bluuebunny/crossref_metadata_2025 huggingface dataset:
Decision makers' perceptions of health technology decision making and priority setting at the institutional level
Authors: Gallego Gisselle , Fowler Sandra , van Gool Kees
Published: February 2010

This study describes health care decision makers?
perceptions about decision making processes for
the introduction, diffusion and prioritisation of new
health technologies at the regional and institutional
level. The aim of the study was to aid the
design of a new process of technology assessment
and decision making for the Northern Sydney
and Central Coast Area Health Service
(NSCCAHS). Twelve in-depth, semi-structured
interviews were conducted with senior health
service managers, nurse managers and senior
medical clinicians in the NSCCAHS. Interviewees
described prioritisation and decision-making processes
as ?ad hoc?. Safety and effectiveness were
considered the most important criteria in decision
making but budgetary consideration often drove
decisions about the uptake and diffusion of new
technologies. Current dissatisfaction with decision-
making processes creates opportunities for
reform, including the introduction of consistent
local technology assessments.
Community-governed health services in Cape York: does the evidence point to a model of service delivery?
Authors: Coombe Leanne L , Haswell-Elkins Melissa R , Hill Peter S
Published: February 2010

Health service delivery model reforms are currently
underway in Cape York in an effort to
improve health outcomes for the Aboriginal and
Torres Strait Islander communities. These reforms
include the transition of the Apunipima Cape York
Health Council from an advocacy agency to a
community-controlled health service provider.
This paper investigates the literature on existing
community governance models and communitycontrolled
health service delivery models, to guide
the choice of the most appropriate model for the
Cape York health reforms.
The evidence collected suggests a new innovative
health service delivery model is emerging that will
not only improve Indigenous health status, but may
also present a more appropriate model for the
health care sector than the existing mainstream
health service delivery model provided for other
sections of the collective Australian population.
A case study of centralised monitoring of hospital access performance
Authors: Bain Christopher A , Mehta Snehal M , Ratnayake Kanchana , Symonds Terry L , Kennedy Marcus P
Published: February 2010

Access to care for patients remains a concern for
all parties in the provision of hospital services. It is
the subject of patient complaints, large investments
of funds and vigorous debate in the community,
hospitals and the political arena. This is a
common problem in developed nations. There has
been little achievement in information technology
solutions to this significant problem in Australia.
This paper presents a case study of the development
and implementation of an organisational
access display system intended to provide realtime,
or near to real-time information and feedback
on access for staff on the floor. This is
believed to be one of the first times such a
development has been reported in the Australian
literature, albeit limited to the context of a single
organisation.
Quality frameworks for telephone triage
Authors: McGrath Alicia C , Macdonald Christine R
Published: February 2010

The establishment of the Grampians After-Hours
Service has led to the development of a quality
framework for nurse telephone triage. The service
providers believe this framework is the basis for
the service?s success. While quality frameworks
including critical evaluation and peer review are
not new to the health industry, the development of
organisational systems to improve quality in afterhours
services is innovative. The framework
developed is comprehensive, evidenced-based
and emphasises training, protocols and documentation.
It also involves a continuous and nonpunitive
quality review process that operates at
the individual, small group, organisation and
whole-system level. The framework will continue
to improve and at this time provides a foundation
for discussion and further application in the pursuit
of quality improvement in rural after-hours health
services.
PBS reform — a missed opportunity?
Authors: de Boer Rebecca
Published: February 2010

The Pharmaceutical Benefits Scheme (PBS)
reform package was announced in 2006 and was
designed to save the government significant
expenditure on the PBS through mandatory price
cuts and price disclosure arrangements for multibrand
products. Perhaps most significantly, the
formulary was spilt in two with no linkages
between the formularies on either price or therapeutic
outcome. This article examines the potential
impact of these changes on the PBS and
pharmaceutical policy in Australia more broadly.
Australia's pharmaceutical cost sharing policy: reducing waste or affordability?
Authors: Doran Evan , Robertson Jane
Published: February 2010

In this paper we argue that Australia?s pharmaceutical
cost sharing policy has been applied as if
cost sharing is unproblematic for medicine affordability
and good health outcomes. Australian and
international experience with pharmaceutical cost
sharing strongly suggests a negative impact on
affordability and quality use of medicines, disproportionately
affecting low income patients. We
argue that Australia?s use of cost sharing reflects
the currency of a cognitively powerful and morally
charged idea ? moral hazard. Moral hazard refers
to the change in behaviour induced by insurance
coverage. Applied to pharmaceuticals, this means
that low out-of-pocket cost will lead to waste.
Moral hazard mixes the explanatory power of
price with the intuitively cogent notion that if
people do not experience consequences they will
behave irresponsibly. Cost sharing policy has
gone unscrutinised and uncontested not because
cost sharing is unproblematic, but because in the
light of the idea of moral hazard it has all the
question-deadening weight of common sense.
Complementary medicines regulatory reform
Authors: Bollen Michael D , Whicker Susan D
Published: February 2010

AUSTRALIANS ARE BEING encouraged to take
greater responsibility for their own health care.
The concept of self-care is being promoted
widely, including the recent paper released by the
National Health and Hospitals Reform
Commission1 and, more commercially, by the
Australian Self Medication Industry (ASMI).2
Self-care in health refers to the activities
individuals, families and communities
undertake with the intention of enhancing
health, preventing disease, limiting illness,
and restoring health. These activities are
derived from knowledge and skills from the
pool of both professional and lay experience.
They are undertaken by lay people on their
own behalf, either separately or in participative
collaboration with professionals.3
To enable Australian consumers to assume this
responsibility, they should have the right to know
and have access to the evidence-based status of
any treatment they are considering, to enable
them to make well-informed choices. This especially
applies to medicines.
Interpreting the global bio-economy
Authors: Benner Mats
Published: February 2010

THIS BOOK IS AN INSIGHTFUL and theoretically
ambitious anthropological study of the genomics
and biotech industries in the United States and
India. These and related science-based sectors form
part of the bio-economy, a larger complex of manufacturing,
service, and research and development
(R&D) activities, grounded increasingly in advancements
in the biological sciences. In his groundbreaking
study, Kaushik Sunder Rajan seeks to
explain the intersection between biological knowledge
? the new knowledge of life itself ? and the
economic accumulation process in which large
pharmaceutical firms are dominant actors.
The most striking manifestation of the bio-economy
is the emergence of thousands of small biotechnology
and other science-intensive start-up firms.
These populate areas close to major universities in
the developed parts of the world ? in California,
Massachusetts, the Cambridge region in the United
Kingdom, and elsewhere ? but have emerged also
in some centres in developing countries. This is
described in Sunder Rajan?s empirical analysis which
investigates the global evolution of the bio-economy,
with a particular focus on India and California. He
explains the interdependencies between giant pharmaceutical
companies and small dedicated biotechnology
firms, which operate in conjunction with a
myriad of intermediaries, such as venture capitalist
firms that provide funding for promising science
and facilitate interaction between different bio-economic
actors.
Becoming Australian? Two different approaches to health care reform in the United States
Authors: Roydhouse Jessica K
Published: February 2010

THE ?SUBSTANTIAL PRIVATE SECTOR?1 ROLE in
Australian health care has sometimes given rise to
fears of ?Americanisation? of the Australian health
care system, particularly in the media. For example,
in 2000 Kenneth Davidson wrote, ?The USstyle
health financing route being taken by the
Howard Government is mad and bad.?2 The US
system is the ?leading example? of ?inferior system
performance?3 and is often viewed as a
system to be feared and avoided.
Despite spending far more per capita than any
other country on health care, the United States
nonetheless fails to provide equitable health care
for everyone. The system is ?a paradox of excess
and deprivation?,4 spending far more than other
systems without providing adequate care and
treatment for all.
Although the US system is seen as frightening in
Australia, broad historical and political similarities
such as the ?strong?5 role and ?long history?5 of
private insurance and powerful, vocal physicians?
groups1,5 make the Australian experience a useful
comparative one for US policymakers. As Altman
and Jackson note, the US system will probably not
develop into a fully public system, but a system
combining private and public aspects along the
lines of the Australian model is possible.5
Furthermore, while politicians in the US at the
state and local levels have attempted to address
the issue of universal or near-universal coverage
for some time, previous efforts sought to expand
coverage using existing programs instead of
establishing a new system.6 More recently, the
state of Massachusetts and the county (municipality)
of San Francisco have introduced near-universal
health care programs. Although introduced
nearly simultaneously, their development processes
and structures differ. In addition, the Massachusetts
plan in particular was viewed as a
potential model for future sub-national and possibly
national health reforms.
Thus, this short paper examines the two plans
as two different approaches to health care reform
in the US and compares them to the Australian
system, asking the question whether or not current
reform efforts in the US make the system
more like that in Australia, or are likely to do so
in the future.
GP access to MRI: the Australian reality
Authors: Bradfield Owen M
Published: February 2010

Twelve months ago, the Australian Medical Association
(AMA) called upon the Federal Labor Government
to implement a previous coalition policy
allowing general practitioners to directly refer
patients for magnetic resonance imaging (MRI)
scans of the knee and brain. To support their
position, the AMA commissioned a University of
Sydney report evaluating the health care and
economic outcomes of the policy. The AMA
reported that the results supported the policy and
would result in a $42 million saving from fewer
computed tomography (CT) scans and fewer specialist
referrals and consultations. Arguably, this
was not an accurate portrayal of the results.
Further research is needed, and ongoing dialogue
with radiologists and other key stakeholders is
urged, to ensure that access to MRI facilities will
continue to meet future demand and that GPs will
be adequately trained in utilising MRI services.
Leadership transformation in Queensland Health
Authors: Crethar Meagan P , Phillips Jan N , Stafford Paul J , Duckett Stephen J
Published: February 2010

IN 2006, QUEENSLAND HEALTH embarked upon a
major reform program that included a comprehensive
leadership development program for senior
leaders, managers and supervisors. The
objective was to achieve improvements in the
leadership capabilities of key staff that will result
in real improvements in workplace culture. The
components of the program include: actionlearning
leadership development workshops,
360-degree feedback, executive coaching, leadership
learning modules and an interactive leadership
website. The program is constantly evolving,
and implementation commenced in 2007 of a
second phase which includes a number of additional
initiatives ? an Emerging Clinical Leaders
Program, a Top 500 leaders Program, Conflict
Resolution Program for Clinicians and a Clinical
Network Chairs Leadership Program. Workforce
statistics have shown a distinct improvement
since the implementation of the program.
Developing and implementing an action-oriented staff survey: Queensland Health and the 'Better Workplaces' initiative
Authors: Jury Ceri , Anthony Machin M , Phillips Jan , Eng Goh Hong , Olsen Shaney , Patrick Jeff P
Published: February 2010

QUEENSLAND HEALTH IMPLEMENTED the ?Better
Workplaces? staff opinion survey (the survey) in
May 2006. The initiative stands as the largest
single staff survey ever conducted in Queensland,
and one of the largest in Australia. This case study
outlines the process of this project, the outcomes
to date and some of the pitfalls and successes
along the way.
Logistically it involved 37 health service districts
and 10 corporate areas spread across the state. The
survey process incorporated four survey periods
over two years. The aim of the survey was: to
improve workplace culture at the local level and
across the organisation as a whole. Workplace
culture is defined by Cole as ?The collection of
unwritten rules, codes of behaviour and norms by
which people operate, how we do things around
here?1 Queensland Health proposed to improve its
workplace culture by listening to staff and developing
and driving targeted action plans following the
survey with each district and division to create a
climate of trust, respect, and innovation among
staff which will ultimately improve patient outcomes.
?. . . The creation of a culture that is free of
blame and encourages an open examination of
error and failure is a key feature of services dedicated
to quality improvement and to learning.?
Actions and results from the Queensland Health "Better Workplaces" staff opinion survey
Authors: Jury Ceri , Eng Goh Hong , Olsen Shaney P , Elston Jan , Phillips Jan
Published: February 2010

In April 2006, the Workplace Culture and Leadership
Centre (the Centre) from Queensland
Health launched the ?Better Workplaces? initiative.
The objective was to improve workplace
culture and increase the capabilities of its leaders.
A comprehensive program of leadership development
complemented the workplace culture
improvement strategy. As part of the initiative, the
Centre launched a series of staff opinion surveys
to monitor workplace culture improvement over
time. To ensure the survey process was action
oriented, the Workplace Culture Team developed
a companion process ensuring the results were
acted upon and tangible improvements were realised.
This resulted in a comprehensive and robust
process involving the development and implementation
of action plans in every district and
division in Queensland Health.
Necessity breeds innovation: GPs help prevent an emergency department closure
Authors: Partanen Riitta L , O'Brien Maxine L , Eley Diann S
Published: February 2010

In January 2006 the Maryborough Base Hospital
in Queensland faced imminent closure of its emergency
department (ED) due to a shortage of
senior medical staff. At the same time patient
confidence in Queensland Health was low. During
consultation forums, the community had made it
clear that their priority was to maintain emergency
services in Maryborough. In search of a solution,
the Fraser Coast District Health Service asked
Maryborough general practitioners to work in the
Maryborough Hospital ED and/or in the internal
medicine ward as Visiting Medical Officers. While
this represented a solution to the problem, there
was much to be considered before such a plan
could be put into place.
Self-sufficiency in intern supply: the impact of expanded medical schools, medical places and rural clinical schools in Queensland
Authors: Eley Diann S , Zhang Jianzhen , Wilkinson David
Published: February 2010

Objective: The doctor shortage in Australia generally,
and the rural shortage in particular, has led
to an increase in medical schools, medical places
and rural training. If effective, these strategies will
first impact on the intern workforce. We studied
the source of interns in Queensland.
Methods: Analysis of number, source and location
of interns by Rural, Remote and Metropolitan
Area (RRMA) classification (an index of remoteness)
from university and health department
records (2003?2008). Odds ratios compared the
likelihood of intern supply from Queensland universities
and rural clinical schools.
Results: Most interns in Queensland graduated
from Queensland universities in 2007 (287 [72%])
and 2008 (344 [84%]). Proportions increased
across all three RRMA groups from: 82% to 93%
in RRMA1; 56% to 68% in RRMA2 and 67% to
79% in RRMA3. The University of Queensland
(UQ) provides most interns in all RRMA locations
including RRMA3, and this increased from 2007
(n = 33 [35%]) to 2008 (n = 57 [58%]). Interns from
interstate decreased from 61 (15%) in 2007 to 40
(10%) in 2008. Interns from overseas fell from 53
(13%) in 2007 to 27 (7%) in 2008. Rural clinical
schools compared with traditional urban-based
schools were more likely to supply interns to
RRMA3 than RRMA1 hospitals in 2007 (OR, 8.8;
95% CI, 4.6?16.7; P< 0.0001) and 2008 (OR, 6.5;
95% CI, 3.5?12.2; P< 0.0001).
Conclusions: Queensland is close to self-sufficiency
in intern supply and will achieve this in the
next few years. Rural clinical schools are playing
an important role in producing interns for RRMA3
hospitals. Due to its large cohort, UQ remains the
major provider across all RRMA groups.
Admission variables predicting short lengths of stay of acutely unwell older patients: relevance to emergency and medical short-stay units
Authors: Basic David , Khoo Angela
Published: February 2010

Objective: To help develop criteria to identify
older patients suitable for admission to medical
short-stay units, by determining predictors of
length of stay (LOS) of 3 days or less.
Methods: The data were prospectively collected
from consecutive older patients admitted from the
emergency department of a university hospital to
an acute geriatric medicine service. Data included
active medical diagnoses, the Modified Barthel
Index (MBI), the Timed Up and Go (TUG) test,
and demographic information. Logistic regression
was used to model the probability of LOS of 3
days or less (short LOS).
Results: Among 2036 patients discharged alive
from hospital (mean age, 82 years; median LOS, 7
days), 398 had a short LOS (median, 2 days), while
1638 had a long LOS (median, 9 days). In logistic
regression analysis, the main independent predictors
of short LOS were an MBI score >15/20 (OR,
2.98; 95% CI, 1.97-4.49), ability to perform the
TUG test (OR, 2.08; 95% CI, 1.34-3.24) and
absence of delirium (OR, 2.66; 95% CI, 1.56-4.54).
Patients without infection, anaemia, gastrointestinal
disorder and stroke were also more likely to have a
short LOS in multivariate analysis (all P<0.05).
Conclusion: Preserved function, measured
using the MBI and TUG, and the absence of
delirium are strong predictors of short LOS. In
conjunction with early, skilled clinical evaluation,
these criteria could be used to select older
patients presenting to the emergency departments for admission to short-stay units.
Community-based health care:a different approach to health outcomes
Authors: Walker Rae , Mitchell Sally
Published: February 2010

Health sector organisations are undergoing a period of fundamental change. Oneset of changes is about increasing the capacity of the system to provide integratedclient care. This paper discusses the practices that community health care workershave used to approach some basic issues of service integration. Although thediscussion is about practices in community health, the issues are important for healthcare providers, managers and policy-makers throughout the health care system.
The Industry Commission inquiry into charitable organisations
Authors: Suter Keith
Published: February 2010

The Industry Commission has carried out Australia's largest inquiry into charities.It was, from the point of view of charities, an unsatisfactory operation, all the moreso since it was not clear why the task had been given to the commission. This articleexamines the commission?s work in three ways: the overall relationship betweengovernment and charities; the commission?s proposed major reforms; and the minorreforms.
Communication ? The vital link in best practice organisations
Authors: Horsley Katrina
Published: February 2010

The critical issue of communication has been addressed by the Princess AlexandraHospital in Brisbane. The hospital commissioned a communications audit,benchmarked outside the health sector in the service industry, and designed andpiloted communication strategies at an organisational level and in selected clinicalsettings. The communications models developed have emphasised the importance ofplanning, evaluation and flexibility to enable the modification of communicationstrategies to continually improve communication in the organisation. It is envisagedthat regular communication assessments will be conducted with the use of audit toolswhich have been developed to compare results over time.
A typology for legal risk management in patient care in Australian hospitals
Authors: Newby Liza
Published: February 2010

The author reviewed the literature on legal risk management in patient care, andcarried out research in two acute care hospitals. The hospital research involvedauditing policies and procedures, interviewing key people in the hospital, reviewingexternal legal and policy trends, and examining selected complaints files and legalcases. The results were used to develop a ?typology? of legal risk management to provideguidelines and assistance to hospital management in improving their hospital?sstrategic response to legal vulnerability. The model sets out four levels of legal riskmanagement programs, and identifies specific components classified as promoting lossprevention, or loss minimisation.
And the winner is?system!
Authors: Smyth Tim
Published: February 2010

Australian Health Review sought the following replies to the commentary Why a traditional health outcomes approach will fail in health care and a possible solution by Lesia Gale.
Are we ready for change?
Authors: O'Hara Cathy
Published: February 2010

There is no doubt that improved knowledge of health outcomes and theircausation will lead to improved care at a lower cost. The question is: Howprepared are we to accept the challenge that ultimately demands change in anindustry that until recently was steeped in tradition?
Evaluating health information systems: An assessment of frameworks
Authors: Jayasuriya Rohan
Published: February 2010

The rapid increase in investments for computerised systems is a major concern for all health organisations. Questions about these investments arise as information technologyis only one of the areas that are competing for a finite amount of resources. There is also some concern that some of the failures of information technology would have been detected if proper evaluation of information systems were conducted. The state of the art of evaluating information systems shows changes from a very positivist approach tomore comprehensive approaches that would incorporate multiple methods. This paperpresents an assessment of the techniques and methods for information systems evaluation, followed by an application to a case study in community health to illustrate the value of the contextualist approach to evaluation. The paper argues for the use of longitudinal, contextualist approaches to information systems evaluation if decision-makers seek to improve the situation of information systems in the health industry.
Trial of labour versus elective repeat caesarean section:A cost-effectiveness analysis
Authors: Shorten Allison , Lewis Donald E , Shorten Brett
Published: February 2010

For subsequent births, women who have experienced previous caesarean section facea choice between elective caesarean section and trial of labour. The study reported inthis paper utilises Australian hospital data to compare birth outcomes and healthsystem costs of these two options. Although trial of labour is more expensive if the resultis an emergency caesarean section, high rates of successful vaginal delivery mean that,overall, trial of labour is found to be 30- per cent less expensive than elective caesareansection. It is estimated that trial of labour remains the most cost-effective option aslong as less than 68- per cent of women require emergency caesarean section. This studyhighlights the potential importance of more accurate information about a broaderrange of costs and outcomes in order for stronger conclusions to be drawn.
Waiting list statistics as performance indicators: Observations on their use in hospital management
Authors: Cromwell David , Mays Larry
Published: February 2010

Improvements in data collection and the types of statistics collected have enhancedthe usefulness of waiting list statistics as a measure of hospital performance. But thesechanges are not sufficient for waiting list statistics to be used effectively formanagement purposes. The statistics need to be viewed alongside activity data ifclinicians and managers are to identify specific areas that need improvement. Thismeans that how the data are analysed and presented is also important.During a study into the management of waiting lists, we observed that waiting listdata were typically presented in a way that made interpretation difficult. A simplebut effective solution was found by using available PC-based software, but obstaclesremain. These stem from limitations of current information systems and the awarenessamong staff of the potential of common software packages.
Severity variations within DRGs:Measurement of hospital effects by use of data on significant secondary diagnoses
Authors: Hindle Don , Degeling Pieter , Van Der Wel Ono
Published: February 2010

The Diagnosis Related Group classification has provided an excellent basis forenhancing the equity of resource allocation between public acute hospitals. However,it underestimates the higher levels of severity and consequent costliness of referralhospitals.This paper describes a practical way of measuring within-DRG variations in severity,which can be used to increase the precision of casemix-based funding. It involves theregression of length of stay against the numbers of significant diagnoses and procedures,and hence the prediction of additional justified costs. An example is given of itsapplication to data from South Australian public hospitals.
The AHA?s ideas on health policies for Australia
Authors: Smith John
Published: February 2010

In late 1997 the Australian Healthcare Association (AHA) began a process ofreviewing and updating its ideas on health care in Australia. One importantactivity comprised a strategic planning workshop in February 1998, which wasattended by members of the National Council. Experts from government andother health associations also participated, and their support was greatlyappreciated.Preliminary ideas arising from the deliberations are summarised in a discussionpaper which has been widely distributed for comment (AHA 1998). Thefollowing is a condensed version, although the scope is hardly affected.
Sailing without radar: An excursion in resource allocation
Authors: Alexander Kathy , Hicks Neville
Published: February 2010

This paper deals with the knowledge base employed in resource allocation. Itdeliberately distinguishes between ?thick-textured? and ?thin-textured? knowledge. Athick-textured view of change in the health sector accounts for the history, civic goodsand variety of human needs and passions which rationalist economics defines out asa thin-textured matter of individual choices in a free market.1 The narrative materialbegins with a discussion of health service policy-making in South Australia andelsewhere in the 1980s and 1990s, then proceeds to a discussion of priority-settingliterature, which we regard as thin-textured. We offer two accounts of approaches tosetting priorities in health care which we think have overcome some of the deficienciesof the thin-textured approach.
Differentials in hospital admission rates for the Aboriginal and Torres Strait Islander population in New South Wales
Authors: Ishak Maged
Published: February 2010

The indigenous Australian population is well known to have higher rates of morbidityand mortality than the rest of the Australian population. The study reported in thispaper demonstrates the use of hospital admission data from New South Wales tomonitor the health circumstances and the main areas of differentials of the indigenouspopulation in relation to access to primary health care services. The study covers theperiod from 1989 to 1995. In providing a statistical approach to analysing largeroutine databases, the major results have been to provide estimates of the hospitaladmission rates by residential area, sex and age of patient, and to highlight the maindifferences.
Casemix funding in rural NSW:Exploring the effects of isolation and size
Authors: Hindle Don , Frances Maureen , Pearse Jim
Published: February 2010

The New South Wales Department of Health (NSW Health) wishes to makeappropriate use of casemix data as inputs to the determination of funding levels for small rural hospitals. However, other factors such as hospital size and degree of isolation might need to be taken into account.The study reported here involved correlation of actual expenditures with thosepredicted by use of a casemix model alone, across 105 small public hospitals in theState. We then explored the extent to which the correlation could be increased by theaddition of distance and isolation variables.It was found that actual costs were highly correlated with those predicted from thecasemix data alone, and that the correlation increased when both the distance andthe size variables were introduced. However, contrary to expectations, reduced sizewas associated with reduced costs, and reduced isolation was associated with increasedcosts.It was concluded that, while the predicted relationships may be present, they arelikely to be relatively weak and are probably being masked by other factors notpresent in the model. In particular, it seems likely that there are variations inseverity within the acute admitted patient category which are not fully explainedby the casemix instrument used in this study (the DRG classification). We suggestthat other terms be introduced to control for this possibility before any furtherattempt is made to test whether size and distance factors can be identified whichwork in the expected direction.
Hospital outreach service: Helping to prevent nursing home placement
Authors: Bairstow Phillip , Ashe Sarah , Bairstow Mary
Published: February 2010

An outreach service from a post-acute metropolitan teaching hospital delivered anintensive, multidisciplinary and coordinated allied health service, and achieved bothearly hospital discharge and the prevention or delay of nursing home placement. Thisarticle reports on three types of cases which illustrate how the service assisted wardteams, families and patients to determine whether nursing home placement wasessential. For a group of 20 cases, the total reduction in hospital length of stay was556 days, and home accommodation as an alternative to nursing homeaccommodation was achieved for a total of 7505 days. The article outlines a matrixof advantages and disadvantages, both tangible and intangible, of home versusnursing home accommodation. It is suggested that a full costing of this matrix wouldinform debate on the comparative merits of long-term home and nursing homeaccommodation.
Compliance of hand washing practices: Theory versus practice
Authors: Roberts Lorette , Bolton Patrick , Asman Sonia
Published: February 2010

Hand washing remains an important preventative method for making thetransmission of nosocomial infections redundant. Despite awareness by health workersof the practices required and of the legislation governing hand washing, the studyreported here found that compliance to these procedures was quite poor. The resultsof two surveys distributed to health workers and direct observation by clinical staffin an aged care hospital found that 45percent of health workers did not wash their handsand 24 percent did not change their gloves between patient consultation. Methods forincreasing effective hand washing in clinical settings must be identified if hygienicpractice is to be improved.
Lessons from the other side: What can we learn from the private sector?
Authors: Clarke David
Published: February 2010

Business has reacted in an impressive manner to increasing globalisation, short-term stockmarket pressure for performance, emerging industries and new technologies. While the private sector has become increasingly competitive, the public sector has not adopted this commercial rigour. Funding pressures on health services will continue, as will increasing consumer and staff demands and the blurring of public and private health care provision. As a result, there are lessons and techniques the public and private health sectors should learn from each other.I have drawn the issues that follow from my experience in the steel and food industries.
Initiatives in primary health care: Evaluation of a South Australian program
Authors: Murray Charlie , Jolley Gwyneth
Published: February 2010

In 1994 the Primary Health Care Initiatives Program was established as part of the South Australian government's hospital service improvement strategy. In its first year, the program funded 34 demonstration projects, of which half were concerned with improving continuity of care and discharge planning, and half with health promotion or illness prevention. Evaluation of the program has shown that it achieved significant improvements in links and communication between the services involved, in the development of systems and procedures for facilitating discharge-planning and continuity of care, and in enhancing the capacity of organisations to undertake health promotion and illness prevention. Overall, it was not possible to determine whether the program had shortened or avoided hospital stays due to a range of factors, including the many changes occurring in the health system at the time. The program's strong emphasis on evaluation has produced a rich source of information and helped to develop the evaluation skills of project staff.
Canned Laughter
Authors: Goehr Lydia
Published: February 2010

This response to Daniel Leech-Wilkinson's paper questions whether the (explanatory) movement between culture, nature, biology and music is as seamless as his argument suggests.
Towards the Third Way: Interdisciplinary Attitudes to the History and Practice of Listening
Authors: Lockhart William
Published: February 2010

Contributions to the discussions following the papers presented at the Royal Musical Association conference ‘Listening: Interdisciplinary Perspectives’ held at King's College, Cambridge, on 24–25 November 2006 were particularly animated. This paper attempts to capture in outline the main exchanges of the question-and-answer sessions, while at the same time doing justice to the broad interdisciplinary spirit that characterized the event.
Effective casework practice with adolescents: perspectives of statutory child protection practitioners
Authors: Schmied Virginia , Walsh Peter
Published: February 2010

Many child protection practitioners struggle with the complexity of problems and the limited casework time for adolescent cases. However, there is little research on child protection practice or case management that can guide a practitioner working with adolescents in the child protection system. The aim of this study was to explore and describe the nature of effective child protection practice with adolescents from the perspective of statutory child protection practitioners in one state in Australia. Data were collected through focus group discussions and interviews with child protection practitioners and managers currently working with adolescents (n= 44). A grounded theory approach was used to identify the dominant themes or categories and form linkages and relationships through constant comparison techniques. Seven key categories emerged from this analysis: characteristics of the young person and their family; ‘walking it together’– the centrality of relationships; ‘looking back/looking forward’– practice strategies; practitioner attributes and skills; ‘walking a fine line’– working with the families of adolescents; ‘walking with services’– effective inter‐agency work; and organizational context in effective child protection practice with adolescents. Key implications for practice and areas for further research were discussed.
Longevity of seeds of Poa trivialis and Vulpia myuros as affected by simulated soil tillage practices and straw disposal technique
Authors: Jensen P. K.
Published: February 2010

In grass‐seed production, the purity of the product is of high importance and a main issue in an integrated strategy is to reduce or eliminate the seedbank of species which are both difficult or impossible to control in a future grass‐seed crop, and also difficult to separate from the cultivated species. This study investigated the influence of different simulated soil‐tillage practices on persistence of seeds of the two grass species, Poa trivialis and Vulpia myuros, under field conditions. Leaving seeds of the two species at the soil surface reduced the survival of seeds to low levels compared with strategies that involved incorporation of the seeds shortly after seed‐shedding. Persistence of P. trivialis seeds increased with increasing depth of incorporation whereas this relationship was more variable for V. myuros. It was concluded that soil‐tillage strategies that leave the seeds at the soil surface for 1–2 months reduced the survival of seeds of the two species to low levels compared with strategies that involved a deep incorporation of the seeds shortly after seed‐shedding. The study also investigated the possibilities of using the stale seedbed technique to reduce the seedbank of these two species in the autumn ahead of a spring‐established grass‐seed crop. This method was found to be very effective in reducing the potential risk of contamination from this source. Finally, the study confirmed that P. trivialis has very persistent seeds whereas the persistence of seeds of V. myuros is limited.
Nutritive value of herbage of five semi‐irrigated pasture species across an irrigation gradient
Authors: Jensen K. B. , Waldron B. L. , Peel M. D. , Robins J. G.
Published: February 2010

As water resources become limiting, the need to produce stable amounts of herbage with a high nutritive value increases. An understanding of how levels of irrigation affect crude protein (CP) and neutral‐detergent fibre (NDF) concentrations and, in vitro true digestibility (IVTD), is critical in the management of pastures. Smooth bromegrass (Bromus inermis Leyss.), prairiegrass (Bromus willdenowii Kunth), hybrid‐bromegrass [meadow (Bromus riparius Rehm.) × smooth bromegrass], creeping foxtail (Alopecurus arundinaceus Poir.) and RS wheatgrass (Elymus hoffmannii Jensen & Asay) were established under a line‐source irrigation system to evaluate the effect of five water levels and three harvest dates on concentrations of CP and NDF, and values of IVTD. With CP concentration of herbage, there were positive linear significant relationships with decreasing water levels for all species. Rankings for mean CP concentrations across water levels and harvest dates were smooth bromegrass > RS wheatgrass > hybrid‐bromegrass > creeping foxtail > prairiegrass. No consistent relationships with IVTD across water levels were detected among the species. Averaged across water levels, harvest dates and years, smooth bromegrass, hybrid‐bromegrass and creeping foxtail had significantly higher IVTD values than RS wheatgrass and prairiegrass. Rankings of mean NDF concentrations across water levels and harvest dates combined over years were prairiegrass > RS wheatgrass > hybrid‐bromegrass > creeping foxtail > smooth bromegrass. Herbage of smooth bromegrass had higher IVTD values and lower NDF concentrations than hybrid‐bromegrass, prairiegrass, creeping foxtail and RS‐hybrid at all water levels.
Decreased high‐density lipoprotein cholesterol is associated with inflammation and insulin resistance in non‐diabetic haemodialysis patients
Authors: PENG YU‐SEN , CHIU YEN‐LING , CHEN HUNG‐YUAN , YANG JU‐YEH , LAI CHUN‐FU , HSU SHIH‐PING , PAI MEI‐FEN
Published: February 2010

Aim:  Lower serum high‐density lipoprotein cholesterol (HDL‐C) is associated with inflammation, insulin resistance and poor cardiovascular outcomes in the general population. However, in a large‐scale study, the association between HDL and survival in haemodialysis patients was not present. The exact cause of lack of HDL‐C protection in the dialysis population is still obscure.

Methods:  A total of 89 stable non‐diabetic haemodialysis patients were recruited. Fasting serum biochemical parameters, complete blood counts and inflammatory markers were obtained before the mid‐week dialysis. Insulin resistance was assessed by the Homeostasis Model Assessment of Insulin Resistance (HOMA‐IR).

Results:  The mean age was 58.2 ± 13.1 years, 37 (41.6%) patients were male. The mean HDL‐C level was 56.3 ± 17.1 mg/dL. By bivariate correlation analysis, a lower serum HDL‐C level was related to higher body mass index (r = −0.425; P < 0.001), higher triglyceride (r = −0.479; P < 0.001) and higher HOMA‐IR (r = −0.211; P < 0.05) levels. The serum HDL‐C level was also inversely related to high‐sensitivity C‐reactive protein (hsCRP) (r = −0.297; P = 0.005) and tumour necrosis factor‐α (TNF‐α) (r = −0.295; P = 0.005) and directly correlated with adiponectin (r = 0.560; P < 0.001). In multivariate linear regression analysis, HDL‐C was found to be directly correlated with adiponectin (β‐coefficient = 0.569; P < 0.001) and inversely correlated with TNF‐α (β‐coefficient = −0.292; P = 0.001).

Conclusion:  A strong association between HDL‐C, inflammatory surrogates, and insulin resistance in this non‐diabetic, non‐obese haemodialysis patient group is demonstrated. The HDL‐C level is still a good parameter to screen high‐risk patients.
A method for determining the fatigue critical plane for biaxial random vibration in the frequency domain
Authors: MCNEILL S. I.
Published: February 2010

This paper provides a direct method to determine the critical plane orientation for biaxial random vibration. The critical plane is obtained by finding the direction that maximizes the normal stress variance. It is found that the shear stress is uncorrelated with the normal stress in this orientation. Furthermore, the direction of maximal normal stress is shown to coincide with the principal direction in the case of proportional stress components. Spectral fatigue damage methods proposed in recent literature involve a Monte Carlo enumeration step to find the critical plane orientation. By using the proposed technique, computationally expensive enumeration methods are avoided and greater accuracy in the fatigue damage estimate may result.
The effects of submerged aquatic vegetation on the persistence of environmental populations of Enterococcus spp.
Authors: Badgley Brian D. , Thomas Florence I. M. , Harwood Valerie J.
Published: February 2010

Enterococcus spp. are utilized worldwide as faecal indicator bacteria, but certain strains exhibit extended survival in environmental habitats and the factors influencing their persistence are poorly understood. We used flowing freshwater mesocosms to explore the effect of submerged aquatic vegetation (SAV) on the persistence of natural enterococci populations from a subtropical lake. The highest mean densities of culturable enterococci over 2 weeks occurred in SAV [8.6 × 102 colony‐forming units (cfu) per 100 g wet weight], followed by sediments (1.3 × 102 cfu per 100 g) and water (18 cfu per 100 ml). However, due to relative differences in the total mass of each substrate in the entire system (water > sediments > SAV), SAV‐associated enterococci represented only a minor proportion of the total population. Vegetated mesocosms harboured significantly higher mean cfu per mesocosm and cfu densities in sediments compared with their unvegetated counterparts, suggesting that SAV indirectly facilitates persistence in aquatic habitats. Populations were dominated (> 96%) by a single Enterococcus casseliflavus strain according to BOX‐PCR genotyping, which did not change over the 10‐month study and strongly suggests bacterial replication in the lake. The presence of such strains in the environment may represent highly competitive, naturalized and reproducing indicator bacteria populations that are not directly related to pollution events.
Interval-Censored Data with Repeated Measurements and a Cured Subgroup
Authors: Li Jialiang , Ma Shuangge
Published: February 2010

The hypobaric decompression sickness data study was conducted by the National Aeronautics and Space Administration to investigate the risk of decompression sickness in hypobaric environments. The quantity of interest is the time to onset of grade IV venous gas emboli, which was mixed case interval censored because of measurement limitations. In the study, some subjects participated in multiple experiments, leading to repeated and correlated measurements on those subjects. In addition, it has been suggested that some subjects had a much lower risk of developing grade IV venous gas emboli than others, i.e. those subjects were immune from the event of interest (or ‘cured’). We propose to use two-part models, where the first part describes the probability of cure and the second part describes the survival for susceptible subjects. We use two random effects to account for the correlated nature of measurements. A leverage bootstrap approach is proposed for model diagnosis. A simulation study shows satisfactory performance of the estimation and diagnosis approaches proposed. Model estimation and evaluation of the hypobaric decompression sickness data are carefully investigated.
A Note on the (Un)Pleasant Arithmetic of Fiscal Policy: The Case of Italian Public Debt
Authors: Marattin Luigi , Marzo Massimiliano
Published: February 2010

Using the simple arithmetic of government budget constraint, we perform an illustrative analysis on the Italian case, investigating the consequences on the main public finance aggregates of the adoption of a fiscal policy rule responding to past real debt/GDP ratio. Such a rule, firmly grounded in the economic analysis, would allow the reduction of Italy's outstanding stock of debt without requiring the strict adherence to the 3 per cent criterion for deficit/GDP ratio, as prescribed by SGP (Stability and Growth Pact). We perform a forecasting exercise under five alternative scenarios and analyse the details of a structural debt reduction strategy with alternative yearly step.