bluuebunny/crossref_metadata_2025 huggingface dataset:
The Macarthur GP After-hours Service: a model of after-hours care for Australia
Authors: Comino Elizabeth J , Zwar Nicholas A , Hermiz Oshana
Published: February 2010

Introduction: The Macarthur GP After-hours
Service (MGPAS) was established to streamline
the provision of after-hours medical care in an
outer-urban community. This paper reports on a
process evaluation of the MGPAS.
Methods: A mixed methods approach involving
surveys, stakeholder interviews and analysis of
administrative data was used.
Results and discussion: This model of care
was well accepted and regarded by general practitioners,
Macarthur Health Service staff and the
community. The MGPAS was found to be an
acceptable and efficient model of after-hours medical
care. Areas that required further review
included the need for telephone triage, home
visiting and improved communication and referral
to the health service. The financial viability of the
MGPAS depends on supplementary funding due
to the constraints of the Medicare rebate, and
limited opportunities to reduce costs or increase
revenue. Further research, including an economic
evaluation to identify opportunity costs of the
service, is needed.
Creating an integrated vision by collocating health organisations: herding cats or a meeting of minds?
Authors: Jackson Claire L , Nicholson Caroline , Tweeddale Margaret , Kardash Christine , Matthews Pat , O'Donnell John J
Published: February 2010

The Brisbane South Centre for Health Services
Integration (BSCHSI) initiative used a collocation
strategy to integrate local service delivery across
three different health organisations. Physical collocation
was combined with validated integration
strategies to improve organisational operations
among five different work teams involving 90
different individuals. Enhanced communication,
increased knowledge of collocating groups, and
the development of collaboration and partnerships
were key positive outcomes.
Health service integration: a case study in change management
Authors: Allen Connie , Stevens Stella
Published: February 2010

Health service integration seems a logical and
desirable strategy to improve both the efficiency
and quality of service delivery. Failure of implementation
is common but may not be inevitable. This
paper reports on a case study involving structured
interviews and focus groups within one health
service which has attempted to integrate one area
of its acute and community health services. Health
service integration was regarded very positively by
clinicians and administrators in this case study but
the change management process utilised in its
implementation was not, suggesting a need for
greater planning and transparency.
Hospital ethics approval for a population-based case–control study of very preterm birth
Authors: Watson Lyndsey F , Rayner Jo-Anne , Lumley Judith M
Published: February 2010

Aim: To describe the process involved in obtaining
ethics approval for a study aiming to recruit women
from all maternity hospitals in Victoria, Australia.
Design: Observational data of the application
process involving 85 hospitals throughout Victoria
in 2001.
Results: Twenty-three of the 85 hospitals had a
Human Research Ethics Committee (HREC) constituted
in accordance with the National Health and
Medical Council requirements; 27 agreed to accept
decisions from other hospitals having HRECs and
27 relied on ethics advisory committees, hospital
managers, clinical staff, quality assurance committees
or lawyers for ethics decisions. Four of the
latter did not approve the study. Eight hospitals no
longer provided maternity services in the recruitment
period. The process took 16 months, 26 000
sheets of paper, 258 copies of the application and
the cost was about $30 000. Approval was eventually
obtained for recruitment at 73 hospitals.
Discussion: Difficulties exist in obtaining timely
ethics approval for multicentre studies due to a
complex uncoordinated system. All hospitals
should have explicit protocols for dealing with
research ethics applications so that they can be
processed in a straightforward and timely manner.
To facilitate this, those without properly constituted
HRECs should be affiliated with one hospital that
has an HREC.
The economic benefits of health information exchange interoperability for Australia
Authors: Sprivulis Peter , Walker Jan , Johnston Douglas , Pan Eric , Adler-Milstein Julia , Middleton Blackford , Bates David W
Published: February 2010

Objective: To estimate costs and benefits for Australia
of implementing health information exchange
interoperability among health care providers and
other health care stakeholders.
Design: A cost?benefit model considering four levels
of interoperability (Level 1, paper based; Level 2,
machine transportable; Level 3, machine readable;
and Level 4, machine interpretable) was developed
for Government-funded health services, then validated
by expert review.
Results: Roll-out costs for Level 3 and Level 4
interoperability were projected to be $21.5 billion and
$14.2 billion, respectively, and steady-state costs,
$1470 million and $933 million per annum, respectively.
Level 3 interoperability would achieve steadystate
savings of $1820 million, and Level 4 interoperability,
$2990 million, comprising transactions of:
laboratory $1180 million (39%); other providers, $893
million (30%); imaging centre, $680 million (23%);
pharmacy, $213 million (7%) and public health, $27
million (1%). Net steady-state Level 4 benefits are
projected to be $2050 million: $1710 million more
than Level 3 benefits of $348 million, reflecting
reduced interface costs for Level 4 interoperability
due to standardisation of the semantic content of
Level 4 messages.
Conclusions: Benefits to both providers and society
will accrue from the implementation of interoperability.
Standards are needed for the semantic content of
clinical messages, in addition to message exchange
standards, for the full benefits of interoperability to be
realised. An Australian Government policy position
supporting such standards is recommended.
Use of health care services 6 months following major trauma
Authors: Gabbe Belinda J , Sutherland Ann M , Williamson Owen D , Cameron Peter A
Published: February 2010

To establish the use of health care services 6
months following major trauma, 243 blunt major
trauma patients were recruited during their acute
hospital stay and followed up by telephone interview
at 6 months post-injury. Data collected at 6
months included health care service usage and
their level of disability according to the Glasgow
Outcome Scale ? Extended (GOSE). Ninety-four
percent of patients were living in the community at
6 months, and most (69%) reported continued use
of health care services. Of those with ongoing
disability, non-compensable patients were significantly
more likely (OR 3.7; 95% CI, 1.6?8.6) to
have ceased health care service use than compensable patients, independent of injury severity.
Can medical admission and length of stay be accurately predicted by emergency staff, patients or relatives?
Authors: Dent Andrew W , Weiland Tracey J , Vallender Lisa , Oettel Nicola E
Published: February 2010

Objectives: To determine the accuracy of predictions
of the need for hospital admission and, if
admitted, length of stay (LOS) made early in an
emergency attendance by emergency department
(ED) doctors, nurses, patients and relatives, and
the characteristics of ED presentations predictive
of admission and short stays (~3 days).
Methods: Prospective collection of predictions by
medical and nursing staff, patients and relatives of
ED departure status and LOS (1 day, 2-3 days, 4-
7 days or longer) of a convenience sample of
adults presenting with medical symptoms. Predictions
were made before full medical assessment
and matched against actual departure status and
LOS. Vital signs and demographics were
recorded.
Results: Seventy five percent (2159/2904; CI
73%?77%) of all admission predictions in 704
patients were correct with 85% (575/673; CI 81%-
88%) of doctors? predictions correct. Thirty-five
percent (361/1024) of all LOS predictions for 331
patients were correct with 46% (122/268; CI 40%-
52%) of doctors? predictions correct. Risk factors
for short-stay over longer admission included age
less than 65, normal oxygen saturations and selfreferral.
Conclusion: Emergency admissions can be predicted
with reasonable accuracy but LOS is difficult
to predict. Development of a prediction tool
may facilitate streaming and appropriate use of
short-stay units.
Connecting funds with quality outcomes in health care: a blueprint for a Clinical Practice Improvement Payment
Authors: Ward Michael , Daniels Sandra A , Walker Gary J , Duckett Stephen
Published: February 2010

There are significant geographic variations in the
quality of health care, often with substantial gaps
between what is known to be achievable and what
is actually achieved in practice. This is a global
problem that has persisted for many years despite
a variety of conventional quality improvement initiatives.
Attention has therefore recently turned to
realignment of funding with specified levels of
desired quality of care as an alternative. This
paper outlines one approach that will be introduced as a pilot in Queensland.
Health Care Governance: Introduction
Authors: Choy Flannigan Alison , Power Prue
Published: February 2010

IN RECOGNITION OF the importance and the
complexity of governance within the Australian
health care sector, the Australian Healthcare and
Hospitals Association has established a regular
governance section in Australian Health Review.
The aim of this new section is to provide relevant
and up-to-date information on governance to
assist those working at senior leadership and
management levels in the industry. We plan to
include perspectives on governance of interest to
government Ministers and senior executives,
chief executives, members of boards and advisory
bodies, senior managers and senior clinicians.
This section is produced with the assistance of
Ebsworth & Ebsworth lawyers, who are pleased
to team with the Australian Healthcare and Hospitals
Association in this important area. We
expect that further articles in this section will
cover topics such as:
� Principles of good corporate governance
� Corporate governance structures in the public
health sector in Australia
� Legal responsibilities of public health managers
� Governance and occupational health and safety
� Financial governance and probity.
We would be pleased to hear your suggestions
for future governance topics.
Cardiovascular disease management: time to advance the practice nurse role?
Authors: Halcomb Elizabeth J , Davidson Patricia M , Griffiths Rhonda , Daly John
Published: February 2010

Objective: More than two-thirds of health
expenditure is attributable to chronic conditions, of
which a significant proportion are related to cardiovascular
disease. This paper identifies and
explores the factors cited by practice nurses as
impacting on the development of their role in
cardiovascular disease management.
Methods: Sequential mixed methods design
combining postal survey (n = 284) and telephone
interviews (n = 10) with general practice nurses.
Results: The most commonly cited barriers to
role extension were legal implications (51.6%),
lack of space (30.8%), a belief that the current role
is appropriate (29.7%), and general practitioner
attitudes (28.7%). The most commonly cited facilitators
of role extension were collaboration with the
general practitioner (87.6%), access to education
and training (65.6%), the opportunity to deliver
primary health care (61.0%), a high level of job
satisfaction (56.0%) and positive consumer feedback
(54.6%).
Conclusions: Australian government policy
demonstrates a growing commitment to an
extended role for general practice in primary
health care and cardiovascular disease management.
In spite of these promising initiatives, practice
nurses face a range of professional and
system barriers to extending their role. By
addressing the barriers and enabling features
identified in this investigation, there is potential to
further develop the Australian practice nurse role
in cardiovascular disease management.
Supporting cancer control for Indigenous Australians: initiatives and challenges for cancer councils
Authors: Shahid Shaouli , Beckmann Kerri R , Thompson Sandra C
Published: February 2010

As in other developed countries, the Australian
population is ageing, and cancer rates increase
with age. Despite their substantially lower life
expectancy, Indigenous Australians are also experiencing
concerning cancer statistics, characterised
by increasing rates, later diagnosis, higher
mortality, and lower participation in screening than
the non-Indigenous population. Eighteen months
after the first national Indigenous Cancer Control
Forum, this environmental scan within the statebased
Cancer Councils was undertaken to map
activities in service provision in Indigenous cancer
control with a view to sharing the lessons learned.
The findings show that although most of the organisations
had tried to work with Indigenous communities
on cancer issues, there have been difficulties
in building and sustaining relationships with Indigenous
organisations. Lack of having Indigenous
staff internally, few Indigenous-specific resources,
and few planned, long-term commitments were
some of the major impediments. Some of these
limitations can easily be overcome by building and
improving regional or local partnerships, providing
cultural awareness training to internal staff, and by
building the capacity of Indigenous organisations.
Health promotion projects of the Cancer Councils
directed at Indigenous people could be more effectively implemented with such considerations.
Book Review: The Australian health care system
Authors: Day Gary
Published: February 2010

THIS IS THE THIRD edition of one of the seminal
local texts on the Australian health care system.
Over the last seven years, this text has proved a
basis for helping students, casual readers and
health professionals understand Australia?s sometimes
difficult to understand health care system.
The text is divided into ten chapters that deal
with key aspects of Australia?s health care system,
namely:
� Frameworks for analysis
� The Australian population and its health
� Financing health care
� The health workforce
� Departmental and intergovernmental
structures
� Hospitals
� Public health
� Primary and community care
� Pharmaceuticals
� Policy challenges for the Australian health care
system.
There are several key reasons why this text has
been widely used in the past and will continue to
be of value well into the future. The author has
been able to accurately describe the complexities
of the Australian health care system in an easily
digestible way. This is a feat in itself and worthy of
praise. There is an
appropriate use of tables
and figures to support
the written content.
Finally, the author provides
excellent conclusions
that bring together
the salient points and
issues in each chapter.
The publisher promotes
that this edition
includes new material
on health workforce, patient safety and medical
and health insurance. The Australian health care
system delivers on this claim, providing useful
insights and a deeper understanding of the issues
that confront the future direction and delivery of
health services in this country.
This text is a useful addition to any library as
well as a staple for students needing to more
clearly understand the complexities and challenges
of the Australian health care system.
My only suggestion is that the text could have
been enhanced by the inclusion of revision or
reflective questions at the end of each chapter.
In summary, a must-have as part of a good
health-related library.
Acute upper respiratory infections in Western Australian emergency departments, 2000–2003
Authors: Ingarfield Sharyn L , Celenza Antonio , Jacobs Ian G , Riley Thomas V
Published: February 2010

Objective: To describe the epidemiological and
other characteristics of emergency department
(ED) presentations diagnosed with acute upper
respiratory infection (URI).
Design and setting: A retrospective study of
patients given an ED diagnosis of acute URI from
July 2000 to July 2003 at any of the four metropolitan
teaching hospitals in Perth, Western Australia.
Results: Acute URI accounted for 3.6% (95% CI,
3.5?3.7) of ED presentations, and 80.7% (95% CI,
80.1?81.3) of these were aged less than 15 years.
The most common diagnosis was acute upper
respiratory infections of multiple and unspecified
sites, followed by croup and acute tonsillitis. Of
those with croup, 76.0% (95% CI, 74.7?77.3)
presented at night, 67.6% (95% CI, 66.2?69.0)
were male and the number of presentations with
croup was highest in June 2002. The number of
diagnoses of acute tonsillitis did not display a
great deal of variation from month to month.
Overall, hospital admission was 12.3% (95% CI,
11.8?12.8), with a median length of hospital stay
of 1 day (IQR 1.0?2.0). An increase in comorbidity,
residing in the most disadvantaged areas, and
being a re-presentation increased the odds of
being admitted.
Conclusion: Further investigation is needed into
whether alternative medical care services would
be appropriate and acceptable for patients with
less severe acute URIs.
Multifaceted guideline implementation strategies improve early identification and management of osteoporosis
Authors: Kimber Cheryl M , Grimmer-Somers Karen A
Published: February 2010

Background: Osteoporosis contributes significantly
to fractures, subsequent disability and premature
mortality in Australia. Better detection and
management of osteoporosis will reduce unnecessary
health expenditure.
Objective: To evaluate, in one large tertiary
metropolitan hospital, the orthopaedic health care
team?s approach to osteoporosis guideline implementation
to improve early identification and management
of osteoporosis.
Methods: This paper describes the implementation
of multifaceted strategies to improve healthpromoting
behaviours and the uptake of osteoporosis
guidelines by staff in the orthopaedic
outpatient clinic at one metropolitan hospital,
reflecting organisational and individual commitment
to embedding guideline recommendations
into routine practice. Implementation strategies
were aimed at the requirements and perspectives
of different stakeholder groups. Five audit datasets
were compared: 62 patient records in two
baseline audits, and three post-implementation
audits of 31 patient records, collected over the
following 3-month periods (August 2006 to April
2007). All audits used the same criteria to assess
compliance with clinical guidelines, and outcomes
of implementation strategies.
Results: There was consistent improvement in
compliance with osteoporosis guidelines over the
audit periods. Comparing baseline and immediate
post-implementation data, there was a significant
improvement (P < 0.05) in the percentage of
patients with likely fragility fractures who were
identified with an osteoporotic fracture. The percentage
of patients who had a likely fragility
fracture, with whom staff communicated about
their problems and how to deal with them,
increased consistently over all post-implementation
audit periods. For patients with established
osteoporosis who presented with fragility fractures,
there was sustained improvement over the
audit periods in the percentage provided with
guideline-based care.
Conclusion: This study highlights that appropriate
and targeted intervention strategies can be
effective if modelled on best practice guideline
implementation approaches with the use of a
coordinated post-fracture management approach
to osteoporosis.
Exploring the impact of an Aboriginal Health Worker on hospitalised Aboriginal experiences: lessons from cardiology
Authors: Taylor Kate P , Thompson Sandra C , Wood Marianne M , Ali Mohammed , Dimer Lyn
Published: February 2010

To enhance Aboriginal inpatient care and improve outpatient cardiac rehabilitation utilisation, a tertiary hospital in Western Australia recruited an Aboriginal Health Worker (AHW). Interviews were undertaken with the cardiology AHW, other hospital staff including another AHW, and recent Aboriginal cardiac patients to assess the impact of this position. The impact of the AHW included facilitating culturally appropriate care, bridging communication divides, reducing discharges against medical advice, providing cultural education, increasing inpatient contact time, improving follow-up practices and enhancing patient referral linkages. Challenges included poor job role definition, clinical restrictions and limitations in AHW training for hospital settings. This study demonstrates that AHWs can have significant impacts on Aboriginal cardiac inpatient experiences and outpatient care. Although this study was undertaken in cardiology, the lessons are transferable across the hospital setting.
The status of Australian nurse practitioners: the first national census
Authors: Gardner Anne , Della Phillip R , Middleton Sandy , Gardner Glenn E
Published: February 2010

A five-section questionnaire was mailed to all 234 authorised Australian nurse practitioners in late 2007. An 85% response rate was achieved (202 responses). Respondents had a mean age of 47.0 years and 84.2% were women. Only 145 nurse practitioners (72% of respondents) reported being employed in Australia at the time of the census. Emergency nurse practitioners were the most commonly employed nationally (26.9%). Nearly one third of employed nurse practitioners reported that they were still awaiting approval to prescribe medications despite this being a core legislated skill. Over 70% stated that lack of Medicare provider numbers and lack of authority to prescribe through the Pharmaceutical Benefits Scheme was extremely limiting to their practice. These findings are consistent with the international literature describing establishment of reformative health care roles.
Episodes of care:Should we have them?
Authors: Douglas David , Ram Vemuri Siva , Xiao Jianguo
Published: February 2010

In this paper the authors discuss the introduction of ?episodes of care?, a new systemfor monitoring hospital-linked patient care services. They consider the proposal in thecontext of clinical, financial and technical frameworks. The authors conclude thathealth planners are likely to benefit from the introduction of this form of monitoring.The proposed change would also allow more accurate analysis of the true cost ofinterventions. However, it is likely to require significant investment in informationtechnology and there may be loss of patient confidentiality.
The new market in health care:Prospects for managed care in Australia
Authors: Duckett Stephen
Published: February 2010

Most developed countries are experimenting, or moving at full speed, to implementnew forms of health delivery based in part on capitation arrangements and strongeraccountability of health service providers. Proposals for introduction of capitation ormanaged care have been advanced in Australia but have attracted strong oppositionfrom the medical profession. This paper reviews the policy issues surrounding theintroduction of managed care, including how Australia?s current institutional formsmay evolve into managed care provision.
An outcomes approach to population health at the local level in NSW: Practical problems and potential solutions
Authors: Rissel Chris , Ward Jeanette
Published: February 2010

While a health outcomes approach has the potential to improve the health status of Australians as well as health service efficiency, such a policy will be successful only if practice at the local level follows suit. This paper briefly reviews the health outcomes approach and describes how the Central Sydney Area Health Service has established a Needs Assessment & Health Outcomes Unit to help improve health outcomes. The paper discusses issues in working with population health outcomes at the local level, such as the usefulness and limitations of routinely collected data for planning and managing health services, problems of small area data, gaps in the documentation of national health goals and targets, problems of attribution of improved outcomes to specific interventions and definition of responsibilities for action at the local level. It offers some potential solutions relevant at the local level.
Hospital input price indexes in Australia: Are they worth the effort?
Authors: Hindle Don , Newman Julie
Published: February 2010

This paper summarises aspects of the design and use of hospital input price indexes,and describes four indexes produced in Australia in the last decade. It argues that therewould be some benefit in establishing a routine national index, if it were designedto be low-cost.However, care should be taken to avoid excessive reliance on the results in the resourceallocation and funding context. Input prices contribute relatively little to hospitals?expenditure changes. It is also necessary to monitor and manage changes in thevolumes of inputs, and this is likely to be a more rewarding task.
Total quality management practices in the NSW hospital system - an overview
Authors: Ross Philip , Clear Mike , Dixon Kathy
Published: February 2010

A two-phase descriptive study involving a questionnaire survey was undertakenduring 1994 and 1995 to evaluate the extent of implementation of total qualitymanagement practices in New South Wales hospitals accredited by the AustralianCouncil on Healthcare Standards.A survey response rate of 72- per cent was attained. Results indicated that mosthospitals were aware of and consciously implemented aspects of the total qualitymanagement philosophy in some way. There is little evidence that whole systemshave embraced the total quality management approach as a fully integratedendeavour.
Creation of an academic medical centre: Management and service delivery at the Canberra Clinical School
Authors: Gatenby Paul A
Published: February 2010

The Canberra Clinical School is attached to Woden Valley Hospital, the principalhospital in the Australian Capital Territory. The clinical school arose out of amemorandum of understanding signed between the University of Sydney and theACT Department of Health (as it then was) in March 1993. One of theaspirations of those who negotiated the memorandum of understanding was thatthe creation of the clinical school would lead to a cultural shift in attitudes towardschange within the health care system. This paper looks at the management structureof Woden Valley Hospital and at what the development of a clinical school inCanberra can achieve, particularly in relation to hospital and health servicemanagement.
Post acute care: Can hospitals do better with less?
Authors: Caplan Gideon A , Brown Ann
Published: February 2010

Judging by reports in medical magazines and journals, ?early discharge schemes?, bettertermed ?post acute care?, are not popular with doctors. However, government policyencourages earlier discharge from hospital, so that the choice facing clinicians is todischarge patients early with support, or early without support, or deal with theconsequences of length of stay overruns. Fortunately, government funding for post acutecare is increasing. There is a strong rationale for post acute care based on better patientoutcomes and cost-effectiveness, but these desirable results will only be achieved ifscrupulous attention is paid to detail, as embodied in the 10 principles of post acutecare. To function optimally, post acute care should be coordinated by the hospitalwhich provided the acute care.
Funding Melbourne?s hospitals:Some historical moments
Authors: Walker Christine
Published: February 2010

In 1993 the Victorian Government introduced casemix funding as part of itsrestructure of the public hospital system. Casemix funding provides a new basis forgovernment funding according to outcomes. At the same time, restructure of hospitalsallows for a reconsideration of who is eligible to use them. Historical research intothe growth of the public hospital system in Melbourne shows that attempts to reformthe hospital system are as old as the system itself. This paper argues that the views ofhospitals in funding crises and the solutions that are recommended have more to dowith the politics of the day than the economics of running hospitals.
Hospital outcomes management:The Care Continuum and Health Outcomes Project
Authors: Shadbolt Bruce , McCallum John , Bourne Maureen
Published: February 2010

The Care Continuum and Health Outcomes Project is part of a national initiativeto build an outcomes management approach in health care. This paper examines thebaseline performance of the study: In 1995?96, 7154 Australian Capital Territoryhospital inpatients were selected to take part in a five-wave survey over six months.In addition to the survey, the project involved the unit record linkage of routine datacollections. A total of 5668 people (79%) agreed to participate in the survey, with85% of these people agreeing to release their Medicare data. There were significantvariations in participation rates between hospitals and wards. Factors contributingto these variations included patient socioeconomic status, disease type and illnessseverity. In conclusion, the success in establishing the project indicates that it is possibleto conduct a broad scientific study within the health system, and that there are strongimplications that ongoing scientific evaluations can be embedded within routineclinical practice.
The second national hospital costing study: Background, results and implications
Authors: Oates Brett , Murray Jo , Hindle Don
Published: February 2010

The costing of hospital outputs, and especially of acute admitted patients categorisedby DRG, has been the focus of considerable attention in the last decade. Manyindividual hospitals now routinely estimate the costs of their main products, severalState and Territory health authorities undertake periodic multi-site studies, and therehave been a few one-off national studies.This paper summarises the methods and results of the most recent national study,which measured costs at a sample of public and private hospitals around Australiafor the 1996?97 financial year. We briefly describe the main results and note someimplications.
Episiotomy in NSW hospitals 1993-1996: Towards understanding variations between public and private hospitals
Authors: Shorten Allison , Shorten Brett
Published: February 2010

Episiotomy rates for women experiencing childbirth in New South Wales (NSW) hospitals are another indicator that private insurance may be a risk factor for obstetric intervention. A recent comparison of episiotomy rates in NSW public and private hospitals between 1993 and 1996 revealed that episiotomy rates were 12 to 15 percentage points higher in NSW private hospitals than in public hospitals studied. Rates also appear to be declining in NSW public hospitals, yet this trend is not evidentin the NSW private hospitals studied. Although private hospital patients were almost twice as likely to experience forceps or vacuum delivery (often associated with episiotomy), this leaves a 6 to 8 percentage point difference unexplained. Given the potential health-related quality of life issues associated with perineal trauma during childbirth, further analysis of the clinical make-up of privately insured women may help determine the extent to which clinical explanations exist to support the differences in this childbirth intervention.
Falls: A coordinated strategy
Authors: Wood Brian , Bennie Alex , Armstrong Margaret , Michael Sarah , Cameron Ian
Published: February 2010

Falls are a common and serious health problem. Responses to the problem should address the individual, the individual's environment, the system of health or residential care used by the individual, and the local community. This article describes a response to the issue of falls in Ryde Hospital and its surrounding community. This response has multiple components which include patient and staff education and interventions with people who have fallen. These initiatives have been developed without additional resources and incorporated into existing systems of care provision.
Quality and general practice accreditation: The approach of Australian General Practice Accreditation Limited
Authors: Pegram Rob , Wright David
Published: February 2010

The purpose of this article is to outline the underlying assumptions, principles and processes of a continuous quality improvement approach which underpins the accreditation of general practice offered by Australian General Practice Accreditation Limited.
Some features of the spread of epidemics and information on a random graph
Authors: Durrett Rick
Published: February 2010

Random graphs are useful models of social and technological networks. To date, most of the research in this area has concerned geometric properties of the graphs. Here we focus on processes taking place on the network. In particular we are interested in how their behavior on networks differs from that in homogeneously mixing populations or on regular lattices of the type commonly used in ecological models.
Listening as Covert Performance
Authors: Cross Ian
Published: February 2010

This paper presents a view of musical listening as an active, dynamic and interactive process. After briefly considering the historical valorization of listening as critical act within Western musical culture, the paper describes the cognitive processes of schematization that are involved in musical listening. The central role of active engagement with the auditory environment in eliciting emotional responses to music is then sketched out, and the scope and limits of the attentional and motoric processes involved in processes of entrainment – focal in the experience of musical time – are outlined. Neuroscientific evidence that suggests that music is best conceived in terms of a perception–action cycle is reviewed, and the paper concludes by proposing that music is best conceptualized – from a biological perspective – as a communicative medium that is optimal for the management of situations of social uncertainty.
Auditory expectations for newly acquired structures
Authors: Tillmann Barbara , Poulin-Charronnat Bénédicte
Published: February 2010

Our study investigated whether newly acquired auditory structure knowledge allows listeners to develop perceptual expectations for future events. For that aim, we introduced a new experimental approach that combines implicit learning and priming paradigms. Participants were first exposed to structured tone sequences without being told about the underlying artificial grammar. They then made speeded judgements on a perceptual feature of target tones in new sequences (i.e., in-tune/out-of-tune judgements). The target tones respected or violated the structure of the artificial grammar and were thus supposed to be expected or unexpected. In this priming task, grammatical tones were processed faster and more accurately than ungrammatical ones. This processing advantage was observed for an experimental group performing a memory task during the exposure phase, but was not observed for a control group, which was lacking the exposure phase (Experiment 1). It persisted when participants realized an in-tune/out-of-tune detection task during exposure (Experiment 2). This finding suggests that the acquisition of new structure knowledge not only influences grammaticality judgements on entire sequences (as previously shown in implicit learning research), but allows developing perceptual expectations that influence single event processing. It further promotes the priming paradigm as an implicit access to acquired artificial structure knowledge.
Ketogenic diet slows down mitochondrial myopathy progression in mice
Authors: Ahola-Erkkilä Sofia , Carroll Christopher J. , Peltola-Mjösund Katja , Tulkki Valtteri , Mattila Ismo , Seppänen-Laakso Tuulikki , Orešič Matej , Tyynismaa Henna , Suomalainen Anu
Published: February 2010

Mitochondrial dysfunction is a major cause of neurodegenerative and neuromuscular diseases of adult age and of multisystem disorders of childhood. However, no effective treatment exists for these progressive disorders. Cell culture studies suggested that ketogenic diet (KD), with low glucose and high fat content, could select against cells or mitochondria with mutant mitochondrial DNA (mtDNA), but proper patient trials are still lacking. We studied here the transgenic Deletor mouse, a disease model for progressive late-onset mitochondrial myopathy, accumulating mtDNA deletions during aging and manifesting subtle progressive respiratory chain (RC) deficiency. We found that these mice have widespread lipidomic and metabolite changes, including abnormal plasma phospholipid and free amino acid levels and ketone body production. We treated these mice with pre-symptomatic long-term and post-symptomatic shorter term KD. The effects of the diet for disease progression were followed by morphological, metabolomic and lipidomic tools. We show here that the diet decreased the amount of cytochrome c oxidase negative muscle fibers, a key feature in mitochondrial RC deficiencies, and prevented completely the formation of the mitochondrial ultrastructural abnormalities in the muscle. Furthermore, most of the metabolic and lipidomic changes were cured by the diet to wild-type levels. The diet did not, however, significantly affect the mtDNA quality or quantity, but rather induced mitochondrial biogenesis and restored liver lipid levels. Our results show that mitochondrial myopathy induces widespread metabolic changes, and that KD can slow down progression of the disease in mice. These results suggest that KD may be useful for mitochondrial late-onset myopathies.
Longevity of seeds of Poa pratensis and Lolium perenne as affected by simulated soil tillage practices and its implications for contamination of herbage seed crops
Authors: Jensen P. K.
Published: February 2010

In grass‐seed production, the purity of the product is of major importance and high purity can only be obtained by preventing contamination with other species and cultivars during the whole crop rotation. In this context, seeds of previously grown grass species or varieties are particularly important. This study investigated the influence of different soil tillage practices on persistence of newly shed seeds of two grass species, Poa pratensis and Lolium perenne. Leaving the seeds at or close to the soil surface reduced seed survival of both species to low levels compared with strategies that involved a deep incorporation of the seeds shortly after seed‐shedding. Survival rate of seeds of P. pratensis after 1 year was reduced to a low level when seeds were left at the soil surface for 2–3 months before incorporation. Seeds of L. perenne were less persistent and survival rate after 1 year was generally very low if the seeds were left near the soil surface for approximately 1 month before deeper incorporation. Use of the stale seedbed technique to reduce the seedbank of the two species in the autumn ahead of a spring‐established grass‐seed crop was also found to be effective in reducing the potential risk of contamination.
Explaining abundance–occupancy relationships in specialists and generalists: a case study on aquatic macroinvertebrates in standing waters
Authors: Verberk Wilco C. E. P. , Van Der Velde Gerard , Esselink Hans
Published: February 2010

1. A positive interspecific abundance–occupancy relationship is one of the most robust patterns in macroecology. Yet, the mechanisms driving this pattern are poorly understood. Here, we use biological traits of freshwater macroinvertebrates to gain a mechanistic understanding and disentangle the various explanations. We ask whether mechanisms underlying the abundance–occupancy relationship differ between species, and whether information on individual species can be used to explain their contribution to the interspecific relationship.

2. We test the hypothesis that the importance of metapopulation dynamics or niche differences in explaining the relationship differs between species, varying in relation to their habitat breadth. In addition, we analyse how a species’ biological traits shape its habitat breadth and its abundance and occupancy.

3. The abundance and occupancy of the 234 different aquatic macroinvertebrate species were strongly and positively related. Marked differences were found between habitat specialists and habitat generalists in the goodness‐of‐fit of abundance–occupancy relationships. The occupancy‐frequency distribution was bimodal for habitat generalists, allowing ‘satellite species’ to be distinguished from ‘core species’.

4. Habitat generalists appeared to be more widespread but less abundant than habitat specialists, suggesting that the jack‐of‐all‐trades may be master‐of‐none. Species traits (trophic position and other life‐history traits) explained a significant part of the variation around the general relationship. Among habitat specialists, more species showed synchronized life cycles, a low dispersal capacity or clustered oviposition, being better adapted to predictable habitats. Among habitat generalists, more species had long‐lived adults, spreading reproductive effort in time and space, and were strong dispersers, being better adapted to unpredictable habitats.

5. Interspecific abundance–occupancy relationships can be best understood by examining the contribution of individual species. For habitat specialists, the interplay between niche differences (diet and habitat use) and the underlying spatial distribution of environmental conditions result in competitive displacement and differences in species’ success. For habitat generalists, differences in colonization and extinction rates between species are more important. Therefore, both metapopulation dynamics and niche differences can operate simultaneously but apply to different species, thus constituting different endpoints of the same continuum.
Date seed oil inhibits Hydrogen peroxide‐induced oxidative stress in human epidermal keratinocytes
Authors: Ines Dammak , Sonia Boudaya , Fatma Ben Abdallah , Souhail Besbes , Hamadi Attia , Hamida Turki , Basma Hentati
Published: February 2010

Background  Oxidative stress has been implicated in various skin diseases through the generation of reactive oxygen species and the depletion of endogenous antioxidant systems. The administration of antioxidants is reportedly helpful, notably to enhance the healing process. To protect the skin against oxidative damages, we have studied the effect of new oil: “date seed oil” (DSO). This oil, may serve as a potential source of natural antioxidants such as phenols and tocopherols.

Methods  Here, we report the protective effect of DSO against hydrogen peroxide (H2O2)‐induced oxidative stress in terms of lipid peroxidation, depletion of endogenous antioxidant defense enzymes such as superoxide dismutase (SOD), catalase (CAT) and glutathione peroxidase (GPx) using normal human epidermal keratinocytes (NHEK).

Results  In the investigated model system, DSO has significant chemoprotective effect, by inhibition of damage caused by H2O2 compared with cells without such addition endowing with a radical scavenging ability. Treatment of NHEK with DSO inhibited H2O2‐induced lipid peroxidation. In addition, this oil inhibited H2O2‐induced depletion of antioxidant defense components, such as SOD, CAT and GPx.

Conclusions  Our findings demonstrate that DSO is an efficient extract that is able to prevent keratinocytes oxidative damage induced by H2O2 exposure and may thus be a potential promising candidate, as a chemopreventive agent, in the development of keratinocytes‐related pathologies.
Clinical assessment of oral lichen planus based on different scales
Authors: López‐Jornet P. , Camacho‐Alonso F.
Published: February 2010

Background  Different oral lichen planus (OLP) scoring scales have been developed, though none has received unanimous acceptance from all authors. This study involves the clinical application of two symptom and sign measurement scales for assessing OLP.

Material and method  One hundred patients were diagnosed clinically and confirmed as having OLP by biopsy, according to the WHO criteria. A visual analog scale (VAS) was applied (0–10) along with two semi‐quantitative tests for assessing the symptoms and signs.

Results  The Escudier test yielded an overall site score of 3.8 ± 1.83 (mean ± SD), with an activity score of 1.6 ± 2.59 (mean ± SD), and a total weighted score of 7.4 ± 4.78. The pain VAS score was 1.9 ± 2.06. The Malhotra scale (range 1–7) yielded a maximum total score of 2.9 ± 1.21, corresponding to grade 1. The Spearman correlation coefficient between the Escudier and Malhotra scales was 0.54 – the difference proving statistically significant (P < 0.001).

Conclusion  Uniform OLP scoring system measures need to be adopted.
A case with two unusual findings: cutaneous leishmaniasis presenting as panniculitis and pericarditis after antimony therapy
Authors: Eryılmaz Aydolu , Durdu Murat , Baba Mete , Bal Nebil , Yiğit Fatma
Published: February 2010

Background  Cutaneous leishmaniasis is a parasitic disease caused by a Protozoan. Clinically and histopathologically, it can be confused with various dermatologic diseases.

Methods  We report a case of cutaneous leishmaniasis (CL) with two unusual findings. A 49‐year‐old male patient presented to our clinic with a 3‐month history of multiple nodules exhibiting arciform arrangement on the lateral side of the left leg.

Results  Histopathologic examination revealed it as nodular vasculitis. Leishmania smear showed suspicious parasites. Although leishmania culture was negative, PCR was positive for Leishmania. The patient was considered to have CL and was treated with systemic meglumine antimoniate for 14 d. Three days after the end of the treatment, the patient presented to emergency room with a sharp, pleuritic chest pain. He was diagnosed with pericarditis based on clinical and electrocardiogram findings. As other causes of pericarditis were absent, it was thought to be related to antimony therapy.

Conclusion  The histopathologic presentation of CL as panniculitis is a very rare and this is the first case of pericarditis after the antimony treatment.
Sample Size in the Study of Behaviour
Authors: Taborsky Michael
Published: February 2010

The choice of an appropriate sample size for a study is a notoriously neglected topic in behavioural research, even though it is of utmost importance and the rules of action are more than clear – or are they? They may be clear if a formal power analysis is concerned. However, with the educated guesswork usually applied in behavioural studies there are various trade‐offs, and the degrees of freedom are extensive. An analysis of 119 original studies haphazardly chosen from five leading behavioural journals suggests that the selected sample size reflects an influence of constraints more often than a rational optimization process. As predicted, field work involves greater samples than studies conducted in captivity, and invertebrates are used in greater numbers than vertebrates when the approach is similar. However, it seems to be less important for determining the number of subjects if the study employs observational or experimental means. This is surprising because in contrast to mere observations, experiments allow to reduce random variation in the data, which is an essential precondition for economizing on sample size. By pointing to inconsistent patterns the intention of this article is to induce thought and discussion among behavioural researchers on this crucial issue, where apparently neither standard procedures are applied nor conventions have yet been established. This is an issue of concern for authors, referees and editors alike.