bluuebunny/crossref_metadata_2025 huggingface dataset:
Multigrid methods
Authors: Falgout Robert D.
Published: February 2010

This special issue contains papers from the Fourteenth Copper Mountain Conference on Multigrid Methods, held in the Colorado Rocky Mountains on March 22–27, 2009. The papers address a variety of applications and cover a breadth of topics, ranging from theory to high‐performance computing. Copyright © 2010 John Wiley & Sons, Ltd.
Exploring matrix isolated carbenes and bis‐carbenes with electronic spectroscopy as a guide
Authors: Sheridan Robert S.
Published: February 2010

Singlet carbenes exhibit very informative electronic spectra, which vary as a sensitive function of substituents and geometries. In particular, the lowest energy σ–p type excitations for singlet carbenes range broadly from the short wavelength UV to the near IR. Substituent effects on the energy of this key electronic transition can be rationalized by very simple orbital mixing arguments, and parallel similar influences on singlet–triplet energies. Besides providing valuable electronic information on singlet carbenes and bis‐carbenes which have been studied by low temperature matrix isolation methods, UV/Vis spectroscopy has often guided investigations of conformation‐dependent photochemistry of these species. Insights learned from experimental and calculated UV/visible spectra of a broad range of matrix isolated singlet carbenes and bis‐carbenes are described. Copyright © 2010 John Wiley & Sons, Ltd.
Molecular ion yield enhancement in static secondary ion mass spectrometry by soft landing of protonated water clusters
Authors: Li Guangtao , Cyriac Jobin , Gao Liang , Graham Cooks R.
Published: February 2010

An effective online method for molecular ion yield enhancement in static secondary ion mass spectrometry (SIMS) is demonstrated using a custom‐built soft landing (SL) instrument equipped with SIMS capabilities. Dramatic molecular ion yield enhancement has been observed for amino acids and peptides on silica substrates after soft landing a mixture of protonated water clusters [H(H2O)n]+ (n = 4 to > 100). Image current measurements and experiments on semiconducting and metal substrates confirmed that protonation of the analyte molecule and effective charge retention on the substrate is the reason for the observed phenomenon. Enhancement could also be observed‐less conveniently‐by offline treatment of the surface using electrospray deposition of 2% acetic acid in methanol/water solution. Copyright © 2010 John Wiley & Sons, Ltd.
Control of nano/microstructure and pit initiation sites on aluminium surface by use of self‐assembled spheres
Authors: Ono Sachiko , Uchibori Kota , Asoh Hidetaka
Published: February 2010

Nano/microstructure control and electrochemical etching of aluminium substrate using a honeycomb alumina mask fabricated by anodisation with self‐assembled spheres aligned on the aluminium surface were studied to directly control the initiation sites of pits. The transfer of the hexagonally ordered pattern of self‐assembled spheres to the aluminium substrate could be achieved by substantially suppressed anodic oxide growth under the spheres where selective electrochemical etching proceeded. That is, etch pits are generated only in the thinner areas or holes of the honeycomb alumina mask with a one‐to‐one correspondence. With this process, improvements in pit distribution density and the homogeneity of pit sizes, while avoiding excessive dissolution of the aluminium surface, could be achieved easily in comparison with the conventional method. The density of pits could also be controlled by changing the diameter of spheres used as an indirect mask. Copyright © 2010 John Wiley & Sons, Ltd.
Growth studies of Ti‐based films deposited on Si and SiO2 using angle‐resolved XPS
Authors: Oswald S.
Published: February 2010

Ti and TiN films with thicknesses of less than one monolayer and up to several nanometers were deposited by magnetron sputtering onto Si and SiO2. The samples were transferred immediately after deposition into the analysis chamber without breaking the vacuum to avoid oxide formation and contamination. Analysis was done by means of X‐ray photoelectron spectroscopy (XPS) for elemental and bonding state characterization as well as by angle‐resolved XPS (ARXPS) for nondestructive depth profiling. The XPS measurements indicated different phase formation processes at the interfaces, which were used as the base for the ARXPS data analysis. Growth properties for similarly deposited Ti‐, Ta‐ and W‐based films are compared. Copyright © 2010 John Wiley & Sons, Ltd.
Inventing the Egghead: The Paradoxes of Brainpower in Cold War American Culture
Authors: LECKLIDER AARON S.
Published: February 2010

This essay studies the emergence of the egghead as a figuration of intellectuals in Cold War American culture. The characteristics of the egghead accentuated his failed masculinity, queer sexuality, racialized identity, and fragile commitment to American ideals. The egghead functioned both to limit those for whom intelligence was culturally available and to malign those who attempted to advocate education and the expansion of intelligence as a vehicle for social change. Though this was often framed as a liberal political intervention, the climate of the Cold War and the attendant social inequalities in the United States in this period ensured that the popular use of the egghead label served chiefly to build up a virulently white, masculine liberalism.
Illuminating quality in architectural reveals
Authors: Feuerstein Marcia F.
Published: February 2010

Traditionally, architecture mediates joints with mouldings whose qualities describe, like a human face, their character. In contrast, modern architecture uses a reveal or shadow to mark joints. This ubiquitous yet overlooked modern shadow has slipped between the cracks of architectural theory. Is the modern reveal, distained and beloved by architects, the sign of a building without quality?
Modern tropical architecture: medicalisation of space in early twentieth-century Philippines
Authors: Duque Estela
Published: February 2010

In the interwar years European historians and critics of architecture tried to assimilate science into architecture and arts. For example Sigfried Giedion's Space, Time, and Architecture (1941) attempted to bring Einsteinian spacetime into architectural theory, while Nikolaus Pevsner's An Outline of European Architecture (c. 1943) used space as a criterion to differentiate architecture from other art forms. These brought to the idea of ‘space’ a distinctly modern meaning, making it a universal signifier; whereas in the last decade, architectural historians have argued for the historical specificity of space and a deeper examination of the social and spatial practices embedded in the making of space. This study inquires into the atemporal readings of space, using Lefebvre's theory on the production of space by ‘interested subjects’.
No reactions observed in Xe‐Fe system even at Earth core pressures
Authors: Nishio‐Hamane D. , Yagi T. , Sata N. , Fujita T. , Okada T.
Published: February 2010

The behavior of Xe‐Fe system was investigated under ultra‐high pressures by in situ X‐ray diffraction measurements using a laser‐heated diamond anvil cell. Although Xe‐Fe interaction have been regarded as one of the most probable explanations for the missing Xe problem, no compounds and no detectable amounts of dissolution of xenon into crystalline hcp iron occur even above the metallization pressure of xenon up to 155 GPa and 3000 K. Furthermore, the c/a ratio of hcp xenon and iron vary in opposite ways with increasing pressure, indicating that the nature of these two metals deviates more at high pressures. These results and the fact that incorporation of nickel and light elements into iron tends to stabilize structures other than the hcp structure imply that the retention of xenon in the Earth's core is very unlikely by a solid‐solution mechanism, and some other mechanism needs to be found to explain the missing xenon problem.
Welfare states for sale:Neighbouring countries and the public-private mix
Authors: Hindle Don
Published: February 2010

Australians were battling over optional ways of financing health care for most of thelast century. We start this century with the problem unresolved - and the subject ofyet another Federal Government enquiry.
Clinical pathways involving general practice - a new approach to integrated health care?
Authors: Louise Jackson Claire , De Jong Inge , Oats Jeremy
Published: February 2010

The Mater Mothers' Hospital, South Brisbane recently identified a number of difficulties with thematernity share-care program it runs with 1100 local GPs. This paper describes an integrationapproach developed at the Mater which has addressed these problems via the use of clinicalmanagement guidelines across the whole episode of care, the provision of a patient held record /pathway as a clinical practice prompt, clear communication and information management protocolsbetween hospital and general practice, and the provision of continuing medical education for share-carepractitioners.
Management challenges faced by managers of New Zealand long-term care facilities
Authors: Madas Eshwar , North Nicola
Published: February 2010

This article reports on a postal survey of 78 long-term care managers in one region ofNew- Zealand, of whom 45 (58%) responded. Most long-term care managers (73.2%) weremiddle-aged females holding nursing but not management qualifications. Most long-termcare facilities (69%) tended to be stand-alone facilities providing a single type of care (resthome or continuing care hospital). The most prominent issues facing managers wereconsidered to be inadequate funding to match the growing costs of providing long-term careand occupancy levels. Managers believed that political/regulatory, economic and social factorsinfluenced these issues. Despite a turbulent health care environment and the challenges facingmanagers, long-term care managers reported they were coping well and valued networking.
A comparison of the awareness and utilisation of postoperative health services provided to women with breast cancer
Authors: Chisolm Joy , Donoghue Judith , Dunn Kim
Published: February 2010

Nurses at a metropolitan Cancer Care Centre (CCC) noted that women who have had recent breastsurgery for carcinoma had significantly different levels of knowledge and use of support servicesdepending upon public or private hospitalisation. The public hospital participants were more aware ofthe range of available services (mean = 3.6) compared to women from the private sector(mean = 2.6). In addition, the public hospital participants were more likely to access a wider rangeof services post discharge (mean = 2.21) compared to the private hospital women (mean = 0.85).A significant difference was found between younger and older women's use of services.
An assessment of the needs of oncology outpatients for the development of Allied Health Services
Authors: McGrath Pam , Corcoran Veronica , O'Malia Angela
Published: February 2010

This article presents the findings of a study that arose out of the desire by the Allied Health Professionals(AHP) at the Mater Hospital, Brisbane, to better understand the needs of their clients in order to beable to offer a more effective and appropriate service. A questionnaire designed specifically to explorethe needs of patients and their families for AHP services was administered to consecutive patients(n=62) attending the Mater out-patient oncology clinic during one month. The findings provide awealth of practical information for AHPs to use in planning for the effective utilisation of their services,as well as fresh insights into a number of theoretical issues that need further research.
Emergency medicine and "acute" general practice: comparing apples with 0ranges
Authors: Ieraci Sue , Cunningham Paul , Talbot-Stern Janet
Published: February 2010

Emergency Departments (EDs) operate at the interface between the inpatient and ambulatory sectorsof health care. Because of shared funding between the Commonwealth and States for ambulatory care,there has been intense focus on the ED patient population, and the potential to shift the locus of carefor non-inpatients.One of the frequently cited models for the provision of after-hours GP services is the Balmain GeneralPractice Casualty (GPC). This paper analyses the GPC model, looking in detail at casemix, clinicalquality, waiting times and cost-effectiveness. It is argued that the services provided and the casemix ofthe patient population of GPC and EDs are distinctly different. Cost-effectiveness for GPC has notbeen objectively established.Health service planning should recognise the distinct but complementary roles of general practice andemergency medicine. Evaluation of alternative models of service provision should critically examine theavailable evidence, and comparisons should be based on a precise analysis of equivalent services.
The introduction of the Frontline Management Initiative in South Western Sydney Area Health Service
Authors: Hanson Susan , Isouard Godfrey
Published: February 2010

This article provides an overview of the development and implementation of a management development strategy forthe South Western Sydney Area Health Service (SWSAHS). The program, the Frontline Management Initiative(FMI), was introduced as a developmental tool which enabled managers to identify those competencies that theyalready possess and those which they need to develop. The FMI will be progressively implemented throughout the fivesector health services of SWSAHS comprising approximately 1500 managers. This article outlines the introductionand experience of FMI in one sector health service, the development and assessment of a manager's portfolio, thepathway developed from FMI to university based health management courses, the lessons learnt and the futuredirections for management development.
Are Australia's drugs too cheap for ourown good?
Authors: Hindle Don
Published: February 2010

The Pharmaceutical Benefits Advisory Committee (PBAC) plays an important role in controlling the drugs thatare available at subsidised prices under the Pharmaceutical Benefits Scheme (PBS). In brief, the Committeeprovides advice on whether a new drug is sufficiently cost-effective to merit its being added to the PBS. Listingis important to the drug manufacturers, because it has a beneficial effect on sales volume. They are thereforeoften prepared to offer lower prices than would otherwise be the case if availability were determined solely bythe marketplace.
And on the cover of the Guide were two words in red - Don't Panic
Authors: Harvey Roy
Published: February 2010

Roy Harvey is a consultant in health financing, works both in Australia and in developing countries and hasundertaken research and analysis on the economics of the pharmaceutical industry and the PBS since 1968.
Building a Star Alliance:Australian and German DRGs
Authors: Roeder Norbert
Published: February 2010

In 2000, Germany selected the Australian DRG system as a base for a national standard German version (nowcalled German DRGs, or simply G-DRGs). No serious consideration has been given thus far to major changesin the classification, because there are many practical issues that must be addressed within a short time-scale,given the German federal government's requirement that per case payment by DRG be implemented over atransition period from January 2003.
Older patients' utilisation of emergency department resources: a cross-sectional study
Authors: Chu Kevin , Brown Anthony
Published: February 2010

A cross-sectional study was conducted to investigate older patients' utilisation of emergency department resources.Patients aged >65 years, compared with adults <65 years, were more likely to be triaged to higher clinical urgency categories. They have a higher hospital admission rate and longer length-of-stay even after adjusting for triage category.Patients >80 years, compared with 65-79 years, were more likely to be triaged to higher urgency categories. These groups had similar hospital admission rates and lengths-of-stay. Patients �65 years presented in similar numbers during office-hours and after-hours, but after-hours attendances were more likely to be triaged to higher urgency categories. The greater emergency department resource utilisation by older people has implications for the provision of health services in an aging population.
Prevention of stroke in chronic andrecurrent atrial fibrillation
Authors: Kelly Anne-Maree , Kerr Debra , Hew Ruth
Published: February 2010

The objective was to determine the proportion of patients presenting to the Emergency Department (ED) in atrialfibrillation (AF) who are at high risk of thromboembolic stroke as defined by the American Heart Association andwho might benefit from anticoagulation therapy.We enrolled all patients identified as having AF between 28th June 1999 and 26th March 2000. Data collectedincluded demographic information, presenting complaint, discharge diagnosis, risk factors for thromboembolic stroke,contraindications to anticoagulation (as defined by the Stroke Prevention in AF Investigators), admission anddischarge medications, and cardiac rhythm on presentation and at discharge.193 patients were identified within the study period. Two patient histories were not available for review. 121 patientshad a prior history of AF. Of these, 65 patients were at high risk for thromboembolic stroke and had no contra-indicationto anticoagulation therapy. 43 (66%) were on Warfarin at presentation but 14 (22%) were on Aspirinand 8 (12%) were on neither.34% of patients with chronic atrial fibrillation presenting to the ED, at high risk of thromboembolic stroke andwithout contra-indication to anticoagulation, were not anticoagulated on presentation. ED attendance provides anopportunity for intervention for the prevention of stroke in this group.
A critical review of rural medical workforce retention in Australia
Authors: Humphreys John , Jones Judith , Jones Mike , Hugo Graeme , Bamford Errol , Taylor Danielle
Published: February 2010

The problem of how best to recruit and retain doctors in rural and remote communities has led governments to adopt a range of medical workforce incentives, including retention grants. A comprehensive literature survey suggests that medical workforce retention has been poorly distinguished from other supply issues such as recruitment, and that its determinants and the process leading to retention are poorly understood. Such a knowledge gap is likely to limit the effectiveness of retention incentives. This article reports the results of this literature review, and advances a conceptual framework as the basis for ongoing research and evaluating how best to deliver effective retention interventions.
Contemporary issues in Australian midwifery regulation
Authors: Brodie Pat , Barclay Lesley
Published: February 2010

This paper reports on research that examined the Nurses' Acts, regulations and current policies of each state and territory in Australia, in order to determine their adequacy in regulating the education and practice of midwifery. This is part of a three-year study (Australian Midwifery Action Project) set up to identify and investigate barriers to midwifery within the provision of mainstream maternity services in Australia. Through an in-depth examination and comparison of key factors in the various statutes, the paper identifies their effect on contemporary midwifery roles and practices. The work assessed whether the current regulatory system that subsumes midwifery into nursing is adequate in protecting the public appropriately and ensuring that minimum professional standards are met. This is of particular importance in Australia, where many maternity health care services are seeking to maximise midwives' contributions through the development of new models of care that increase midwives' autonomy and level of accountability.
The provision of hanbang herbal medicine in the Korean community in Australia: entrepreneurial or caring for fellow Koreans?
Authors: Han Gil-Soo
Published: February 2010

This study explores the underlying factors that sustain the practice of herbal medicine in a non-English speaking background (Korean) community in Australia. Qualitative study was undertaken of 8 herbal doctors' practice of herbal medicine, their understanding of Korean immigrants' life and work involvement, and the use of herbal medicine, using semi-structured interview schedules. The demand for herbal medicine is linked to Korean immigrants' involvement in manual work or long working hours irrespective of their qualifications. Hanbang tonic medicine is a way to maintain their health - that is, a capacity to work. Although hanbang doctors claim that hanbang medicine differs from biomedicine, they share more similarities than differences under the current economic environment. The increasing interest in complementary therapies has ramifications on people's health and health care industry. Government and professional regulations on complementary therapies could be developed in close consultation with relevant stakeholders. Health care practice in the migrant community is an area to be approached with caution.
System dynamics and action research in aged care
Authors: Walker Beverly , Haslett Tim
Published: February 2010

This paper documents an Action Research project undertaken to implement a Continuity of Care Model in anExtended Care Centre. System Dynamics modelling and group-modelling techniques were used to examine andimprove patient length of stay (LOS). Several indicators of success of the project are noted. They included thereduction of LOS, improvements in teamwork and staff morale, and various systemic adaptations in other parts ofthe health care sector. Upstream providers responded to the reductions in patient numbers by swamping the Centrewith intractable patients. This effectively reduced up-stream providers' LOS, and returned the Centre's LOS to pre-interventionlevels.
Health needs assessment and the ecology of care: a research note
Authors: Trout Florence
Published: February 2010

A Health Needs Assessment project was undertaken in 1999 for The Royal New Zealand Plunket Society (Inc.),a voluntary community organisation that provides child and family health promotion to 50,000 new babieseach year nationwide. Specially qualified registered nurses, community workers and volunteers deliver theservice that includes home visiting as part of universal health care.
Australian hospital services: An overview
Authors: Duckett S.J.
Published: February 2010

Hospital services in Australia are provided by public hospitals (about 75% of hospitals, two-thirds of separations) and private hospitals (the balance). Australians use about one bed day per person per year, with an admission rate of about300 admissions per thousand population per annum. Provision rates for public hospitals have declined significantly (by 40%) over the last 20 years but separation rates have increased. Average length of stay for overnight patients has been stable but, because the proportion of same day patients has increased dramatically, overall length of stay has declined from around seven days in the mid 1980s to around four days in the late 1990s. Overall, the Commonwealth and state governments each meet about half the costs of public hospital care, private health insurance meets about two-thirds of the costs of private hospitals.
Ethically defensible decision-making in health care: challenges to traditional practice
Authors: Susan Bailey Dr
Published: February 2010

The concept of paternalism is deeply entrenched in health care. Decision-making about health care can be extremelydifficult at times, and many competing interests may influence the outcomes. However, ethically defensible practice aligns itself with acknowledging the patient's prima facie right to be treated as an autonomous individual. This includes the patient's right to make informed decisions or to decide that other(s), such as the close family, should makedecisions on his or her behalf.
The 2003-2008 Australian Health Care Agreements - an industry perspective
Authors: Cormack Mark
Published: February 2010

This paper presents a public hospital and health care industry perspective on the development of the 2003 - 2008 Australian Health Care Agreements. The Australian Healthcare Association conducted a national industry consultation exercise from June to September 2002 in the lead up to the development of the next round of agreements. While acknowledging that the size of the funding commitment from the Commonwealth to the states will be the central focus of negotiations, health industry representatives identified issues of equal importance. The AHCAs' linkages with other health programs need to reflect that health care has moved beyond the confines of the hospitals. Adjustments and output targets need to provide incentives to improve and reform the industry. The success of private health insurance policy has not yet translated into benefits for the public hospital sector, and any funding contingencies between the two programs cannot be justified at this time. Special priority areas such as health workforce will need specific policy and program responses.
Experiencing "change" from within: situating the transition to primary health care in a remote Australian context
Authors: Lockhart Chris
Published: February 2010

The transition to primary health care (PHC) is often described in an idealised manner, which either ignores or obscures the experiences associated with its implementation at the local level. By adopting an anthropological perspective, this article highlights some of these experiences and the context within which they occur for one health care organisation in remote Western Australia. It Specifically focuses on problems associated with economic rationalism, managerialism, and the inherently fragmented character of health service organisations. Such issues must be allowed to inform idealised PHC models in order to make them more applicable and attuned to local needs and realities.
Waiting time information services: what are the implications of waiting list behaviour for their design?
Authors: Cromwell David , Griffiths David
Published: February 2010

In some countries, patients requiring elective surgery can access comparative waiting time information for various surgical units. What someone can deduce from this information will depend upon how the statistics are derived, and how waiting lists behave. However, empirical analyses of waiting list behaviour are scarce. This study analysed three years of waiting list data collected at one hospital in Sydney, Australia. The results highlight various issues that raise questions about using particular waiting time statistics to make inferences about patient waiting times. In particular, the results highlight the considerable variation in behaviour that can exist between surgeons in the same specialty, and that can occur over time.
Consumer participation in mental health services: who wants it and why?
Authors: Tobin Margaret , Chen Luxin , Leathley Colleen
Published: February 2010

Contemporary health policy dictates that health services have a demonstrable consumer focus and actively progress the issue of consumer participation in services. Given that costs of such initiatives are not insignificant, there is a responsibility to ensure that the resources are being directed to appropriate means, and are achieving worthwhile results. In examining the impact and effectiveness of consumer participation initiatives in their own Service, the authors undertook a qualitative study exploring the extent and quality of consumer participation following a three-year period of support and funding. Using trained consumers as interviewers, current consumers were asked about their perceptions and personal experience of "participation". Findings identified low familiarity and involvement with the concept of consumer participation overall. Barriers to involvement included lack of motivation or invitation, stigma, and a lack of information. A need to integrate consumer participation activities into the wider system was also noted. The authors conclude that simply devoting energy and resources to consumer initiatives, and thereby achieving a politically correct approach, may not be a worthwhile exercise. Such initiatives need to be based on evidence, available resources and identifiable and achievable outcomes, with a balance struck between endorsing the value of consumer participation and establishing realistic goals for what can be offered and managed.
Improving nursing recruitment and retention in a sub-acute health service
Authors: Lilly Alan
Published: February 2010

The current worldwide shortage of nurses is well-documented. This paper describes one organisation's 'back to basics' approach to nursing recruitment and the results of a vigorous recruitment program in 2001.Within 12 months, this organisation employed more than 200 new nursing staff, opened 67 beds, reduced agency use by 69%and reduced vacancies by 80%. Based on agency premium costs, there were minimum savings in the order of $800,000 per annum.
Characteristics of patients receiving health assessments, care plans or case conferences by general practitioners, as part of the Enhanced Primary Care program between November 1999 and October 2001
Authors: Wilkinson David , McElroy Heather , Beilby Justin , Mott Kathy , Price Kay , Morey Sue , Best John
Published: February 2010

We aimed to describe the characteristics of patients receiving health assessments (HA), care plans (CP) or case conferences (CC) through the Enhanced Primary Care (EPC) program between November 1999 and October 2001. The Commonwealth Department of Health and Ageing provided data. In all, 43%of non-Indigenous people who had a HA were aged 75-79 years and 32%were aged 80-84 years. Those having a HA at home were older (30.3% aged 85 years and above) than those having a HA in GP's rooms (20.2%85 years and above). For Indigenous people, between 12 and 17%of all HAs were done among each five-year age group between 55 and 84 years. As a group, CPs were mostly done among older people, with a higher proportion done among older women (74.2%among those 55 years and above) than older men (66.4%). Most CCs were also done among older people (60.4%55 years and above). Of the 286,250 people that had at least one EPC service, most (219,210; 76.6%)had only one. Of these, 153,624 (70.1%)had a HA. Of those having at least one EPC service, 95.7%had two services (most often a HA plus a CP). To date EPC activity has been concentrated among the elderly, gender patterns are similar, and few patients have received more than a single EPC service, which is usually a HA.
Evidence-based practice for young people who self harm: can it be sustained and does it improve outcomes?
Authors: Einfeld Stewart L , Beard John , Tobin Margaret , Buss Richard , Dudley Michael , Clarke Adam R , Knowles Michelle , Hamilton Blake
Published: February 2010

In 1998-1999, two Area Health Services in NSW conducted a project to implement evidence-based service enhancements for the clinical management of young people who present with Deliberate Self Harm (DSH) behaviour. The present study examined what structures and procedures were required to implement and sustain evidence-based practice in different health care settings for patients with DSH behaviour. Service provision was assessed at three points during the initial project to assess the degree of change that occurred, and 9 months after the completion of the project to allow an assessment of sustainability of the service provision. We examined staff perceptions of the importance of education, management directives, policy and procedure changes, and cultural/ attitudinal changes, in implementing clinical best practice. Results indicated that support from both service management and clinical staff is necessary for successful implementation of service enhancements. High levels of staff education and policy development were also associated with high levels of service performance. The best sustained enhancements were those that were developed by the services themselves.
Letter to the Editor
Authors: Smiles Sandra
Published: February 2010

A letter to the editor from the Australian midwifery regulation in the Northern Territory in response to the article on Australian midwifery regulation by Pat Brodie and Lesley Barclay (AHR, vol 24 no 4 2001).
A comparison of morbidity and services provided in three primary care settings
Authors: Bolton Patrick , Mira Michael
Published: February 2010

Objective:To describe and compare the pattern of morbidity in a general practice casualty with primary care patients inemergency departments (EDs).Setting and subjects:Patients presenting to a general practice casualty and primary care patients in two EDs in Sydney, NSW.Results:The pattern of morbidity in the general practice casualty was similar to that among ambulatory patients in EDs.Conclusion:Opportunities may exist to substitute care between casualty services provided by GPs and those provided in EDs.
The dynamics of local rules in hospital admission processes
Authors: Haslett Tim , Walker Beverly C.
Published: February 2010

This paper reports on research into admission practices at a sub acute extended care hospital. A system dynamicssimulation model of the patient flow from feeder hospitals to the hospital was built to show the impact of the localrules used by the medical registrar. Local rules are behaviours that are local, and often idiosyncratic, adaptations tothe local environment. The model showed these adaptations had a significant impact on the acuity of patients beingadmitted as a result of the separation policies of the feeder hospitals. This patient mix in turn affected the hospitalability to meet its budget.
Factors influencing women's use of health services for Sexually Transmitted Infections in eastern Nepal
Authors: Poudel-Tandukar Kalpana , Poudel Krishina C , Macdougall Conlin
Published: February 2010

This paper explores low levels of women's health service utilization for Sexually Transmitted Infections (STIs)in Nepal. We interviewed 120 women individually and 53 in focus groups. Predictors of lower utilisation were self-medication, consultation with faith healers, inadequate knowledge of STIs, beliefs about causes, fear, social taboos and stigmatisation, women's secondary status, and presence of male health professionals. Results indicate the importance of people's beliefs in their decisions about health care. Strategies to improve access to health services in Nepal should systematically investigate the role of all these factors to improve access to and utilisation of health services for STIs.
Community involvement in health in Mongolia: hospital boards and other participatory structures
Authors: O'Rourke Michael , Hindle Don , Dungu Yondon , Batsuury Ravjir , Sonin Sodov , Jeugmans Jacques , Yasukawa Takako
Published: February 2010

Under the Soviet central planning model that operated until 1990,the Mongolian population had little or no involvement in decision-making about health care. As part of overall health sector reform in Mongolia, hospital boards have been established, with significant community representation, to guide strategic and financial management and to assist in developing services according to community needs and expectations. We discuss experiences, and steps taken to resolve initial problems. We also describe other more recent participatory models including the family group practice initiative which involves the community choosing their doctor, community management of revolving drug funds, establishment of community health volunteer networks,and the government's information campaign strategy on the reforms. The community participation models in Mongolia are part of an ongoing process of openness and emphasise the commitment to change in that country. We argue that these experiences have the potential to guide and inform similar measures in other transitional countries.
Accessing health information in a hospital setting: a consumer views study
Authors: Sandford Jayne
Published: February 2010

Meeting consumers' needs for health information is an important role for all health professionals. A Consumer Views Study was conducted at Flinders Medical Centre (FMC)to ensure strategies for improving access to health information for staff and consumers were congruent with consumers' views. Semi-structured questionnaires were completed by 100 consumers of FMC services. A key finding was the strong preference consumers have for accessing health information through staff members, which confirms the important part that education plays in information provision. A concern was that less than half of the participants were provided with written information. This could be indicative of the difficulties staff have in accessing health information to provide to consumers. Results also showed the important role General Practitioners (GPs) have in providing health information to consumers. Findings have helped shape strategies that focus on coordinated electronic access to quality health information, which will support staff in accessing and providing health information to consumers, and improve direct access to health information for consumers.
A study of quality management practices in nursing in universities in Australia
Authors: Cruickshank Mary
Published: February 2010

In Australia,the traditional Quality Assurance approach used in the hospital setting has played an important role in nursing practice.During the past decade, nurses have begun making a paradigm shift from Quality Assurance to Total Quality Management but scant attention has been paid to quality management practices in nursing in the higher education sector. This paper reports on a quantitative study examining the perceptions of nurse academics to the applicability of TQM to nursing in universities. The findings identified how TQM could be applied to suit the nursing culture in the higher education sector.
Erratum for Cromwell DA, Griffiths DA 2002
Authors: Cromwell DA , Griffiths DA
Published: February 2010

Erratum for Cromwell DA, Griffiths DA 2002, 'Waiting time information services: how well do different statistics forecast a patient's wait?'
A new look for Australian Health Review
Authors: Dwyer Judith , Leggat Sandra G
Published: February 2010

WE ARE DELIGHTED to welcome you to the new
look of the Journal. In recognition of the
importance of Australian Health Review to management
and policy decision makers in Australia,
the Australian Healthcare Association
has initiated some major changes to assist us to
better meet our readers? needs. The journal is
now being produced with the support of
AMPCo, the Australasian Medical Publishing
Company. The changes in print format and
presentation of papers will be accompanied by
a more interactive website, and authors and
reviewers will soon notice a more streamlined
editorial and production process.
It is also a pleasure to welcome Mr Gary Day,
of the Queensland University of Technology, to
the new role of book review editor for the
journal. Gary's appointment will enable the
journal to include more regular coverage of
significant books and reports.
The librarians and archivists among our
readers will note that we have started a new
volume (number 28) for the occasion. Volume
28 will have three issues, which, combined
with those in volume 27, will make 5 issues for
2004. The next volume (number 29) will start
in 2005.
Why it is time to review the role of private health insurance in Australia
Authors: Roff Michael , Segal Leonie
Published: February 2010

TO THE EDITOR: Since its introduction on 1
January 1999, the 30% rebate has been the subject
of much misleading comment by the opponents of
the private health sector. A recent addition to these
ranks was published in the first edition for 2004 of
Australian Health Review (Segal 2004).
There is no real attempt at balance in the article.
While Segal argues that the rebate has failed to take
the pressure off public hospitals, we are not told,
for example, that almost one-in-five extra patients
admitted by public hospitals in the three years to
2002-03 were actually private patients!
Similarly, the article is littered with generalisations
and, in some cases, misleading or completely
incorrect statements, such as ?Private hospitals do
not offer a complete hospital service . . .? Even a
cursory examination of the available national data
indicates that private hospitals provide services in
all but 7 of the 654 diagnosis-related groups
(DRGs) recorded. Private hospitals perform all the
remaining 647 DRGs.
Ideology, change and conflict
Authors: Grant Colin
Published: February 2010

Background ? or product disclaimer
It is a long time since my very brief tenure as
editor of Australian Health Review came to an
end. Not, though, as long ago as I had thought!
Swift recourse to an old c.v. shows it was in 1993
that I left the University of New South Wales to
become a Visiting Fellow in Hong Kong and teach
more or less the same sorts of health and management
subjects which I had taught in Sydney, and
compile, with Peter Yuen, a ground-breaking
source book on the Hong Kong health care
system that looks uncannily like the sort of data
book that I was prone to write with the inestimable
Helen Lapsley about our Australian system.
Perhaps in making a charm-laden invitation to
contribute something to AHR, Allan Hughes might
have thought I would produce some dazzling
synthesis of contrasts and comparisons between
the two systems. But I doubt that he would have
been even momentarily so unrealistic. My move to
Hong Kong gave me the chance to extricate myself
from following the tortuous development of our
system. In turn my departure from that maddening,
bustling and exciting city a couple of weeks
after the Hand-over (Glorious Re-unification or
Great Take-Away) left me rapidly out of touch with
their health care system too.
Jumping ship
Authors: Richards Chris F
Published: February 2010

THE RADIO CLOCK strikes up as it has done
many thousands of times before to usher in
another day. But this is not just any day. This is the
last time that you will quickly shower and shave,
toss on the executive uniform of tailor-made suit
and tie, throw down toast and coffee, and head
down the freeway in the company car to enter the
office and battle once again with the problems of
money (or rather the lack of it) and those queuing
to spend it. Today is to be your Waterloo, when
you become both Napoleon and Wellington. You
will ?lose? because you finally decided to leave the
battlefield and ?jump ship?, but you will also ?win?
because you imagine that a world apart from the
hospital will (at this time in your career) be a better
one. You realise (and the irony is not lost on you)
that you are leaving a hospital to improve your
own mental and physical well being!
Catching up in pharmaceuticals: government policies and the rise of genomics
Authors: Benner Mats
Published: February 2010

Genomics ? the sequencing of the human
genome and the identification of the genetic
mechanisms of development and disease ? is
driving a restructuring of the global pharmaceutical
industry. Many policy initiatives in biomedicine
are based on the assumption that strength in
genomics research will be translated into economic
success, that is, that investments in genomics
will be a way to catch up in the development of
the bio-industries. There is therefore intense competition
between nations and regions to establish
a strong position in genomics, as shown in the
growth of public expenditure on biomedical
research in the last decade. This article addresses
questions regarding the possibility of smaller
countries catching up in the bio-based economy,
given its present concentration within a few
research-intensive networks and the historical
advantage of established knowledge clusters,
which exist primarily in the United States.
The value of local area planning
Authors: Austin Sandy , Kennedy Rob , Napper Paul
Published: February 2010

The following case study describes the Barwon
Primary Care Forum (BPCF) model for local area
planning and the value this model has brought to
the member agencies. The model was developed
from a locally identified need for social planning
which historically had resulted in numerous community
consultations and needs assessments,
often duplicative and potentially burdensome to
the community. The process for this local area
planning model is described in detail.
Effects of increased private health insurance on hospital utilisation in Victoria
Authors: Sundararajan Vijaya , Brown Kaye , Henderson Toni , Hindle Don
Published: February 2010

The proportion of Victorians and Australians generally
with private health insurance (PHI)
increased from 31% in 1998 to 45% in 2001. We
analysed a dataset containing all hospital separations
throughout Victoria to determine whether
changes in the level of private health insurance
have had any impact on patterns of public and
private hospital utilisation in Victoria.
Total utilisation of private hospitals grew by 31% from
1998?99 to 2002?03, whereas utilisation of public
hospitals increased by 18%. Total bed-days have
increased in both private hospitals and public hospitals
by 12%. The proportion of all separations at
private hospitals has remained relatively stable
between these 2 years, with 33% of all separations
being private patients in private hospitals in 1998?
99, increasing slightly to 35% by 2002?03. Analysis
of a number of specific DRGs shows that patients
with more severe disease are more likely to be seen
at public hospitals; notably this trend has strengthened
between 1998?99 and 2002?03.
The number of patients treated in Victorian public
hospitals has continued to grow, despite a rapid
increase in the utilisation of private hospitals.
Given the limited extent of the shift in caseload
share between the two sectors, the effectiveness
of the Commonwealth?s subsidy of private health
insurance as a mechanism to reduce pressure on
the public sector needs to be carefully examined.
Why it is time to review the role of private health insurance in Australia
Authors: Segal Leonie
Published: February 2010

The role of private health insurance (PHI) within the Australian health-care system is urgently in need ofcomprehensive review. Two decades of universal health cover under Medicare have meant a change in the function ofPHI, which is not reflected in policies to support PHI nor in the public debate around PHI. There is increasingevidence that the series of policy adjustments introduced to support PHI have served to undermine rather than promotethe efficiency and equity of Australia's health care system. While support for PHI has been justified to 'take pressure offthe public hospital system' and to 'facilitate choice of insurer and private provider', and the incentives have indeedincreased PHI membership, this increase comes at a high cost relative to benefits achieved. The redirection of hospitaladmissions from the public to private hospitals is small, with a value considerably less than 25% of the cost of thepolicies. The Commonwealth share of the health care budget has increased and the relative contribution from privatehealth insurance is lower in 2001-02, despite an increase in PHI membership to nearly 45% of the population,compared with the 30% coverage in 1998. The policies have largely directed subsidies to those on higher incomes whoare more likely to take out PHI, and to private insurance companies, private hospitals and medical specialists. Ad hocpolicy adjustments need to be replaced by a coherent policy towards PHI, one that recognises the fundamental changein its role and significance in the context of universal health coverage.