. By explicitly controlling for the impact of global factors, we show that this result cannot be explained by recent worldwide trends. A more refined analysis based on an industry breakdown suggests that the increase in national index comovements is mainly driven by financial, industrial, and consumer services sectors.
55/02: A manufactured architecture in a manufactured landscape
Authors: Sheil Bob
Published: February 2010

The spectacular surroundings of Kielder Water & Forest Park, in Northumberland, England, are a confluence of opposing states: the man-made and natural; the utilitarian and recreational; the beautiful and isolated; shaped by weather converging from east and west. Kielder Castle was built in 1775 as the Duke of Northumberland's hunting lodge. In recent years the territory has gained notoriety for a series of innovative art and architectural commissions including Belvedere by Softroom Architects (1999), Kielder Skyspace by the American artist James Turrell (2000), Minotaur by architect Nick Coombe and artist Shona Kitchen (2003), and Kielder Observatory by Charles Barclay Architects (2008). This paper outlines one of Kielder's most recent additions – a shelter entitled 55/02 – the result of a collaboration between sixteen*(makers) and manufacturers Stahlbogen GmbH. The work rekindles the symbiotic relationship between design and making once central to the production of architecture. The reawakening of this tradition has been stimulated by the mainstream adaptation of CAD/CAM as an industrial and disciplinary medium which binds the protocols of drawing with those of fabrication. However, as this account of the project shows, the relevance of an increasingly digitised world extends beyond the production of 55/02 as an artefact – it forms the basis of the architecture's relationship with its locality as an industrial, historical, social, cultural and manufactured landscape [1].
Sun, wind, rain and the sewer: outward form opportunities in a degraded landscape
Authors: Stenson Timothy
Published: February 2010

The US housing market is infamous on at least two counts: implicated in the global financial crisis and notorious for its unsustainable consumption of resources and consequent discharge of carbon dioxide. Lately anything like good news regarding housing in the USA is scarce. However, the pause resulting from the collapse of the market, and increasing concern regarding building's agency in the environment, combine to provide an opportunity to reconsider the form and performance of housing. This may yet create an opening for design.
Knowledge in the making
Authors: Kirkeby Inge Mette
Published: February 2010

This project began when one of my research colleagues, a civil engineer, pointed to his very thorough study of daylighting in buildings and said: ‘Here is all that architects need to know about light – why don't they use it?’ A discussion followed about what kind of knowledge is relevant, when, and for whom. It ended with the questions: ‘What kind of knowledge do architects really use in their design process?’ and ‘How can we as researchers provide the different kinds of knowledge that are useful for practice?’ These questions became the basis of a research project and this paper reports on its studies and discussions.
Coastal emissions of methyl bromide and methyl chloride along the eastern Gulf of Mexico and the east coast of the United States
Authors: Hu Lei , Yvon‐Lewis Shari A. , Liu Yina , Salisbury Joseph E. , O'Hern Julia E.
Published: February 2010

Measurements of methyl bromide (CH3Br) and methyl chloride (CH3Cl) were made during the Gulf of Mexico and the East Coast Carbon (GOMECC) cruise in the summer of 2007. This was the first large‐scale study of CH3Br and CH3Cl in the coastal ocean. The mean atmospheric mixing ratios were 10.1 ppt for CH3Br and 517 ppt for CH3Cl. Surface seawater concentrations ranged from 0.8 pM to 5.0 pM for CH3Br and from 61.5 pM to 179 pM for CH3Cl. Biological processes contribute to the elevated seawater concentrations of CH3Br, while a combination of biological processes and terrestrial sources may contribute to elevated seawater concentrations of CH3Cl. Vertical distributions show highest concentrations of CH3Br and CH3Cl in the subsurface seawater below the mixed layer due to high degradation rates near the surface. Good correlation of the production rates between CH3Br and CH3Cl suggests they have some common sources in the coastal ocean. After excluding the open ocean points, annual coastal emissions in the studied region were 0.01–0.06 Gg yr−1 for CH3Br and 0.3–1.6 Gg yr−1 for CH3Cl. By simple extrapolation, the global coastal emissions were estimated at 0.5–3.6 Gg yr−1 for CH3Br and 19–98 Gg yr−1 for CH3Cl. Including the coastal ocean emissions of CH3Br and CH3Cl will increase the estimate of global oceanic emissions by 1%–9% and 1%–8%, respectively.
Structural basis for the function of DEAH helicases
Authors: He Yangzi , Andersen Gregers R , Nielsen Klaus H
Published: February 2010

DEAH helicases participate in pre‐messenger RNA splicing and ribosome biogenesis. The structure of yeast Prp43p‐ADP reveals the homology of DEAH helicases to DNA helicases and the presence of an oligonucleotide‐binding motif. A β‐hairpin from the second RecA domain is wedged between two carboxy‐terminal domains and blocks access to the occluded RNA binding site formed by the RecA domains and a C‐terminal domain. ATP binding and hydrolysis are likely to induce conformational changes in the hairpin that are important for RNA unwinding or ribonucleoprotein remodelling. The structure of Prp43p provides the framework for functional and genetic analysis of all DEAH helicases.
Distributional impact of higher patient contributions to Australia's Pharmaceutical Benefits Scheme
Authors: Walker Agnes
Published: February 2010

This paper uses NATSEM's Pharmaceutical Benefits Model to analyse the effects of a hypothetical25 per cent rise in patient contributions to prescribed medicines under Australia's PharmaceuticalBenefits Scheme (PBS). The model, based on microsimulation techniques, is able to provide a muchbroader range of outcomes information, at a much greater level of detail, than is possible withtraditional methods.Higher patient contributions are analysed in terms of their impact on the government to patient splitin PBS costs, as well as the distribution of such costs across age groups, family incomes, family types and36 prescribed medicine types. Also considered are changes in the shares of family disposable incomesspent on prescribed drugs arising from the higher patient contributions.
Assessing need in a privately insured population -the MBF Preventive Health Survey
Authors: Francis Jane , Bauman Adrian , Chey Tien
Published: February 2010

A self-administered mailed questionnaire was used to assess the health behaviours and health status of a randomsample of members of the Medical Benefits Fund of Australia Limited (MBF). The data reaffirmed that the privatelyinsured were more likely to have lower levels of major health risks and to practise better prevention than the uninsured.The survey was useful as a planning tool for MBF, confirming areas of preventive health that were already takenseriously by MBF members. Given the social advantages of these privately insured people, the results may also pointto optimal health promotion and disease prevention rates expected in a population.
First, build the foundations:Practical considerations in general practitioner-mental health service liaison
Authors: Welch Mark , Philip Tina , Aldridge Greg
Published: February 2010

The co-working relationship between general practitioners and local mental health serviceslies at the heart of the success of recent changes in mental health care. These changes haveseen large-scale deinstitutionalisation, a shift to primary and community care, and agovernment policy of prevention and partnerships. This article outlines a liaison projectdeveloped jointly by the South-East New South Wales Division of General Practice and theSouthern Area Mental Health Service to address these issues. We describe the developmentof a protocol of basic standards which were practical, pragmatic and possible and, when fullyestablished, would be the foundation of effective, efficient and efficacious shared care inmental health.
The role of the Advanced Casualty Management Team in St John Ambulance Australia (New SouthWales District)
Authors: Duffield Christine , MacNeil Finlay
Published: February 2010

St John Ambulance is a household name synonymous with the teaching and provision of firstaid. Recently the organisation has developed pre-hospital emergency care services through theintroduction of the St- John Ambulance Australia Advanced Casualty Management Team inNew South Wales. The Advanced Casualty Management Team represents a move away fromthe practice of first aid by lay personnel and is a natural extension of the traditional workand principles of St John Ambulance. This article provides an overview of the AdvancedCasualty Management Team and discusses its contribution to pre-hospital trauma caredelivery.
Preliminary findings on financial impact of relocation for specialist treatment
Authors: McGrath Pam
Published: February 2010

There has been little analysis of the process of relocation for specialist treatment for patients with haematologicalmalignancies. Existing work does not cover the financial impact on families of such an experience. This paperdescribes seminal work in this area by presenting findings from research based on interviews with patients and familiesaffected by relocation. The two-fold intent informing this discussion is to provide data to initiate research in the area,whilst fostering a consideration of epistemological issues at the interface of qualitative and quantitative research. Theresults show that there are very significant financial problems. In planning psychosocial support for such families,serious consideration must be given to both their short and long-term economic plight.
Improving local services for women with breast cancer: Interviews with general practitioners in Central Sydney
Authors: Ward Jeanette , Rikard-Bell Glenys
Published: February 2010

We conducted interviews with 85 randomly selected general practitioners (GPs) in Central Sydney to examine patterns of referral of women with breast cancer, satisfaction with local services, awareness of evidence-based guidelines and suggestions for local support.Previous experience was the most frequently cited factor influencing choice of specialist (n=80, 94%)followed by personal knowledge of the consultant's expertise (n=72, 85%). Only one third of respondents agreed women wanted to be more involved in choosing the specialist (n=28, 33%). Of 79 women recently diagnosed with breast cancer, the majority (96%) had been referred to a male surgeon (n=71, 96%).While only 35% of the GPs rated the care received by women with breast cancer in local facilities as 'excellent', significantly fewer rated communication between GPs and specialists as 'excellent' (35% v19%, p<0.01). Younger GPs were less likely to rate communication as 'excellent' compared with GPs aged 55 years or older (p=0.01). Only 18% of GPs considered their patients as having been 'very well informed' about their treatment choices. Younger GPs were more likely than older GPs to recall all available breast cancer guidelines (p=0.02). Significantly more GPs (68%) requested seminars with experts than any other types of educational support (p<0.001).To improve outcomes for women with breast cancer, mechanisms to support communication between GPs and specialists are recommended. Seminars for GPs with experts who emphasize evidence-based guidelines should be funded and evaluated, especially for impact in meeting the needs of older GPs.
The role of Informatics to support evidence-based practice and clinician education
Authors: Hovenga Evelyn , Hay Dawn
Published: February 2010

This paper reports the results of a national event held during November 1998 to educate health professionalsrepresenting multiple disciplines about evidence-based practice (EBP), its implementation and the use of informaticsto support EBP. A combination of educational delivery methods and multimedia was used. Through local group work,participants identified obstacles to EBP implementation and developed strategies to overcome these in their own localenvironments. Major and common findings were a lack of management support and infrastructures needed for thesuccessful adoption of evidence-based practices by all.
Private health care in Australia:why the government should intervene
Authors: Sullivan Francis
Published: February 2010

The 30 percent health insurance rebate is popular. Both major political parties are committed to it. However,merely pump priming health funds will not guarantee that essential private services remain available to relievethe pressures on public hospitals. It is time for a more interventionist role by government to ensure essentialprivate hospital services remain affordable and accessible for vulnerable people.
Caring about carepaths
Authors: Pearson Belinda  J , Macintosh David J
Published: February 2010

This short paper describes an experiment in the use of clinical pathways for orthopaedic patients at Cairns Base Hospital. We rapidly found they improved the management of cost and quality, and that there were many beneficial side-effects. Our approach was subsequently adopted in other departments. Unfortunately, external support for further developments has not been forthcoming and we argue that this may be an unwise move.
On learning to say 'sorry' and other strategies for quality improvement
Authors: Siddins Mark , Eagar Kathy
Published: February 2010

Stephen Bolsin provides us with a timely opportunity to question and review the role of organised medicine inself-regulating professional standards. His paper stands in stark contrast to recent applications by twoorganisations representing surgeons and consultant specialists to become registered trade unions (Foley, 2001).While those applications represent only a minority of the medical profession (and are largely designed as vehiclesto campaign against efforts to eliminate unexpected bills for private patients and in an effort to combat theAustralian Competition and Consumer Commission), they raise obvious questions about the future oforganised medicine and its status as a 'profession'.
Caring about carepaths: on locus of control, holons and weltanschauung
Authors: Braithwaite Jeffrey
Published: February 2010

Stakeholders in acute care experience problems at various levels and in many places. Numerous critics have pointed to flaws in the system such as fragmentation, structural deficiencies, lack of clinical governance, insufficient resources, serendipitous rather than planned outcomes, poor systems and neglect of health promotion, prevention and education, to mention only some.
DRGs in Germany:implement quickly and refine at leisure
Authors: Bresslein Susann
Published: February 2010

In this commentary, I will describe the circumstances that led to Germany deciding to move to per case paymentby DRG over the next few years, and point out some of the immediate challenges. I will conclude by arguingthat the challenges are such that Germany is unlikely to have the time or the inclination to make any significantmodifications to DRGs in the near future.
Collaborating to manage polypharmacy
Authors: Tasker Judith , Wiseman Rob , Bolton Patrick , Tipper Steven
Published: February 2010

DiNCQUMGP (Divisions National Consortium for the Quality Use of Medicines in General Practice) reports on acollaboration between doctors, pharmaceutical companies, government agencies, and medicine users to managepolypharmacy (prescribing multiple medicines to a patient) amongst older people.We have reported the outcomes of our collaboration (improving the Quality Use of Medicines) elsewhere. Here wediscuss how we worked together, opened up new opportunities, and learned from one another. The first part of thisarticle outlines a constructive new way of thinking about collaborating, that we argue is fundamentally different fromcurrent approaches. The second part describes what we did in the words of those involved.
Contemporary management issues for Aboriginal Community Controlled Health Services
Authors: Taylor Judy , Dollard Joanne , Weetra Colin , David Wilkinson and
Published: February 2010

Aboriginal Community Controlled Health Services face particular management issues as they adjust to the dominantWestern paradigm of managerialism and the market model of health service provision. Their cultural orientation leadsto distinctive organisational features which both advantage and disadvantages them in this environment. The holisticmodel of health used and community control enable the delivery of integrated, culturally appropriate health care.However, effective community control is difficult to achieve. Services may benefit from partnerships with collaboratorssuch as hospitals, regional health services and university departments of rural health if the partnerships are based onmutual respect and ensure that community control is retained.
Agenda-setting in health reform:the role of community
Authors: Aldrich Rosemary , Mooney Gavin
Published: February 2010

This paper presents a number of issues surrounding the setting of agendas for health care reform. We argue the needfor increased community involvement, as well as the necessity to wrest health-care decision-making from health careprofessionals, or at least to ensure that such decision-making is informed by community values.We attempt to answer a few questions: who sets the health reform agenda and who should set it, how is the agendaset and why is this critical, when and where is the agenda set, and how should the agenda be set in the future?
Multi-presenter mental health patientsin emergency departments -a review of models of care
Authors: Westwood Barbara , Westwood Geoffrey
Published: February 2010

Only a small proportion of the treatment of mental illness occurs in an institution or hospital. By far the most significant treatment happens in the community and in the patient's own social and family environment. However, de-institutionalisation of mental health services has brought increasing numbers of patients to the emergency department in need of psychiatric assistance. The traditional service model of emergency departments, focusing on physical illness and injury, is being challenged. The literature review identified numerous psychiatric service models inplace but dramatically highlighted the lack of a specific service model addressing psychiatric patients who present on multiple occasions [multi-presenters] in emergency departments. At present, accurate data on the effects of multi-presentation of psychiatric disorders are not available. Recent international and local research into models of service delivery management and best practice is examined.
Trends in hospital service provision
Authors: Hargraves Jenny , Grayson Narelle , Titulaer Ian
Published: February 2010

In this paper,trends in hospital service provision are measured using data on the numbers and nature of hospitals,on hospital expenditure and on hospital activity over recent years.The number of public acute care hospitals was fairly stable,however,bed numbers decreased.Hospital numbers rose for private hospitals,as did numbers of beds,particularly for group for-profit private hospitals.Recurrent health expenditure on hospitals as a proportion of all recurrent health expenditure fell,although it rose for private hospitals, and real increases in expenditure occurred for both public acute and private hospitals.Population rates for separations and patient days rose for private hospitals and were stable and fell, respectively,for public acute hospitals. Average length of stay decreased for both public acute and private hospitals, with increasing numbers of separations occurring on a same day basis.Increasing proportions of procedures were undertaken during same day stays,and in private hospitals.Separation rates varied geographically, with highest rates overall,and for public hospitals and overnight separations,for patients resident in remote centres and other remote areas.Highest rates for private hospitals were for patients resident in capital cities,other metropolitan centres and large rural centres.
Maternal and infant health prepayment schemes in Shandong, China: a survey of demand and supply
Authors: Xu Lingzhong , Liu Xingzhu , Sun Xiaoyun , Fang Liyi , Hindle Don
Published: February 2010

Maternal and infant prepayment schemes(MIPSs) appeared in China in the early 1980s, as a way of helping women to set aside adequate funds for childbirth. The responsibility for design was devolved to the county level, and many different approaches have been applied. For this and other reasons, there has been no consensus on important matters such as the level of prepayment, the range of covered services, and whether township health centres or family planning stations should operate the schemes. We aimed to clarify some of the uncertainty by conducting combined analyses of cost, willingness to pay, and willingness to supply. We used structured survey instruments to interview 4271 households with children aged under one year, and 18 township health institutions. Our analyses suggest that the ideal prepayment should be higher and the range of covered services should be wider than the current average, and that health centres rather family planning stations should operate the schemes.
The funding of private hospitals in Australia
Authors: Bloom Abby L.
Published: February 2010

Private hospitals are an essential component of Australia's complex mix of public and private health funding and provision. Private hospitals account for 34.3 per cent of all hospital separations, and over half (56.2%) of all same-dayseparations. The revenue (funding) of the sector approached $4 billion by 1998/99, and as a result of its recent rapid growth capital expenditure in the sector was nearly $550 million in the same year. Private casemix of privatehospitals is distinctive, and characterised by a high proportion of surgical procedures in general (48.1per cent), andmore than a majority of all services in such areas as rehabilitation, orthopaedics (shoulder, knee, spinal fusion, and hand surgery), alcohol disorders, same day colonoscopy and sleep disorders. This chapter synthesises data from amultitude of sources to produce a comprehensive picture of Australia's private hospital sector and its funding. It examines the funding (revenue) sources of private hospitals, and considers how and why private hospitals approach theissue of funding from a different perspective than their public sector colleagues. To illustrate how Australian privatehospitals approach revenue (funding) strategically, a series of indicative types of hospitals is explored.
Capital investment in public hospitals
Authors: Deeble John
Published: February 2010

Capital investment is a major concern for public hospitals.Relative to operating expenditures,it has been almost constant for 40 years,despite great changes in technology and patient throughputs.Research studies during the last decade suggest that over that time almost all investment has been on simply replacing existing assets.Per person,the total capital stock has actually declined. However most replacement outlays are predictable.Although major building outlays may still need some central supervision, equipment replacement can be projected with enough confidence to fund it through operating grants.Using data from several surveys,some capital-weighted DRGs have been developed and a funding system suggested.
Young people with brain injury in nursing homes: not the best option!
Authors: O'Reilly Kate , Pryor Julie
Published: February 2010

We discuss the growing needs for appropriate accommodation for young people with acquired brain injury by exploring the accommodation of young people with brain injury in nursing homes. While the actual number is not clear, it is certainly expected to grow. Reviewing the literature and drawing on clinical experience exposes how nursing home becomes an option for these people. We argue that this should not be an option for this typically young male population, and give some suggestions for more appropriate accommodation.
Palliative care and haematological malignancy: a case study
Authors: McGrath Pam , Joske David
Published: February 2010

There is now substantial evidence that patients with haematological malignancies are not referred to the palliative system. Findings from the in-depth qualitative analysis of a successful case study are presented as a paradigmatic example of creative solutions that are available to begin to address this issue of inequity of access. The data provides important insights on the factors that facilitated timely referral to the palliative system, factors that facilitated the opportunity to die at home, a description of important elements of the dying experience, and the outcome of the palliative care experience for the carer. The opportunity for a satisfying dying experience can be afforded to haematology patients. This case study highlights some aspects that need to be considered during the development of palliative services for these diagnostic groups.
Wingecarribee health service model for transitional care
Authors: Jarvis Annette , Grant Simon
Published: February 2010

The Wingecarribee Health Service (WHS) has developed a program of ambulatory care different from the commonlyaccepted models. The program provides a "whole service" approach to care, with integration of hospital, allied health and community services in partnership with other key stakeholders such as general practitioners (GPs) and non-governmentorganisations (NGOs). It departs from the medical model and embraces the health service's commitment to a wellness approach to care. The program is focused on providing the most appropriate care, in the most appropriate location by the most appropriate provider.
The lore about private health insurance and pressure on public hospitals
Authors: Cromwell David
Published: February 2010

Since being elected in 1996,the Coalition government has pursued a raft of policies to increase the proportion of Australians with private health insurance. Against some criteria, these policies have been a success. The proportion of Australians with private health insurance had gradually fallen from around 50%in 1984,to be around 30%in late 1998.With the introduction of a 30%rebate on health insurance, and the introduction of premiums based on a person's age at the time of joining a health fund, coverage rose to 45.9%by September 2000 and has dropped only slightly since (AIHW, 2002). Moreover, the cash reserves of the health insurance companies have improved substantially from the unhealthy levels reported in 1997 (Cormack, 2002). It has also succeeded in giving many more people the ability to make a choice about their health care (Department of Health and Aged Care, 1999).
The devil is in the detail: lessons for multi-disciplinary care teams from alocal evaluation of coordinated care
Authors: Shannon Elizabeth
Published: February 2010

The national evaluation report on the first round of Coordinated Care Trials focused on relationships of care coordination from two main perspectives: that of the General Practitioner (GP) as care coordinator; and the GP perception of non-GP care coordinators. As the majority of the Tasmanian care coordinators came from a nursing background and dealt with a wide range of health care providers, in addition to GPs, a more complex local analysis was required. It was found that relations between care coordinators and other health providers varied considerably by profession andnew strategies were required to ameliorate the resulting conflict. This aspect of the local evaluation provides useful lessons for analysing and avoiding some sources of conflict in the formation and functioning of multi-disciplinary health care teams.
Toward greater integration of the health system
Authors: Swerissen Hal
Published: February 2010

As demand for hospital and emergency services grows there will be pressure to improve the integration of primary, acute and continuing care services. Research on ambulatory sensitive care conditions suggests that a significant proportion of hospital use is potentially preventable by primary health and community care services. The desire for better health outcomes and reduced use of acute care suggests a greater focus on primary health and community care. Reforms have generally emphasised planning, funding and regulatory mechanisms including brokered management of services for an enrolled population, capitation payments and pooled funding across primary,acute and continuing care, the development of coordinated service pathways and the consolidation of responsibility for costs and outcomes. Australia's division of funding, regulatory and planning responsibilities across jurisdictions introduces a unique set of challenges to address these issues. Nevertheless, there are a number of options better aligning Commonwealth and State initiatives through the Australian Health Agreements and funding for range of primary health and community care funding programs.
Issues and challenges facing rural hospitals
Authors: Wilkinson David
Published: February 2010

Australia's rural hospitals face most of the same issues and challenges faced by metropolitan hospitals. However they also face additional challenges around geographic isolation,their iconic status and role as major employers in local communities,and their close relationship with community based health services. Future opportunities include more formal integration with community service through multipurpose service arrangements, regional networking with urban centers,expanded us of IT linkages, and with the expanding rural academic networks. Rural hospitals' roles as key aged care providers in the country is a particular challenge.
Safe working hours - doctors in training a best practice issue
Authors: Lewis Andrew
Published: February 2010

In 1995,the Australian Medical Association launched its Safe Working Hours campaign. By 1998,this had been developed into a National Code of Conduct that continues to resonate in the Australian public health system. However, and particularly in respect of Doctors in Training (DITs) who continue to work long hours, there are levels of resistance to proposals that seek to re-organise work or change prevailing professional and cultural expectations.Long working hours have substantial impacts on a DIT's capacity to consistently deliver high quality patient care, dilute the effectiveness of their training regime and have negative consequences on their health, social life and family responsibilities. While public hospitals often maintain the view that minimal budget flexibility restricts their capacity to affect change in a positive way, in fact devisable productivity and efficiency gains can be achieved by reducing working hours. Further, the medical profession needs to consider whether long hours provide an optimal environment for quality learning and performance.
The process and impact of workplace change: a business unit in the NSW public hospital sector
Authors: White Nadine
Published: February 2010

Over the last decade most of the debate regarding workplace reforms in the health sector has tended to centre on funding and activity levels and their impact on outcomes. Yet there has been little analysis of either the mechanisms by which these reforms have been introduced or their impact on the work life of employees. It is the intention of this paper to analyse the mechanism used to implement workplace change and the impact of that change on employees using a case study method. The paper will firstly identify the various mechanisms by which workplace change may be introduced and provide a brief background on the case study unit. The following sections will discuss the development and implementation of a performance management system, using an informal workplace consultation and negotiation mechanism. The final section will explore the impact of the change mechanism by analysing the objectives of the organisation. The paper, in conclusion, will argue that while the mechanism and the introduction of this instance of workplace change did not in the long term achieve the desired objectives as a specific management tool it has had an ongoing impact on managers, employees and the workplace. The paper draws on evidence from related literature, analysis of primary documents and 10 semi-structured interviews. Data collection, including the interviews with employees and managers, was conducted primarily during the second half of 2001, as part of a broader research project on bargaining structures and workplace change.
Variation between Divisions of General Practice in the uptake of health assessments, care plans and case conferences through the Enhanced Primary Care program
Authors: Wilkinson David , McElroy Heather , Beilby Justin , Mott Kathy , Price Kay , Morey Sue , Best John
Published: February 2010

We aimed to describe the variation in rates of uptake of the enhanced primary care (EPC) Medicare Benefits Schedule items for health assessments (HA), care plans (CP) and case conferences (CC), between Divisions of General Practice from November 1999 (when these items first became available) to October 2001.There was substantial variation in uptake of the various EPC services between Divisions of General Practice, ranging from very low to high. For HA the rate in the highest uptake Division was 496 per 1000 eligible population, and the lowest was zero. There are seven Divisions with high and six with very low uptake, with the rest ranging between 100 and 400/1000.Five Divisions had CP rates over 15/1000 total population; most Divisions had fewer than 10/1000,and many had less than 5/1000.A similar pattern is observed for CC. The levels of uptake for HA increased in the second year of the program for all but eight Divisions of General Practice, and the levels of uptake for CP increased in all but two Divisions. In the first two years of availability, uptake has been highly variable across Divisions of General Practice. Uptake has however increased substantially and consistently in the second year of the program.
Video-conferencing: under-used by rural general practitioners
Authors: Robinson Sanske
Published: February 2010

The objective was to investigate the use of and value General Practitioners place on video-conferencing as a tool in providing rural health care. The participants were 8 rural general practitioners in rural Victoria towns. I found that six out of the eight GPs did not value video-conferencing as a tool to assist with patient care, and the other two GPs were interested in the technology only for certain aspects of support with patient consultations and continuing education. I conclude that there needs to be a review of whether video-conferencing equipment should continue to be implemented in the same way that it has been so far in Victoria, and of the cost-effectiveness of providing video-conferencing facilities in rural health services. In particular, there needs to be a review of whether more training and support for rural general practitioners is needed to increase the uptake of video-conferencing. Alternatively, analysis can be undertaken of the intrinsic value of using video-conferencing as an interactive tool for obtaining specialist support for patient care or undertaking continuing education via video-conferencing, and the program discontinued if it is found to be unwarranted.
Supportive environments for physical activity and the local government agenda: a South Australian example
Authors: Macdougall Colin , Wright Cheryl , Atkinson Rick
Published: February 2010

In the promotion of moderate physical activity it is increasingly argued that a supportive physical environment is a key factor, and that local government is ideally placed to play an important role. This study reports on the factors that led one local government to take such a leading role. A semi-structured interview was conducted to find out why a chief executive officer of a local government decided that the creation of supportive environments for physical activity was the core business of council. The results show that key ingredients were that local government should take a strategic rather than an operational focus on the issue, that there should be open organisational structures to allow the various functions of local government to work together, and that there must be appropriate leadership. The findings suggest ways for engaging local government as a key partner in promoting supportive environments that are consistent withliterature on policy, organisational structure and leadership theory.
Qualifications and experience: how well prepared are nurse managers compared to health service executives?
Authors: Duffield Christine , Franks Helen
Published: February 2010

The purpose of the paper was to compare the demographic details, educational qualifications, professional support and career guidance experiences of two groups of health managers as reported in previous research. One group comprised nurse managers (Duffield et al 2001) and the other comprised senior health administrators (Harris, Maddern & Pegg 1998).Employment and education data from self-administered questionnaires were compared. Nurse managers were predominantly female (88%), while the administrators were 50% female. The nurse managers, although with a relatively equal rate of managerial qualifications as their health service counterparts, had not attained as many senior positions in health care administration. Over half had not had a mentor. Nurse managers have skills attained through their academic studies and experience that cause them to be as capable as (if not in some cases better than) health service administrators. Increased use of mentoring may provide opportunities for professional advancement in wider administrative areas.
The Effect of Increased Private Health Insurance Coverage on Victorian Public Hospitals
Authors: Powers Neil , Sandararajan Vijaya , Gillett Steve , Marshall Ric
Published: February 2010

It was anticipated that the recent reforms to private health insurance arrangements would reduce the demand pressureson Australian public hospitals. However, this has not been demonstrated by trends in elective surgery waiting lists inVictorian public hospitals. Moreover, it appears that the increased caseload assumed by Victorian private hospitals sincethe reforms took effect mainly reflects an increase in low cost same day episodes.
The Hong Kong SARS report: an Australian perspective
Authors: Devanesen Dr Sherene
Published: February 2010

I was appointed to the Hong Kong SARS Expert Committee in my capacity as the President of theRoyal Australasian College of Medical Administrators. This commentary on my experience was writtenwith a view to considering how Australia would respond to a similar outbreak.
Future demand for general practice services: Effects of population change and trends in service use
Authors: Joyce Catherine M , Wimalaratne Sru , McNeil John J
Published: February 2010

This study investigated three key determinants of demand for general practice services: population growth, populationageing and trends in service use. Projection of future service use on the basis of the two demographic factors yielded aprojected growth in number of general practice services of 5.9% by 2006, with a further 6.5% growth by 2011. Whentrends in service use were taken into account as well as demographics, a lower rate of growth in services was projected,but an increasing proportion of long consultations and an increasing proportion of services for older adult patients. Itis concluded that population ageing and population growth will continue to be major drivers of demand for generalpractice services in the next decade. Patterns of service use will also be a key contributor, with increased use of longconsultations suggesting a greater requirement for the general practice workforce than has previously been proposed.
Patients rarely detect breaches of confidence
Authors: Mulligan Ea , Paterson Moira
Published: February 2010

Objective:To measure the prevalence of patient reported breaches of confidence emanating from health services inSouth Australia.Methods:A community household survey with follow up telephone interviews of those reporting unauthorised disclosures.Recruitment interviews were conducted during October and November 2001 with 3037 South Australian residentsover 15 years of age. South Australian households were selected randomly within a representative selection of censuscollection districts. Follow up telephone interviews were conducted with 18 respondents who reported unauthorisedinformation releases in the twelve months prior to the initial survey.Results:The one year prevalence of breaches of confidence reported by patients was 0.23 +/- 0.17% (1.96 x SE).This prevalence was significantly lower than a previously published estimate (Mulligan, 2001) of 1.1 +/- 0.4%(difference between proportions p= 0.003, z= 4.415) which relied upon reports of information disclosed without thepatients permission as a proxy for breaches of confidence.An incidental finding was that 0.20+/- 0.16% (1.96 x SE) of respondents reported exchanges of information amongstmembers of treating teams which had not been authorised by the patient.Conclusion:True breaches of confidence arising from health care interactions are rarely detected by patients. Ordinary informationsharing within treating teams may be a more important source of misunderstandings between patients and health careproviders. This issue can be addressed at the point of care by informing patients what will be done with their healthinformation and who may later gain access to it.
Evidence-based clinical practice in falls prevention: a randomised controlled trial of a falls prevention service
Authors: Whitehead Craig , Wundke Rachel , Crotty Maria , Finucane Paul
Published: February 2010

Aims:Evidence-based guidelines recommend a range of treatments for falls and injury prevention. We undertook arandomised trial of a falls prevention service to screen for falls risk factors and recommend to GPs an evidenced baseprescription for falls prevention.Methods:All patients who presented with a fall to the Emergency Department at Flinders Medical Centre over a 22-week periodwere considered for the study. We excluded patients with dementia, resident in high care or those transferred to otherhospitals and outside our catchment area. Of those who consented, we randomised patients between usual care or toan intervention consisting of a falls risk assessment and writing of an evidence-based prescription faxed to their GPfor action. Patients were followed for six months and uptake of advice and fall rates were monitored.Results:Four hundred and fifty patients presented with a fall-related attendance and of these 261 patients were eligible forinclusion in the trial. Of these 261 patients, 140 consented and were enrolled in the trial. Over the six monthspatients in the intervention group were more likely to uptake preventative advice (OR=12.3; 95%CI=4.2-35.9).We were unable to show a reduction in falls (OR=1.7; 95%CI=0.7-4.4).Conclusions:A patient centered evidence-based approach is feasible and effective in increasing uptake of falls prevention advice.Long term compliance with advice needs further exploration.
Creating the space for spiritual talk: insights from survivors of haematological malignancies
Authors: McGrath Pam , Clarke Hilary
Published: February 2010

The findings presented in this article are from a recently established research program that aims to make a contributionto health care by using qualitative methodologies to deepen our understanding of the notion of spirituality and todocument appropriate ways of responding to the spiritual issues experienced by those coping with serious illness. Thediscussion focuses predominantly on the insights provided by survivors of haematological malignancies about factorsimpacting on their need to talk about spiritual issues. The aim of presenting the findings is to highlight the importanceof providing the opportunity for patients to talk about spiritual issues and to provide health and allied healthprofessionals with insights on how to deal with this aspect of patient care. The insights provided by the participantsgo a substantial way in outlining the who, what, where and when of providing supportive communication onspiritual issues.
A review of community consultation in the development of a multi purpose service in rural and remote Australia
Authors: Durey Angela , Lockhart Chris
Published: February 2010

This paper examines the role of community consultation
and participation in the process of establishing
a Multi Purpose Service (MPS) program in
two towns in Western Australia. Information was
gathered through written documents and semistructured
interviews with individuals who were
integral to the process. Consumer involvement in
health care is increasing, and while claims of
being community driven underpinned the MPS
program, our findings suggest otherwise. Conflicts
of interest, a lack of representation, and misunderstandings
about the meaning of community consultation
were present throughout the process of
implementation. Moreover, official reports either
ignore or downplay these events. We conclude
that more attention must be paid to the role of the
community in the health reform agenda generally
and the MPS program specifically.
Towards an outcomes-based system
Authors: Hughes Allan D
Published: February 2010

THE DILEMMA over how best to satisfy unlimited
demand with limited resources is the core problem
of health care funding, management and politics.
Governments and health authorities have struggled
with the conflict throughout history and dealt with
it with varying degrees of sophistication and success.
Current strategies in Australia predominantly
involve limiting supply by limiting access, most
commonly by limiting workforce, physical facilities,
equipment, pharmaceuticals and operating
funding, in any combination. Application of these
strategies inevitably results in delays in service or
non-provision of service for some. While such a
pragmatic approach to the problem is effective for
the purpose of financial control, it causes funding
tensions and is a weak system for ensuring that the
limited resources are used to best effect.
Casemix funding is well established in Australia,
but is primarily used in an attempt to
equitably distribute available resources. Although
it is touted as a system for funding output, it is a
simplistic and inaccurate system based on
weighted throughput of patients and makes no
attempt to take into account the effectiveness of
services provided.