bluuebunny/crossref_metadata_2025 huggingface dataset:
A retrospective comparative study of patients with chest pain and intra-ward transfers
Authors: Blay Nicole , Donoghue Judith , Mitten-Lewis Suzanne
Published: February 2010

This retrospective, comparative survey examined patients who had a discharge diagnosis of chest pain and were admitted to The St. George Hospital between July 1999 to June 2000. The aim was to identify the clinical wards/units to which patients were admitted and the number of intra-ward transfers' patients experienced during their hospitalisation. Patients admitted to the cardiology ward/units and outlying wards were compared to determine the number of intra-ward transfers and length of hospital stay. The study found that older patients were more likely to be transferred and that the number of intra-ward transfers impacted uponlength of hospital stay.
A decade of change in a community health service: a shift to acute and short-term care
Authors: Kemp Lynn , Comino Elizabeth , Harris Elizabeth , Killian Debbie
Published: February 2010

There have been major policy changes impacting on community health services such as early discharge and hospital in the home initiatives. The effects of such policies on the client profile of community health services are not well known. Administrative data was used to explore a decade of changes in South Western Sydney Area Health Service community health services. There is a clear shift from a service primarily focussed on child health screening to one that is increasingly providing acute and shorter-term care to adults with physical health problems. The changes are reflective of policies that are moving acute treatment services into the community.
The effects of increased private health insurance: a review of the evidence
Authors: Hindle Don , McAuley Ian
Published: February 2010

Private health insurance membership declined
steadily between 1984 and 1997, after which
major government interventions caused it to
increase. We review some of the literature and
conclude that the increases in membership were
probably associated with a loss of equity and costeffectiveness
for the health care system as a
whole.
We attempt to explain why the government made
the changes and conclude that the main factors
were vested interests of those who have benefited
and a confusion of objectives.
The changes may have resulted in a more balanced
use of available resources (such as the
balance between government and private hospital
utilisation) but these and other desirable objectives
might have been better achieved in other
ways. We advocate that a more serious effort be
made in future to ensure that policy takes more
account of evidence, logic, and system-wide
design and coherence.
Care coordination and health sector reform
Authors: Dwyer Judith , Leggat Sandra G
Published: February 2010

THE PRODUCTIVITY COMMISSION (Productivity
Commission 2004) has nominated nationally
coordinated health sector reform as one of two
top priorities (along with natural resource
management) for extending the industry reform
agenda under the aegis of National Competition
Policy. This is in recognition of the importance of
these areas for the wellbeing of Australians, and
the level of resources they will require in future
years. The Commission states that ?an
independent review of Australia?s health system as
a whole is a critical first step in achieving
cooperative solutions to deep-seated structural
problems? (p. XI). The fragmentation in health
system governance that results from the national?
state split is mirrored in the lack of coordinated
care at many levels throughout the system. The
Commission?s proposal has been welcomed by
many in the health industry, no doubt with some
nervousness, because of the broad and deep
conviction that something has to change in the
apparently intractable problem of split funding
responsibilities.
?Today?s health-care delivery systems are not
organized in ways that promote best quality.
Service delivery is largely uncoordinated,
requiring steps and patient ?hand-offs? that slow
down care and decrease rather than improve
patient safety? (OECD 2004). Improving care
coordination is high on the list of issues to be
addressed in any reform of the health sector.
This issue of the journal features a collection of
papers which address the sometimes jagged
?seams? in the current system. They offer
insights into some of the consequences of the
structural problems the Productivity Commission
would like to see addressed, and document
an energetic search for methods of enhancing
the effectiveness of health care.
The decision process of leaving nursing
Authors: Cheung Jenny
Published: February 2010

This article reports the findings of a research
study investigating the decision process of former
division one nurses in deciding to leave the profession.
Semi-structured interviews were conducted
wi th 29 par t icipants. For many
participants, leaving nursing was not an easy
decision. This article outlines the decision processes
of five of the study participants to illustrate
the complex psychological process associated
with quitting. The insight gained may shed light on
how to entice back nurses who have left the
profession and address the needs of those thinking of leaving.
A prospective, randomised controlled trial of an aged care nurse intervention within the Emergency Department
Authors: Basic David , Conforti David A
Published: February 2010

The aim of this randomised controlled trial involving
224 elderly patients was to determine whether
early geriatric assessment (in the form of an aged
care nurse intervention based in the emergency
department) reduced admission to the hospital,
length of inpatient stay (LOS), or functional
decline during the hospitalisation. Baseline geriatric
assessments were recorded in the medical
files of intervention patients (n = 114). The nurse
also liaised with the patients? carers and health
care providers, organised referrals for out-of-hospital
assessment and support services, and
assisted in the care of those admitted as inpatients
by documenting suggestions for assessment
and referral. Assessment data from control
patients (n = 110) were withheld, and the nurse
had no further involvement in their inpatient or
outpatient care. One hundred and seventy-one
patients (76%) were admitted to the hospital, for a
median LOS of 10 days. The nurse successfully
identified those needing admission (odds ratio
[OR], 14.0; 95% confidence interval [CI], 2.6?
75.1). Thirty-nine of 160 inpatients with available
data (24%) had a functional deterioration during
the hospitalisation. The intervention had no significant
effect on admission to the hospital (OR, 0.7;
CI, 0.3?1.7), LOS (hazard ratio, 1.1; CI, 0.7?1.5)
or functional decline during the hospitalisation
(OR, 1.3; CI, 0.5?3.3).
Canadian health system reforms: lessons for Australia?
Authors: P Marchildon Gregory
Published: February 2010

This paper analyses recent health reform
agenda in Canada. From 1988 until 1997, the
first phase of reforms focused on service integration
through regionalisation and a rebalancing
of services from illness care to prevention
and wellness. The second phase, which has
been layered onto the ongoing first phase, is
concerned with fiscal sustainability from a provincial
perspective, and the fundamental nature
of the system from a national perspective.
Despite numerous commissions and studies,
some questions remain concerning the future
direction of the public system. The Canadian
reform experience is compared with recent Australian
health reform initiatives in terms of service
integration through regionalisation, primary
care reform, Aboriginal health, the public?private
debate, intergovernmental relations and the role
of the federal government.
Strengthening clinical governance through cultivating the line management role
Authors: Balding Cathy
Published: February 2010

The implementation of clinical governance in
health care services introduces increased responsibility
and transparency around safety and quality
into all staff roles. Encouraging staff to assume
these responsibilities as part of their daily routine
is fundamental to achieving effective clinical governance,
and requires health care managers at all
levels to embrace clinical governance leadership
and management. Fostering this role will need to
be approached skilfully if managers are to achieve
effective leadership of clinical governance activities.
This paper reviews the management and
quality-related literature to explore how these
roles may best be developed to ensure that health
care managers are equipped and willing to undertake
the critical task of translating clinical governance policy into day-to-day practice.
Predictors of failure by medical practitioners to report suspected child abuse in Queensland, Australia
Authors: Schweitzer Robert D , Buckley Lisa , Harnett Paul , Loxton Natalie J
Published: February 2010

Objective: The goal of this investigation was to
examine the level of notification of child abuse and
neglect and the perceived deterrents to reporting by
medical practitioners, who are mandated to report
their suspicions but might choose not to do so.
Design: A random sample of medical practitioners
was surveyed. About three hundred medical
practitioners were approached through the local
Division of General Practice. 91 registered medical
practitioners in Queensland, Australia, took
part in the study.
Results: A quarter of medical practitioners admitted
failing to report suspicions, though they were
mostly cognisant of their responsibility to report
suspected cases of abuse and neglect. Only the
belief that the suspected abuse was a single
incident and unlikely to happen again predicted
non-reporting (?2 [1, N = 89] = 7.60, p<0.01). No
gender, age or parent status differences were
found between reporters and non-reporters.
Conclusions: Although the rate of non-reporting
shows improvement from previous research, it is
still at an unacceptable level. The failure to report
appears to result not from judgement about the
presence or absence of indicators of child abuse
and neglect but a threshold that moves individuals
to act on their suspicions. Professional development
should focus on some of the fallacies which
often influence medical practitioners? decisions.
"There's no point in complaining, nothing changes": rural disaffection with complaints as an improvement method
Authors: Jones Judith A , Meehan-Andrews Terri A , Smith Karly B , Humphreys John S , Griffin Lynn , Wilson Beth
Published: February 2010

Objective: To validate earlier findings that lack of
access to health services is the most likely issue
of complaint by rural consumers, and that lack of
knowledge about how to make effective complaints
and scepticism that responses to complaints
bring about service improvement account
for the under-representation of complaints from
rural consumers.
Design: Unaddressed reply-paid mail survey to
100% of households in small communities, and
50%, 20% or 10% in progressively larger communities.
Setting: Eight communities in the Loddon-Mallee
region of Victoria.
Participants: 983 householders most responsible
for the health care of household members,
responding to a mailed questionnaire.
Main outcome measures: Issues of complaints
actually made; issues of unsatisfactory situations
when a complaint was not made; reasons for not
complaining; to whom complaints are made; and
plans for dealing with any future complaint.
Results: Earlier findings were confirmed. Lack of
access to health services was the most important
issue, indicated by 54.8% of those who had made
a complaint, and 72% of those who wanted to but
did not. The most common reason given for not
complaining was that it was futile to do so. Lack of
knowledge of how to make effective complaints
which might contribute to the quality assurance
cycle was evident.
Conclusions: Rural consumers? disaffection with
health complaints as a means to quality improvement
poses a significant barrier to consumer
engagement in quality assurance processes. Provider
practices may need to change to regain
community confidence in quality improvement
processes.
CONSUMER VIEWS ABOUT the quality of health
services provide a valuable source of information
to those concerned with accountability and quality
assurance in service provision.1,2 When such
views are expressed as complaints which are
responded to in ways which focus on quality
improvement rather than allocation of blame,
opportunities may arise to improve the quality of
health services for all consumers.3,4
SMS text messaging improves outpatient attendance
Authors: Downer Sean R , Meara John G , Da Costa Annette C , Sethuraman Kannan
Published: February 2010

Objective: To evaluate the operational and
financial efficacy of sending short message service
(SMS) text message reminders to the mobile
telephones of patients with scheduled outpatient
clinic appointments.
Design: Cohort study with historical control.
Setting: Royal Children's Hospital, Melbourne,
Victoria.
Patients: Patients who gave a mobile telephone
contact number and were scheduled to attend an
outpatient clinic at the Royal Children's Hospital,
Melbourne in October, November and December
2004 (trial group) or in October, November and
December 2003 (historical control group).
Main outcome measures: Failure-to-attend
(FTA) rate compared between the trial group,
whose members were sent a reminder, and the
historical control group, whose members were
not sent a reminder. Financial benefits versus
cost of sending reminders.
Results: 22 658 patients with a mobile telephone
contact number scheduled to attend an
outpatient clinic appointment in October, November
and December 2004 were sent an SMS
reminder; 20 448 (90.2%) of these patients
attended their appointment. The control group
included 22 452 patients with a mobile telephone
contact number scheduled to attend an appointment,
with 18 073 (80.5%) patients attending.
The FTA rate was significantly lower in the trial
group than in the historical control group (9.8% v
19.5%; P < 0.001). The cost of sending the SMS
reminders was small compared with the
increase in patient revenue and associated benefits
generated as a result of improved attendance.
Conclusions: The observed reduction in FTA
rate was in line with that found using traditional
reminder methods and a prior pilot study using
SMS. The FTA reduction coupled with the
increase in patient revenue suggests that
reminding patients using SMS is a very cost
effective approach for improving patient attendance.
Social determinants of health — why we continue to ignore them in the search for improved population health outcomes!
Authors: Harvey Peter W
Published: February 2010

There is now unequivocal evidence that the health
status of individuals and of whole communities is
socially and economically determined, as are
many other aspects of our lives. This suggests, as
advocates of public health and population health
approaches argue, that our efforts in managing
our health and wellbeing should focus much more
on early intervention and prevention programs
than has been the case to date.
However, although this ideology of social and
economic determinism is generally accepted,
practice does not reflect such values. Indeed, as
increasing demand at the critical end of health
service provision sees us spending more and
more of our limited health care resources on acute
and chronic illness, less resources are devoted to
constructing and maintaining health-creating communities
and environments. Paradoxically, while
most of our leaders, academics and policy makers
have themselves been nurtured in a sound understanding
of cause and effect in the world, they are
ignoring these fundamental premises in their
approaches to the provision and management of
health care.
This paper explores some of the reasons why this
might be the case and draws on key evidence to
suggest that the time has come for us to think
more ideologically in approaching health care in
the future.
Hospitals then and now: changes since the start of Medicare
Authors: Nichol Bill
Published: February 2010

NO ABSTRACT
Current practice in the assessment and management of acute diabetes-related foot complications
Authors: Jessup Rebecca L , Spring Anita A , Grollo Aspa
Published: February 2010

A retrospective audit of client histories from 1
April 2004 to 31 March 2005 was conducted.
Assessment, investigations on admission, management,
length of stay and outcomes were
assessed and compared with evidence-based
guidelines. A total of 62 clients with 115 admissions
were identified. The finding that HBA1c
(glycated haemoglobin) levels were measured on
admission 50% of the time suggested there is
significant variability in assessment, investigation
and management of acute diabetes-related foot
complications. There is a need to better utilise
evidence-based clinical guidelines, and for
greater emphasis on linking individuals who are
at risk of hospitalisation into appropriate outpatient services to improve outcomes.
Public policy and private health insurance: distributional impact on public and private hospital usage
Authors: Walker Agnes E , Percival Richard , Thurecht Linc , Pearse Jim
Published: February 2010

Objective: To study the effectiveness of recent
private health insurance (PHI) reforms, in particular
the 30% rebate and Lifetime Health Cover, in
terms of their stated aim of reducing the load on
public hospitals.
Methods: Combines the use of two new projection
models ? ?Health Insurance? (PHI)
and ?New South Wales Hospitals? that use public
and private hospital inpatient data from 1996?97
to 1999?2000, and NSW population and private
health insurance coverage statistics.
Results: With the PHI reforms 15% fewer individuals
would use public hospitals in 2010 than
without these reforms (around 18% fewer among
the 40% most affluent Australians and 9% among
the 40% least affluent). Lower public hospital
usage would mainly be due to Lifetime Health
Cover.
Conclusion: If the PHI reforms remain in place,
in 2010 a significant proportion of hospital use
would be redirected away from the public sector
and towards the private sector, with the shift being
greatest among better-off Australians.
Learning to manage in health
Authors: Geelen-Baass Briana NL
Published: February 2010

'I'M A MRP' is the grammatically incorrect
response I offer anyone who asks the ever popular
'What do you do?' question. The error in the
statement may be understood when you realise
that the acronym stands for an inanimate entity:
Management Residency Program. Despite the
struggle I have with the inherent clumsiness of
the phrase, I am actually quite happy to use the
term. I feel comforted by the idea of having an
identity. I think this comes from my former life as
a Prosthetist/Orthotist (P&O). As a P&O, you
have an identity. Regardless of where you are
working, you are a P&O and this is interesting in
itself. It's a great conversation piece. Now that I
attempt to make the move into management, I
find myself placing greater importance on where
I am rather than what I am. It now matters more
to me which organisation I belong to. I?d like to
attribute this to an academic theory such as
Henry Mintzberg's, which would suggest that my
focus is changing from a professional orientation
to an organisational one.1 However, I realise there
is a slight possibility that the title 'health manager'
is actually just boring. I know lawyers who
find themselves in the same predicament. As soon
as they say, 'I'm a lawyer', conversation comes to
a screeching halt.
Trends in cancer mortality during the 20th century in Australia
Authors: Freak-Poli Rosanne , Bi Peng , Hiller Janet E
Published: February 2010

An epidemiological study was conducted, using
annual cancer mortality data over the period 1907
to 1998, to explore change in Australian cancer
mortality. A 3-year moving average mortality was
calculated to minimise the annual fluctuations
over the study period. The results suggested that
overall cancer mortality rose slightly over the past
century, with a small decrease in more recent
years. The male and female cancer mortality rates
diverged over time. Younger age groups had low
and stable death rates, 35?59 years age groups
demonstrated decreased rates, and older age
groups had increased rates over the study period.
Modifiable lifestyle factors and other possible reasons for the changes were explored.
Medical role substitutions and delegations ù overcoming the fear
Authors: Murphy Brendan
Published: February 2010

This paper outlines the increasing need for new
health care practitioners to work under delegation
or as substitutes for medical practitioners to
resolve the Australian health workforce crisis. The
personal experience of the author and common
issues for medical practitioners related to the
introduction of these new roles are discussed.
Changing shape: workforce and the implementation of Aboriginal health policy
Authors: Lloyd Jane E , Wise Marilyn J , Weeramanthri Tarun
Published: February 2010

Thirty-five interviews were conducted in a case
study on the implementation of the Northern Territory
Preventable Chronic Disease Strategy
(PCDS) to explore the role of the health workforce
in the implementation of Aboriginal health policy.
There was a tendency for the workforce to implement
those aspects of the policy that drew on
existing skills in treatment and management and
to avoid or delay implementation that required the
acquisition of new skills in primary prevention.
Factors that facilitated the implementation of the
PCDS included the addition of new resources,
employment of additional staff, training, increased
commitment from managers, and the creation of
dedicated chronic disease positions. Factors
impeding implementation included insufficient
numbers of service providers, too little support for
current Aboriginal Health Workers, and high staff
turnover.
Models of Care: Editorial
Authors: Yarmo-Roberts Deborah
Published: February 2010

THE ARTICLE FEATURED in the Models of Care
section is ?Care management for older people
with mental health problems: from evidence to
practice? written by Sue Tucker, Jane Hughes,
Caroline Sutcliffe and David Challis (page 210).
The article presents findings from a UK-based
study that reviewed the types of work activity for
nursing and social work practitioners caring for
older people with mental health problems. The
study found that the focus of the work activity
varied among the professional groups even
though their role was meant to be the same. The
data were then reviewed to determine the extent
to which the work patterns met eight standards of
good practice in intensive care management for
older people with mental health problems. It was
evident that more emphasis needed to be placed
on the management of the staff in the coordinating
and provision roles with better alignment of
the role with the intended standards of practice.
The findings advocate for changes in the role,
caseloads, location and management of staff, and
in their assessment, care-planning and review
processes.
Attitudes, beliefs and values of students in undergraduate medical, nursing and pharmacy programs
Authors: Perkins Rodney J , Horsburgh Margaret , Coyle Barbara
Published: February 2010

First and final year students in medicine, nursing
and pharmacy programs at the University of Auckland
completed a questionnaire used in studies of
professional subcultures. Before entering training,
students differed in how they believed clinical work
should be organised. The collectivist attitude of
pharmacy students was greater among those
completing their studies than it was among those
commencing study.
Doctors, nurses, pharmacists and other professional
groups are expected to work in multidisciplinary
teams to deliver high quality health services.
This study suggests that the individualistic attitudes
of medical students may need to be
addressed during training if medical students are
to graduate with a commitment to working in
teams, an expectation of clinical governance.
Pathology in education and practice: a time for integration?
Authors: Mortimer Robin , Lakhani Sunil
Published: February 2010

While there has been a strong history of pathology
in understanding disease, in recent years we have
seen less appreciation of the value of pathology in
clinical practice. Divisions at the clinical level, with
pathology delivered from isolated buildings at the
periphery of hospitals rather than within the heart
of it, confirms in the mind of the new graduate the
lack of importance of the discipline, despite using
the service daily. We argue that it is time for a
reintegration of pathology services.
Emergency department use in a rural Australian setting: are the factors prompting attendance appropriate?
Authors: Callen Joanne L , Blundell Leanne , Prgomet Mirela
Published: February 2010

Increases in attendance rates at emergency
departments (EDs) have prompted concerns
regarding inappropriate utilisation. Factors instigating
patient ED attendance were examined
using a cross sectional survey of 522 patients
presenting to the ED of a rural hospital in Australia,
during a 1-week period. The results highlighted
the importance of the rural hospital ED as
an additional and alternate service to existing
primary care facilities, particularly outside of business
hours. The findings indicated that although
patients? perception of an emergency does not
necessarily correspond with clinical interpretations,
the primary factors prompting attendance,
including general practitioner unavailability, referrals
and special service needs, suggest that, from
a patients? perspective, the majority of presentations to the ED are justified.
Editorial: Models of Care
Authors: Yarmo-Roberts Deborah
Published: February 2010

Australian Health Review has featured the Models
of Care section for its third year. The aim of
the section is to highlight the vast issues that
impact various 'models of care', expose the
breadth and depth of the models and their
impact and increase the profile of quality-based
articles. As interested stakeholders, we are
continually exposed to the latest models of care
claiming to be a solution for some of the health
care system's weaknesses ? namely, issues of
equity, accessibility, quality and affordability.
Individuals and populations across the globe
are touched by these matters, and health care
systems grapple with ways in which to improve
such weaknesses.
In previous Editorials, I have covered a range
of issues relating to models of care including:
� Functions (ie, assessment, costing, planning,
implementing, client advocacy, monitoring,
evaluating);
� Evidence;
� Information management and use of technology;
� Stakeholder interest (ie, government, health
fund, provider management, health professionals,
clients); and
� Policy impact.
The reality is that the core issues mentioned
above (access, equity, etc) are always going to
be around, and any models of care claiming to
be breakthrough solutions to health care service
issues are hoaxes. So, it is no wonder that
prescriptive models of care are often ineffective.
Taking a broader view of the multitude of
issues that impact the care process and eventual
outcomes is more sensible.
An evaluation of community-based resources for management of diabetes-related foot disorders in an Australian population
Authors: Bergin Shan M , Campbell Don A , Colman Peter G , Brand Caroline A
Published: February 2010

We aimed to evaluate service model configuration, service capacity and accessibility of diabetes-related footcare in an Australian community health setting. Eighty-eight community-based podiatry clinics were surveyed using the self-administered Footcare Provider Survey. Survey domains included communication, resources, service coordination and barriers to service provision. Sixty-nine from a possible 88 Victorian community podiatry clinics (78%) responded. Sixty-one (88%) provided ongoing care to individuals with diabetes-related foot disorders. Communication with vascular and orthopaedic specialists was reported to be readily available in 37% and 27% of cases respectively. Overall, communication with general practitioners was deemed readily available in 62% of cases. Just 39% of podiatrists statewide agreed overall resources were sufficient, with 26% agreeing staffing levels were adequate. Thirty-nine percent of community podiatrists used clinical care pathways, and onsite collaboration was deemed appropriate in just 30% of cases. Perceived barriers to provision of care included inadequate staffing and resources, lack of confidence from other health professionals in the podiatrists? ability to manage diabetes-related foot disorders, and lack of access to specialists.
Health services management education in South Australia
Authors: Selby Smith Chris
Published: February 2010

In December 1994 the Australian College of Health Service Executives (SABranch) sought ?a needs analysis for health management training programs withinSouth Australia?. Although the college was interested in a range of matters, thecentral issue was whether the current Graduate Diploma in Health Administration(or a similar course) would continue to be provided in Adelaide. The college providedbackground material and discussions were held with students, the health industry,relevant professional associations and the universities. This commentary sets out someof the background factors and my conclusions, which have been accepted by the SouthAustralian authorities.
Psychiatric and substance abuse disorder diagnoses as predictors of length of hospital stay
Authors: Ben-Tovim David I , Elzinga Rob , Burgess Phillip
Published: February 2010

The mental health and substance abuse components of AN-DRG 3 were examinedusing data from all inpatient separations in two Australian States over a two-yearperiod. Assignment to a mental health or a substance abuse diagnosis related group(DRG) predicted about 20- per cent of the variability in average length of stay ofpatients treated for such conditions. Assignment to a substance abuse DRG was amuch less robust predictor of length of hospital stay than assignment to a mental healthDRG. There was little variation between years or States. Day-only intent patientswere excluded, as were long-stay outliers identified using an inter-quartile rangetrimming process. Psychiatric DRGs are similar to a number of other non-surgicallyfocused diagnosis related groups in their capacity to predict length of hospital stay. Theyare likely to remain an important component of casemix classification systems.
Thoughts before whistling
Authors: Berglund Catherine
Published: February 2010

Whistleblowing is a public alert by an insider of an organisation to a practice orconcerning potential they observe in the organisation. This paper proposes that therisk, values at stake, timeliness and manner of complaint be considered before awhistle is blown. It also notes education and monitoring mechanisms.
Comparing patient satisfaction, outcomes and costs between cataract day surgery and inpatient surgery for elderly people
Authors: Fan Yu-Pei , Boldy Duncan , Bowen Denise
Published: February 2010

The study reported in this paper examined the characteristics of elderly peopleundergoing cataract surgery and compared patient perspectives and satisfaction,outcome, costs, reported health problems and social circumstances of day surgerypatients and hospital inpatients, The study sample was drawn from the client databaseof a health insurance fund and covered 291 people aged 60 years or more who hadrecently undergone cataract surgery.Overall, both day surgery patients and inpatients indicated a high level of satisfactionwith their eye surgery (about 80- per cent for both groups). The majority of patientsfrom both groups reported an improved level of vision, with vision outcome in theday surgery group being as good as in the inpatient group. Overall, inpatienttreatment was more costly and involved higher out of pocket expenses.The study results indicate a potential to increase the number of patients undergoingcataract surgery as a day patient procedure. Pre-operative preparation contributed topatient satisfaction and the availability of family and/or social support was animportant factor influencing day surgery admission. Whilst patients reporting healthproblems were less inclined to have cataract surgery than were day patients, this onlyaccounted for one-fifth of the total inpatient group. Developing systematic andappropriate case selection criteria and effective case management will contribute tomore efficient use of hospital resources, an increased use of day surgery facilities, andhence a more cost-effective overall cataract surgery service for elderly people.
The effect of age and chronicity on patient recall of public hospital outpatient clinic use
Authors: Grimmer Karen , Bowman Paula
Published: February 2010

This paper reports on an investigation of the effect of age and chronicity on theaccuracy of recall by allied health patients of their attendance at outpatient clinicsat a public hospital over the previous 12 months. Patients consistently under-reporteduse of outpatient clinics, when compared with hospital records. Age and chronicitywere not found to be determinants of the observed differences. Other potentialinfluences on patient recall were identified to assist future testing.
Australian registered nurses describe the health care workplace and its responsiveness to sexual harassment:
Authors: Madison Jeanne
Published: February 2010

This report is a summary of findings from a 1995 study of Australian registered nursesand their perceptions of their health care workplaces, especially as it relates to sexualharassment. There is little Australian-based empirical research available to guidehospitals and health care facilities in developing appropriate policies regarding sexualharassment. Additionally, hospitals have few assessment tools at their disposal todetermine if policies and procedures are well known and effective. As the majoremployer of registered nurses, hospitals and health care facilities need to be concernedabout employees? perceptions of the workplace.
Commentaries on 'Trusting the surgeon: A tornado from Bristol' (editorial)
Authors: Braithwaite J , Brand D , Lumby J
Published: February 2010

Commentaries on 'Trusting the surgeon: A tornado from Bristol' by Don Hindle.
Shifting to capitation in primary care: What might the impact be in New Zealand?
Authors: Cumming Jacqueline , Mays Nicholas
Published: February 2010

Primary medical care in New Zealand has traditionally been delivered by general practitioners and funded by a mix of fee-for-service government subsidies, user part-charges and private payments. In 1998, New Zealand's national purchaser of publicly-funded healthcare, the Health Funding Authority, proposed to pay health service organisations capitation fees per enrolled patient, as well as fees-for-service for immunisations and some performance-related payments. This article considers the implications, drawing on theory and research from New Zealand and elsewhere, of different methods for paying general practitioners and other primary care professionals. The main focus is on whether giving a greater emphasis to capitation will lead to a fairer distribution of resources and better access to services for those groups of people who are not well served by the current system.
Program budgeting and marginal analysis: A case study in chronic airflow limitation
Authors: Crockett Alan , Cranston Josephine , Moss John , Scown Paul , Mooney Gavin , Alpers John
Published: February 2010

Program budgeting and marginal analysis is a method of priority-setting in health care. This article describes how this method was applied to the management of a disease-specific group,chronic airflow limitation. A sub-program flow chart clarified the major cost drivers. After assessment of the technical efficiency of the sub-programs and careful and detailed analysis,incremental and decremental wish lists of activities were established. Program budgeting and marginal analysis provides a framework for rational resource allocation. The nurturing of a vigorous program management group, with members representing all participants in the process (including patients/consumers), is the key to a successful outcome.
George Rupert Palmer - DRG carrier and champion
Authors: Turner Liane , Short Stephanie D
Published: February 2010

Prompted by the retirement of the distinguished health economist, researcher and academic,Professor George Rupert Palmer, the purpose of this paper is to reflect upon and acknowledge one of his many contributions to health services research and development. By employing a conceptual framework devised by Kimberly and de Pouvourville (1993) for analysis of the diffusion of innovations, this paper argues that Palmer played a crucial role in the diffusion into and within Australia of a particular casemix method, diagnosis related groups (DRGs). Textual and interview evidence presented in the paper supports the identification of George Rupert Palmer as the principal carrier of DRGs into Australia, and as one of its key champions within Australia.To many, Professor George Palmer is one of the 'founding fathers' of casemix in Australia. A health economist, he has led much of the research underpinning its introduction into the health care system (Galbraith 1993, p 14).
Listening to the Other: A Counter-Cultural Ear in iPodic Times
Authors: Chua Daniel K. L.
Published: February 2010

This response aims to widen the implications suggested by Bernd Wannenwetsch by exploring how music may promote a listening that breaks out of a monad-like subject.
The Aqueous Soluble Polyphenolic Fraction of Psidium guajava Leaves Exhibits Potent Anti‐Angiogenesis and Anti‐Migration Actions on DU145 Cells
Authors: Peng Chiung-Chi , Peng Chiung-Huei , Chen Kuan-Chou , Hsieh Chiu-Lan , Peng Robert Y.
Published: February 2010

The aqueous extract of Psidium guajava budding leaves (PE) bears an extremely high content of polyphenolic and isoflavonoids. Whether it could be used as an anti‐tumor chemopreventive in view of anti‐angiogenesis and anti‐migration, we performed the assay methods including the MTT assay to examine the cell viability; the ELISA assay to test the expressions of VEGF, IL‐6 and IL‐8; the western blot analysis to detect TIMP‐2; the gelatinolytic zymography to follow the expression of MMPs; the wound scratch assay to examine the migration capability; and the chicken chorioallantoic membrane assay to detect the suppressive angiogenesis. Results indicated that the IC50 of PE for DU145 cells was ~0.57 mg ml−1. In addition, PE effectively inhibited the expressions of VEGF, IL‐6 and IL‐8 cytokines, and MMP‐2 and MMP‐9, and simultaneously activated TIMP‐2 and suppressed the cell migration and the angiogenesis. Conclusively, PE potentially possesses a strong anti‐DU145 effect. Thus, clinically it owns the potential to be used as an effective adjuvant anti‐cancer chemopreventive.
Amino acid identity at one position within the α1 helix of both the histidine kinase and the response regulator of the WalRK and PhoPR two-component systems plays a crucial role in the specificity of phosphotransfer
Authors: Jende Inga , Varughese Kottayil I. , Devine Kevin M.
Published: February 2010

Two-component systems usually function as cognate pairs, thereby ensuring an appropriate response to the detected signal. The ability to exclusively phosphorylate a partner protein, often in the presence of many competing homologous substrates, demonstrates a high level of specificity that must derive from the interacting surfaces of the two-component system. Here, we identify positions within the histidine kinases and response regulators of the WalRK and PhoPR two-component systems ofBacillus subtilisthat make a major contribution to the specificity of phosphotransfer. Changing the identity of the amino acid at position 11 within theα1 helix of WalK and at position 17 within theα1 helix of PhoP altered discrimination and allowed phosphotransfer to occur with the non-cognate partner. Changing amino acids at additional positions of the WalK kinase increased phosphotransfer, while changes at additional positions in PhoP only had an effect in the presence of the change at position 17. The importance of amino acid identity at these two positions is supported by the fact that the amino acid combinations of Ile and Ser in WalRK, and Leu and Gly in PhoPR, are very highly conserved among orthologues, while modelling indicates that these amino acid pairs are juxtaposed in the WalRK and PhoPR complexes.
Responses of C3 and C4 grasses to application of nitrogen and phosphorus fertilizer at two dates in the spring
Authors: Rubio G. , Gutierrez Boem F. H. , Lavado R. S.
Published: February 2010

In grasslands composed of C3 and C4 plants, a different pattern of response by the two photosynthetic types to fertilizer may change the floristic composition of the community. In this study, we evaluated the effects of an application of nitrogen (N) and phosphorus (P) fertilizer at two dates in the spring on the aerial growth of C3 and C4 grasses. Danthonia montevidensis and Stipa neesiana(C3), and Setaria geniculata and Sporobolus indicus (C4), were selected from a native grassland of the Flooding Pampa, Argentina. Two consecutive experiments (early and late spring) were conducted in pots filled with the local soil. The C3 grasses showed no response in aerial biomass, and only minor responses in aerial concentrations of N and P, numbers of leaves and tillers, and nutrient use efficiency to an application of P or N fertilizer. In contrast, their C4 counterparts showed a consistent positive response. C4 species performance was considerably influenced by date of fertilizer application in the spring. There was on average a 1·8 and a 2·5 increase in aerial biomass in early and late spring, respectively, to fertilizer application. The later date in spring was associated with higher ambient temperatures and it appeared that temperature rather than fertilizer application was the main limiting factor for C3 species. It was concluded that the positive response in C4 species to an application of P and N fertilizer indicates that the differences between C3 and C4 species were related to a higher demand to sustain greater growth rates in C4 species.
Genotoxic and apoptotic effects of Goeckerman therapy for psoriasis
Authors: Borska Lenka , Andrys Ctirad , Krejsek Jan , Hamakova Kvetoslava , Kremlacek Jan , Palicka Vladimir , Ranna Dianna , Fiala Zdenek
Published: February 2010

Background  Goeckerman therapy (GT) for psoriasis is based on cutaneous application of crude coal tar [polycyclic aromatic hydrocarbons (PAH)] and exposure to ultraviolet radiation (UVR). PAH and UVR are mutagenic, carcinogenic and immunotoxic agents that promote apoptosis.

Methods  We evaluated dermal absorption of PAH as well as the genotoxic and apoptotic effects of GT in 20 patients with psoriasis, by determining numbers of chromosomal abnormalities in peripheral lymphocytes, and levels of 1‐hydroxypyrene (1‐OHP), p53 protein and soluble FasL (sFasL) in urine and/or blood, before and after GT. Psoriasis Area and Severity Index (PASI) score was used to evaluate clinical efficacy of GT.

Results  Compared with pre‐treatment levels, there was a significant increase in urine 1‐OHP, indicating a high degree of dermal absorption of PAH (P < 0.01). We also found a significant increase in the number of chromosomal abnormalities in peripheral blood lymphocytes (P < 0.001), suggesting that GT is genotoxic; significantly increased p53 protein in plasma (P < 0.05), an indicator of cell response to DNA damage; and significantly increased sFasL in serum (P < 0.01), an indicator of apoptosis. The PASI score was significantly decreased after GT (P < 0.001), confirming clinical benefit of this treatment.

Conclusion  Our results demonstrate high dermal absorption of PAH during GT and provide evidence that GT promotes genotoxicity and apoptosis.
Bacterial resistance in French acne patients
Authors: Dumont‐Wallon G. , Moyse D. , Blouin E. , Dréno B.
Published: February 2010

Background  The percentage of strains of Propionibacterium acnes resistant to antibiotics in acne is increasing in many countries, raising the question of the risks associated with bacterial resistance. Numerous series of cases have been published on European populations of acne patients, but at the moment we still have very few data regarding France.

Objectives  The aim of this study was to evaluate the prevalence of P. acnes resistant strains to erythromycin, tetracycline, and doxycycline in a population of French acne patients.

Methods  Specimens were collected from 273 patients in 43 centers located throughout France (12 hospitals and 31 private office practices).

Results  75.1% of the patients were carriers of P. acnes strains resistant to erythromycin and 9.5% to tetracycline. One hundred percent of strains resistant to tetracycline were also resistant to doxycycline. There was no significant difference among the regions and between patients followed in hospital or private office.

Conclusions  It clearly appears that the percentage of patients with P. acnes strains resistant to erythromycin is similar to that in other countries, but lower for tetracycline or doxycycline in comparison to other European countries.
Transcriptional analysis of molecular interactions between Pseudomonas fluorescens strain TDK1, Oryza sativa and Cnaphalocrocis medinalis
Authors: Saveetha K. , Karthiba L. , Raveendran M. , Saravanakumar D. , Raguchander T. , Samiyappan R.
Published: February 2010

Rice leaffolder Cnaphalocrocis medinalis is a devastating insect pest posing major threat to rice cultivation. Plant growth‐promoting rhizobacteria Pseudomonas fluorescens strain TDK1 was found to induce high degree of resistance in rice plants against leaffolder insect through Induced Systemic Resistance in our previous studies. Thus the present study was aimed to understand the molecular mechanisms involved in P. fluorescens TDK1‐mediated host plant resistance against leaffolder infestation on rice. Transcript profiling was done through DD‐RT‐PCR method in leaffolder‐infested rice plants that were treated with and without Pf TDK1. A total of 3500 transcripts were displayed, of which 165 transcripts exhibited differential expression during rice–Pf TDK1–leaffolder interactions. The differential transcripts were 58 in Pf TDK1‐treated + leaffolder‐challenged, 51 in leaffolderinfested and 56 in Pf TDK1‐treated rice leaf sheath tissues. Annotation and mapping of differentially expressed genes onto metabolic pathways revealed the interaction of leaffolder and Pf TDK1 in rice plant at the molecular level. Furthermore, Pf TDK1 induced over‐expression of genes found to regulate the diverse metabolic processes by the selective integration of defensive signals in rice plants.
Disaster mental health training programmes in New York City following September 11, 2001
Authors: Gill Kimberly B. , Gershon Robyn R.
Published: February 2010

The need for mental health resources to provide care to the community following large‐scale disasters is well documented. In the aftermath of the World Trade Center (WTC) disaster on September 11, 2001, many local agencies and organizations responded by providing informal mental health services, including disaster mental health training for practitioners. The quality of these programmes has not been assessed, however. The National Center for Disaster Preparedness at Columbia University's School of Public Health reviewed disaster mental health training programmes administered by community‐based organizations, professional associations, hospitals, and government agencies after September 11. Results indicate that the quality and the effectiveness of programmes are difficult to assess. A wide range of curricula and a widespread lack of recordkeeping and credentialing of trainers were noted. Most of the training programmes provided are no longer available. Recommendations for improving the quality of disaster mental health training programmes are provided.