bluuebunny/crossref_metadata_2025 huggingface dataset:
Improving the quality of hospital services: how diverse groups of consumers prefer to be involved
Authors: Johnson Anne , Bament Danielle
Published: February 2010

Consumer participation in hospitals is increasingly being advocated for as a way to contribute to improving safety and quality. This article reports on the results of a study conducted to investigate if, and how, a range of consumers would prefer to be involved in improving the quality of hospital services. Face-to-face interviews were conducted with 100 users of a hospital, telephone interviews were conducted with 2,005 members of the broader South Australian community, focus groups were conducted with 22 representatives of consumer and community groups and in-depth interviews conducted with four representatives who could not attend the focus groups.The results indicate that for users of the hospital and members of the broader community, there is a significant preference to be involved in more passive methods of participation that are initiated by the hospital, such as written and phone surveys. This is preferable to writing letters of complaint or compliment, participating in more active methods that require one-off commitment (focus groups and public planning forums) and ongoing commitment such as being members of working groups to address specific issues and hospital committees. In contrast, representatives of consumer and community groups have a strong preference to be involved in active methods of participation such as working groups to address specific issues and hospital committees. We found that there are considerable differences between age groups and educational attainment and preference for participation. If these issues are not taken into account, and a range of participation methods used, then there is the potential for some population groups to be excluded from having some input into improving the safety and quality of hospital services.
A response to the Australian Health Care Agreements series
Authors: Dwyer John
Published: February 2010

A response to the Australian Health Care Agreements series published in AHR 25-6.
Developing a linked administrative database of health service utilisation by the aging population of Metropolitan Perth
Authors: Loh P K , Stevens Jenny , Donaldson Mark
Published: February 2010

The increasing use of health services by the older population has placed significant stresses on the health system ofWestern Australia. This is a report of the development of a linked administrative database of health resource utilisationby the aged population of metropolitan Perth. Hospital administrative databases linked to clinical or administrativedatabases of other health providers are reviewed. Length of stay data is linked to aged care assessments, referrals tonursing homes and community services. The linked databases approach allows the study of resource allocation and canpinpoint systemic stress in aged care. It is a tool for reducing the duplication of services, the pressure on beds in healthinstitutions, and cost by improving efficiencies.
Towards a socio-political understanding of the pharmaceutical sector
Authors: Lofgren Hans
Published: February 2010

MUCH IS AT STAKE in scientific and technological,
and economic and political, processes pertaining
to the biosciences and pharmaceuticals.
The value of the global drug industry is
approaching US$500 billion while the health
needs of the developing countries are of staggering
proportion. From an Australian perspective,
opportunities and constraints of medicinal drug
policy are associated closely with rapid and
possibly fundamental shifts occurring within the
worldwide pharmaceutical industry, as well as
global regulatory developments. Several articles
in this special issue of Australian Health Review
provide insight into these global dynamics.
Other contributions explore policy themes of
particular interest to an Australian readership.
Writers on medicinal drug policy and regulation
come from a variety of disciplines, including
business and management, health and social
policy studies, economics, sociology, and political
science. The range and volume of the specialised
literature on this sector reflects its social
and economic significance and its unmatched
complexity in terms of interdependencies
between business, government, professions, and
civil society actors. Most articles in this issue
have an emphasis on politics and sociology ?
this may compensate somewhat for the dominance
usually exercised by economists in framing
social science research and policy debate on
pharmaceuticals.
An aggression policy that works
Authors: Kitchener Denby A , Sykes Sharon R , McEwan Allan G
Published: February 2010

In 1999, a survey of the clinical staff in Royal
Darwin Hospital showed that most instances of
aggressive and abusive behaviour by patients or
visitors occurring in the hospital went unreported
because staff believed there would not be any
follow-up investigation or action taken by management.
In response, a hospital working party
was formed to develop and implement an
aggression management policy with practical
effective strategies. The principal tool used was
an Action Plan that delineated an immediate
response to the aggression, as well as long-term
strategies such as negotiated care and behaviour
modification programs. An advocate is provided
for the patient and debriefing for staff
members. If the aggressive behaviour continues,
early discharge of the patient could be initiated.
The fundamental principle of the policy is to
prevent fostering a culture of acceptance of
aggressive behaviour through appropriate early
intervention. In 2002, a follow-up survey showed
that 82% of aggressive incidents were being
reported and dealt with by management in a
timely manner ? a significant improvement.
Impact of private health insurance incentives on obstetric outcomes in NSW hospitals
Authors: Shorten Brett , Shorten Allison
Published: February 2010

The purpose of this study is to analyse the impact of changes in Australian private health insurance coverage as seen inNSW public and private hospital birth profiles, and identify trends in obstetric outcomes from 1997-2001. NSWMidwives Data Collection unit record data is analysed for women who gave birth to a live singleton baby of termgestation (=37weeks) and cephalic presentation in NSW hospitals during 1997 - 2001. Use of private hospitals forchildbirth has increased in conjunction with increases in private health insurance coverage. Although some obstetricinterventions have increased for both public and private hospitals over time, clinical factors do not explain the largedifferences in birth interventions and outcomes between NSW public and private hospitals. Incentives to increaseprivate health insurance coverage appear to be having a negative impact on childbirth, in terms of higher birthintervention and operative birth rates in NSW private hospitals.
Demographic patterns of emergency presentations to Northern Territory public hospitals
Authors: Lee Andy H , Meuleners Lynn B , Zhao Yuejen , Intrapanya Methinee , Palmer Didier , Mowatt Elizabeth
Published: February 2010

Andy H Lee is associate professor, School of Public Health, Curtin University of Technology; Lynn B Meuleners is research fellow, Injury Research Centre, University of Western Australia; Yuejen Zhao is an epidemiologist in the Northern Territory Department of Health and Community Services;Methinee Intrapanya is a registered nurse, Didier Palmer is director of the Emergency Department, Royal Darwin Hospital and Elizabeth Mowatt is director of Emergency Department, Alice Springs Hospital.This study investigates demographic patterns of emergency presentations to Northern Territory (NT) public hospitalsover the past five years with respect to population changes, Aboriginality and age of patients. Retrospective analysis was undertaken on the 1996-2001 data extracted from the NT Module of Caresys and the Hospital Morbidity Data System. There was a 4.6% decrease in total presentations to the five public hospitals but a 9.4% growth in the population during the study period. Substantial differences in emergency presentation patterns were found between Aboriginal and non-Aboriginal patients. There were more Aboriginal presentations than non-Aboriginal presentations for all age groups except for 5 to 19 years and 70 to 74 years. Analysis based on the national triage scale showed the higher needs of older adults with the 60 or over age group accounting for the majority of presentations, and Aboriginal presentation rates exceeded the non-Aboriginal presentation rates in most triage categories. Re-attendance within seven days at the emergency departments occurred predominantly among Aboriginal patients regardless of age group. The analysis has highlighted several emerging demographic patterns. The issue of non-urgent visits by Aboriginal patients occupying a large portion of the emergency department utilisation also needs to be addressed.
The Australia and New Zealand Horizon Scanning Network
Authors: Mundy Linda , Merlin Tracy L , Parrella Adriana , Babidge Wendy J , Roberts Dianne E , Hiller Janet E
Published: February 2010

UP UNTIL 1982, new health technologies, procedures
or services were introduced into the health
system in an uncontrolled, unregulated manner.
This had the potential for wide-ranging impact on
the public health care system including ballooning
costs, a lack of preparedness by training and
accreditation organisations, and consequent patient
safety concerns. Health technology assessment was
introduced into Australia in 1982 when the
National Health Technology Assessment Panel was
formed. This original panel has undergone numerous
name changes and evolved into the Australian
Government-funded Medical Services Advisory
Committee (MSAC).1 The primary role of the
MSAC is to inform the Federal Minister for Health
and Ageing on the safety, effectiveness and costeffectiveness
of new medical technologies and procedures
using the available evidence.2 Assessments
of the safety, effectiveness and cost-effectiveness of
these technologies may occur only after the technology
has diffused and is practised widely.3 Early
identification of such technologies may avoid the
detrimental consequences of their indiscriminate
introduction and could result in the adoption of
beneficial and cost-effective technologies and the
elimination of technologies that are unsafe or for
which there is no evidence of cost-effectiveness.4
Distance difficulties
Authors: Meiklejohn Beryl
Published: February 2010

WELL WRITTEN, THIS BOOK
shows that two of the most vulnerable
groups from either side of the
health agenda are at risk. Cramer
has identified the professional and
personal risks of the health professionals
who provide health services
to Australia?s most disadvantaged
group.
In providing service, nurses are
put into some of the most difficult
situations and have to cope with added stress of providing
health care that is outside their training and professional
dimensions. Decision making is made difficult by having
little or no health history; language barriers; and poor
communication with the support service. Prevention and
maintenance services are poorly delivered because of lack
of time and resources. Visiting medical officers only have
enough time to see acute patients, and review of medication
is not done. To add to this predicament, the nurses have to
contend with a very mobile community, unable to provide
payment and fulfil other commitments of the client.
Their workload and expected duties are not always
appreciated by management and other support services.
Where there should be two registered nurses, only one is
employed. They often have to travel long distances to
follow up clients, be on duty for long hours, or participate
in community discussions outside the clinic times. The
nurses who continue to work in isolated Aboriginal
communities are special and over time have developed
their practice. The question is, is it best practice or more
an ad hoc practice?
Nurses in remote areas work under stressful work
and living conditions and continue to provide the only
health service for the community, if they don?t give up
and leave. Nursing in remote Aboriginal communities
is not romantic or exotic, but can be rewarding for
some of the nurses.
This book should be read by all health care professionals,
especially those considering working in rural
or remote areas.
The journey of a teaching hospital to becomea learning organisation
Authors: Rowley Stuart D
Published: February 2010

This paper describes how an acute tertiary referral
hospital moved away from a ?culture of blame?,
using change management principles aligned with
the concept of the learning organisation. I outline
the process of change, and describe its outcomes.
The result is summarised as an improvement in
desired attributes of the organisation?s culture, as
evidenced by consistent improvement in the
results of a proprietary staff survey. I conclude that
the concept of the learning organisation is a useful
one for hospitals that seek to improve the organisational culture.
From the Book Review Editor
Authors: Day Gary E , Mills Terry , Hyett Kate
Published: February 2010

IN THIS ISSUE of the Journal, several reviewers have done an excellent job in providing you with an
assessment on a number of ?technical? books that would be useful to health policy makers, researchers
and managers. At the moment there appears to be a wealth of excellent texts to assist health managers
and researchers and we offer here three reviews on the issues and concepts of measuring health and
health operations research. Additionally, there is a review on the third edition of a popular health
economics text. Happy reading!!
The experience of Australian project leaders in encouraging practitioners to adopt research evidence in their clinical practice
Authors: Henderson Amanda J , Davies Jan , Willet Michaela R
Published: February 2010

Objective: This paper describes a qualitative
program evaluation which sought to identify factors
that either assist or impede the adoption of
clinical evidence in everyday practice.
Design and Participants: Thirteen Australian
projects were funded in a competitive grant program
to adopt innovative strategies to improve the
uptake of research evidence in everyday clinical
practice. Project leaders? reports were analysed to
collate common themes related to 1) critical elements
in successful application of research knowledge,
2) barriers to implementing evidence, and 3)
lessons for other organisations that might implement
a similar project.
Results: Despite the diversity of the methods
used to establish projects and the range of topics
and clinical settings, many similarities were identified
in the perceived critical success elements,
barriers, and lessons for adopting clinical evidence.
Eighteen themes emerged across the data
including: leadership support; key stakeholder
involvement; practice changes; communication;
resources; education of staff; evaluation of outcomes;
consumers; knowledge gaps; adoption/
implementing staff; access to knowledge; risk
assessment; collaboration; effectiveness of clinical
research evidence; structure/organisation; cultural
barriers; previous experiences; and
information technology.
Conclusion: Leaders of projects to adopt evidence
in clinical practice identified barriers, critical
success elements and lessons that impacted on
their projects. A range of influences on the adoption
of evidence were identified, and this knowledge
can be used to assist others undertaking
similar projects.
Lean thinking across a hospital: redesigning care at the Flinders Medical Centre
Authors: Ben-Tovim David I , Bassham Jane E , Bolch Denise , Martin Margaret A , Dougherty Melissa , Szwarcbord Michael
Published: February 2010

Lean thinking is a method for organising complex
production processes so as to encourage flow
and reduce waste. While the principles of lean
thinking were developed in the manufacturing
sector, there is increasing interest in its application
in health care. This case history documents
the introduction and development of Redesigning
Care, a lean thinking-based program to redesign
care processes across a teaching general hospital.
Redesigning Care has produced substantial
benefits over the first two-and-a-half years of its
implementation, making care both safer and
more accessible. Redesigning Care has not been
aimed at changing the specifics of clinical practice.
Rather, it has been concerned with improving
the flow of patients through clinical and other
systems. Concepts that emerged in the manufacturing
sector have been readily translatable into
health care. Lean thinking may play an important
role in the reform of health care in Australia and
elsewhere.
The capability of nurse practitioners may be diminished by controlling protocols
Authors: Carryer Jenny , Gardner Glenn , Dunn Sandra , Gardner Anne
Published: February 2010

Nurse practitioners will become a vital component
of the health workforce because of the growing
need to manage chronic illness, to deliver effective
primary health services, and to manage workforce
challenges effectively. In addition, the role of nurse
practitioner is an excellent example of increased
workforce flexibility and changes to occupational
boundaries. This paper draws on an Australasian
research project which defined the core role of
nurse practitioners, and identified capability as the
component of their level of practice that makes
their service most useful. We argue that any
tendency to write specific protocols to define the
limits of nurse practitioner practice will reduce the
efficacy of their contribution. The distinction we
wish to make in this paper is between guidelines
aiming to support practice, and protocols which
aim to control practice.
The role of ethnicity in determining access to and acceptability of home visiting for early childhood health and wellbeing
Authors: Ming Wen Li , Orr Neil , Rissel Chris
Published: February 2010

This paper explores access to and acceptability
of home visiting for early childhood health and
wellbeing among the New South Wales population.
The study examined demographic and
social characteristics of children and their families
to identify the factors that predicted home
visiting by a community health nurse or volunteer,
as well as the level of acceptability of home
visiting as a strategy for improving child health.
The data were extracted from the 2001 NSW
Child Health Survey and a total of 3570 respondents
who reported having a child aged 4 years or
under were included in the study. The results
show that culturally and linguistically diverse
populations were less likely to be visited by a
nurse or volunteer (adjusted odds ratio (OR),
0.78; 95% CI, 0.64?0.97), and when they were
visited were more likely to find the visit ?uncomfortable?
or ?very uncomfortable? (adjusted OR,
1.54; 95% CI, 1.19?1.99). Other factors associated
with acceptability included the age of both
children and mothers, education levels of parents
and home smoking status. For home visiting to
be effective in promoting child health, these
factors must be considered.
Factors influencing triage decisions in mental health services
Authors: Grigg Margaret , Herrman Helen , Harvey Carol , Endacott Ruth
Published: February 2010

The aim of the study was to identify the factors
influencing the timing of an assessment after
contact with a triage program in a communitybased
area mental health service in Australia.
Triage decisions apparently were influenced by
several groups of factors: patient characteristics;
the source and mode of the contact with triage;
and to a large extent by mental health service
factors including the training, supervision and
support of triage workers and the perceived availability
of an assessment. While demand factors
such as patient characteristics influenced the
triage decision, supply factors also played an
important role.
Use of Western Australian linked hospital morbidity and mortality data to explore theories of compression, expansion and dynamic equilibrium
Authors: Lynch Cameron , Holman C D'Arcy J , Moorin Rachael E
Published: February 2010

Three hypotheses have been advanced to predict
changes in population health in countries experiencing
low birth and death rates, and increasing
expectation of life. Determining which of these
best accounts for changing patterns of illness and
death is an important step in understanding both
the public health and economic impacts of health
interventions in an ageing population. The aim of
this study was to use the WA Data Linkage
System to evaluate the compression, expansion
and dynamic equilibrium theories in Western Australia.
Changes in life expectancy, average age at
first-time hospitalisation and time spent in chronic
disabling or activity limiting states were used to
evaluate the competing hypotheses.
Life expectancy increased by 4.0 and 2.6 years
over the 24-year study period in males and
females, respectively. However, average time
spent with a diagnosed chronic disabling condition
increased by 9.2 and 9.4 years in males and
females, respectively. These results suggest that
an increase in the ?medicalisation of more serious
morbidity? may be in operation in Australia.
Interprofessional pre-qualification clinical education: a systematic review
Authors: Davidson Megan , Smith Robyn A , Dodd Karen J , Smith Jenni S , O'Laughlan Meredith J
Published: February 2010

A search was made of relevant databases and the
reference lists of key textbooks and reviews. Of
420 potentially relevant articles, 25 were included
in the review. Medicine, nursing, physiotherapy,
occupational therapy and social work were the
professions most often included. Aims and activities
of interprofessional clinical education (IPCE)
programs were varied, and there was inconsistency
in outcome evaluation approach and tools.
The models of IPCE described in the literature are
diverse. The major barriers to IPCE were logistical,
and the careful planning and negotiation
required to overcome these barriers was time
consuming. Detailed planning, stakeholder enthusiasm
and commitment appear to be essential to
the success of IPCE. The literature provides guiding
principles for establishing a program; however,
there is limited evidence to support a particular
approach.
The working world of nursing unit managers: responsibility without power
Authors: Paliadelis Penelope S
Published: February 2010

This paper seeks to explore the responsibility and
power of the role of nursing unit managers
(NUMs) in rural New South Wales using Kanter?s
theory of organisational power as a framework.
Using in-depth individual interviews with twenty
NUMs, data were analysed from four perspectives
to gain a deep understanding of the NUMs? working
world. The findings show that the NUMs? role
is substantive, encompassing both clinical and
managerial functions. Overall, the findings indicate
that the participants lacked power commensurate with their role responsibilities.
Social isolation and loneliness among older people: issues and future challenges in community and residential settings
Authors: Grenade Linda , Boldy Duncan
Published: February 2010

Although often associated with older age, loneliness
and social isolation are not well understood
in terms of their prevalence, risk and protective
factors. Evidence suggests that only a minority of
community-dwelling older people are ?severely?
lonely or isolated, however a number of factors
need to be considered to fully understand the
extent and significance of the problem. Community-
based studies have identified a variety of risk
factors for loneliness/isolation including widowhood,
no (surviving) children, living alone, deteriorating
health, and life events (eg, loss and
bereavement). Having a confidant has been identified
as a protective factor for loneliness. However,
evidence is often unclear or inconclusive,
especially within residential settings. We identified
the need to conduct more residential care-focused
research; the importance of addressing a variety
of methodological concerns; and the need for
practitioners to develop intervention programs that
are appropriately targeted, evidence-based and
evaluated.
The internet as a source of health information in three disparate communities
Authors: Dart Jared
Published: February 2010

A survey questionnaire was designed and implemented
across three different communities to
determine the current utilisation, importance, trust
and future preference for the internet as a source
of health information in three different socioeconomic
groups. The following were the key results.
Fewer respondents in the low socioeconomic
group accessed online health information than the
mid-high socioeconomic or university samples.
The internet was a much more important source
of health information for the university sample.
The use of online health information and the
importance ascribed to the internet as a source of
health information was related to home internet
access and the frequency of internet use in all
three populations. Most respondents do not bring
online health information to their doctor (>70% of
those who access online health information). Age
alone did not relate to the current use of the
internet as a source of health information. Most
respondents in all populations did not trust the
internet. In all populations the internet was a more
preferred source of health information than its
current use would suggest, especially among
those with home internet access and frequent
users of the internet.
Digital pen and paper technology is an effective way of capturing variance data when using arthroplasty clinical pathways
Authors: Derhy Patrick H , Bullingham Karen A , Bryett Andrew J
Published: February 2010

The aim of this study was to test the effectiveness
of digital pen and paper technology (DP&PT) to
capture clinical pathway variance data in real time
and at the point of care for patients on an arthroplasty
pathway.
This study was conducted across multiple departments
providing orthopaedic services in a public
health care facility. Treating clinicians were
required to record variance data on a predefined
coded template, and these data were uploaded to
a database for analysis and reporting. The information
could be represented in a web-based user
interface for immediate review.
User acceptance, length of stay (LOS), accuracy
of data, and reliability of the DP&PT hardware
were measured. User acceptance was high; LOS
reduced; and the data and hardware were,
respectively, found to be accurate and robust.
This technology provides a dependable, real-time
solution to transform handwritten clinical data into
a digital format. The data available will help inform
clinicians of areas for clinical practice improvement,
and provide ongoing monitoring of care
processes for patients on a clinical pathway.
Future studies should aim to assess if using this
method to capture variance data is a more efficient
and effective means of informing clinical
decision making than retrospective review processes.
The annual variation in activity and funding for acute public hospitals in NSW,1988?89 to 1992?93
Authors: Sibbritt David , Gibberd Robert
Published: February 2010

Casemix-based funding was introduced into the Victorian health system withoutan assessment of the annual variation in inpatient activity. Before undertaking sucha funding reform, it would be appropriate to determine the level of annual variationin inpatient activity for individual hospitals that could be attributable to chance orrandom variation. If the annual random variation is not accounted for, then casemix-basedfunding may actually lead to inefficiencies. For this study, hospital inpatientactivity and funding data for 120 acute public hospitals from New South Walesfor the years 1988?89 to 1992?93 were used to estimate the standard deviationof the annual random variation in activity and gross operating payment. Throughlinear regression, estimates of the standard deviation of random variation about theunderlying trend were obtained for each hospital. The results showed that, dependingon the size of the hospital, total diagnosis related group cost weights have a standarddeviation in the range of 2 to 16- per cent of total activity, whilst gross operatingpayment has an equivalent standard deviation that ranges from 1 to 10- per centannually. The magnitude of the variation would suggest that funding of hospitalsshould either be based on average activity over several years or based on bands ofactivity in order to reduce the potential random variation in funding levels.
Why a traditional health outcomes approach will fail in health care and a possible solution
Authors: Gale Lesia
Published: February 2010

This paper challenges the assumption that improved knowledge of health outcomesand their causation will lead to more rational decision-making, resulting in improvedcare at lower costs. The assumption implies that the health system completely controlsall those functions, factors and initiatives that can affect the implementation of thestandard. These include policies, procedures, applications of techniques, skill mix ofstaff, inter-team interaction, communication systems, education, and so on. Changesin policy do not automatically mean a change in practice.Implementation is often approached in a manner that is perceived by staff as punitive,focusing on changing the individual rather than the system in which they work. Notonly is this approach opposite to basic total quality management principles, but it alsofails to acknowledge that most of the improvements arising from the health outcomesapproach are a result of staff being prepared to continuously work harder, often ignoringthe ?system?, to maintain their high standard. However, continuing deterioration in thesystem in which they work sets the scene for an accident or incident to occur.The answer lies in revisiting the traditional quality assurance cycle and acknowledgingthat health care has never been able to effectively ?close the feedback loop?, that is, thehealth system is continuously increasing the sophistication of data collection techniqueswithout giving equal consideration to what needs to be done to ensure effectiveimplementation and evaluation.This paper outlines how Campbelltown Health Service directly addressed this issuethrough its process of achieving international certification to ISO 9002:1994.
Utilisation of Australian health care services by ethnic Chinese
Authors: Fun Chan Yuk , Quine Susan
Published: February 2010

Australia is a multicultural society in which migrants from non-English-speakingbackgrounds may be more vulnerable to illness after their new settlement, andlanguage difficulties and cultural differences may affect their use of health services.The present qualitative study used focus group interviews to explore the health servicesused by Chinese migrants from Hong Kong and China. The general findings includedstrong preference for Chinese-speaking general practitioners, insufficient interpreterservices, low use of preventive services, and lack of knowledge about the existence androle of ethnic health workers. The paper reports specific differences between migrantsfrom China and Hong Kong, and by age group. It discusses reasons for these findingsand notes the implications.
The research and educational priorities of rural occupational therapists
Authors: Daly John , Adamson Lynne , Chang Esther
Published: February 2010

The aim of this pilot research project was to identify the research and educationalpriorities of occupational therapists practising in rural New South Wales. Eightparticipants were recruited in the south-western region of the State. The Delphitechnique was used to obtain the most reliable consensus of the research participants.Priorities emerged in four designated areas: (1) research that would be of value toclients; (2) research that would be of value in providing community care for clients;(3) research that would be of value in facilitating health promotion and diseaseprevention; and (4) research that would be of value to professional and educationalneeds. In the final phase of the study, 23 high priorities were identified. The findingsof the study suggest directions for research and continuing education in occupationaltherapy which may benefit rural practitioners and their clients.
Knowledge of and attitudes to the health outcomes approach among community mental health professionals
Authors: Crocker Tom , Rissel Chris
Published: February 2010

A focus on health outcomes has significant potential for increasing health gain ifadopted by health care staff as part of their professional practice. Understanding healthcare staff attitudes and receptiveness towards health outcomes may facilitate uptakeof this workplace innovation. Community mental health clinicians (n = 101) weresent a questionnaire assessing their knowledge of and attitudes to the health outcomes approach, their expectations as to its likely impact on them, as well as features of their workplace in general. Analysis of the 65 returned questionnaires identified some pessimism about what focusing on health outcomes would achieve for community mental health clinicians or their clients. Training in practical applications of healthoutcomes measures, involvement in and ownership of health outcomes projects and recognition of health outcomes achievements would facilitate adoption of a health outcomes approach by community mental health clinicians.
Building a learning organisation in a child and adolescent mental health service
Authors: Birleson Peter
Published: February 2010

In recent business literature, the model of the learning organisation has been proposedas a solution to the problem of continually changing environments and increasingconsumer expectations of maximum quality and value for money. The model seemshighly appropriate for health services, which are staffed by educated professional staffwho must become more adaptive and concerned with improving consumer outcomes.This case study describes how the principles of learning organisations have beenapplied to the design of a new structure and the creation of a learning culture withina mental health service for children and adolescents.
Casemix classification systems
Authors: Fetter Robert B
Published: February 2010

The idea of using casemix classification to manage hospital services is not new, but has been limited by available technology. It was not until after the introduction of Medicare in the United States in 1965 that serious attempts were made to measure hospital production in order to contain spiralling costs. This resulted in a system of casemix classification known as diagnosis related groups (DRGs). This paper traces the development of DRGs and their evolution from the initial version to the All Patient Refined DRGs developed in 1991.
Development and localisation of casemix applications for inpatient hospital activity in EU member states
Authors: Wiley Miriam M
Published: February 2010

The successful infiltration of casemix techniques across geographical, systemic and cultural boundaries provides an interesting and timely example of the translation of research evidence into health policy development. This paper explores the specifics of this policy development by reviewing the application of casemix techniques within the acute hospital systems of European Union member states. The fact that experimentation with or application of casemix measures can be reported for the majority of European Union member states would suggest that the deployment of these measures can be expected to continue to expand within these health systems into the new millennium.
CAN SOLID BODY DESTRUCTION EXPLAIN ABUNDANCE DISCREPANCIES IN PLANETARY NEBULAE?
Authors: Henney William J. , Stasińska Grażyna
Published: February 2010

In planetary nebulae (PNe), abundances of oxygen and other heavy elements derived from optical recombination lines are systematically higher than those derived from collisionally excited lines. We investigate the hypothesis that the destruction of solid bodies may produce pockets of cool, high-metallicity gas that could explain these abundance discrepancies. Under the assumption of maximally efficient radiative ablation, we derive two fundamental constraints that the solid bodies must satisfy in order that their evaporation during the PN phase should generate a high enough gas-phase metallicity. A local constraint implies that the bodies must be larger than tens of meters, while a global constraint implies that the total mass of the solid body reservoir must exceed a few hundredths of a solar mass. This mass greatly exceeds the mass of any population of comets or large debris particles expected to be found orbiting evolved low- to intermediate-mass stars. We therefore conclude that contemporaneous solid body destruction cannot explain the observed abundance discrepancies in PNe. However, similar arguments applied to the sublimation of solid bodies during the preceding asymptotic giant branch phase do not lead to such a clear-cut conclusion. In this case, the required reservoir of volatile solids is only one ten-thousandth of a solar mass, which is comparable to the most massive debris disks observed around solar-type stars, implying that this mechanism may contribute to abundance discrepancies in at least some PNe, so long as mixing of the high-metallicity gas is inefficient.
Regional variations in the population structure of Pseudomonas syringae pathovar phaseolicola from Spain are revealed by typing with PmeI pulsed-field gel electrophoresis, plasmid profiling and virulence gene complement
Authors: San José Mateo , Rodicio M. Rosario , Argudín M. ángeles , Mendoza M. Carmen , González Ana J.
Published: February 2010

One hundred and twenty pathogenic isolates of Pseudomonas syringae pv. phaseolicola recovered in Spain were subjected to biochemical and genomic typing, and investigated for virulence gene complement. Fifty-six were recovered from common beans (Phaseolus vulgaris) of the type Granja Asturiana, grown in a northern Spanish region (Asturias), and 64 from other common beans cultured in the neighbouring region of Castilla y León. Typing by PmeI digestion followed by pulsed-field gel electrophoresis revealed 27 profiles, with only three being common to both regions. Relationships between profiles distributed the isolates into two clusters: A (subdivided into subclusters A1 and A2) and B. Cluster A included all isolates from Granja Asturiana and about a quarter of the isolates from Castilla y León. Isolates from cluster A were negative for mannitol utilization and hybridized to probes for the argK–tox region responsible for phaseolotoxin production. Isolates that grouped in cluster B, which were only found in Castilla y León, were able to utilize mannitol but did not hybridize to probes for the argK–tox region. Separation of the isolates into three genomic groups, subsequently termed PphA1, PphA2 and PphB, was also supported by effector gene complement and location. In PphB, all effector genes tested (hopX1, hopF1, avrB2 and avrD1) mapped on chromosomal fragments, but faint hybridization of avrB2 with plasmids of about 40 kb was also observed. In PphA hopX1 mapped on the chromosome; in PphA1 avrB2 and avrD1 were carried on virulence plasmids (most of approx. 125 kb) and hopF1 was not detected, while in PphA2 the three genes were located on plasmids (approx. 75–160 kb). These results can be used as a framework to investigate the basis of regional variation in population structure, and for further epidemiological surveillance of P. syringae pv. phaseolicola.
Accounting for residual effects of previously applied nitrogen fertilizer on intensively managed grasslands
Authors: Vellinga T. V. , André G. , Schils R. L. M. , Kraak T. , Oenema O.
Published: February 2010

Only 0·20–0·70 of the fertilizer‐nitrogen (N) applied to grassland is taken up in herbage in the harvest directly following application. Residual effects at subsequent harvests can be large but are poorly quantified, and rarely taken into account in current management practices. An increased understanding of N‐use efficiency per harvest can improve operational management. This study systematically assessed the residual effects of previously applied N fertilizer on N uptake, dry matter (DM) yield and soil mineral‐N (SMN) during the whole of the growing season. It is based on field experiments conducted on peat and mineral soils in 1991–1994. Statistical models were derived for SMN, N uptake and DM yield as a function of previously and freshly applied N fertilizer. There were clear residual effects of previously applied N in later cuts. They were relatively greater at higher levels of N fertilizer. On peat soils, 0·15–0·25 of the N applied was recovered as SMN. On mineral soils the proportion was maximally 0·08. There was a clear relationship between SMN and N uptake in the subsequent cut on mineral soils but not on peat soils. The value of SMN as a tool to adjust fertilizer‐N application rates was hence found to be limited. There were clear relationships between the amount of previously applied N and the N uptake in subsequent cuts, on both soil types and over the whole of the growing season. It was concluded that the total amount of previously applied N is a useful indicator for adjusting N‐fertilizer application rates.
Cohort variation in offspring growth and survival: prenatal and postnatal factors in a late‐maturing viviparous snake
Authors: Baron Jean‐Pierre , Le Galliard Jean‐François , Tully Thomas , Ferrière Régis
Published: February 2010

1. Recruitment to adulthood plays an important role in the population dynamics of late‐maturing organisms as it is usually variable. Compared to birds and mammals, few studies assessing the contributions to this variation of environmental factors, offspring traits and maternal traits have been carried out for late‐maturing snakes.

2. Cohort variation in recruitment through offspring growth and survival in the meadow viper (Vipera ursinii ursinii) was evaluated from 13 years of mark–recapture data collected at Mont Ventoux, France. In this species, females are mature at the age of 4–6 years and adult survival and fecundity rates are high and constant over time.

3. Offspring were difficult to catch during the first 3 years of their lives, but their mean annual probability of survival was reasonably high (0·48 ± 0·11 SE). Mass and body condition at birth (mass residuals) varied significantly between years, decreased with litter size, and increased with maternal length.

4. Cohorts of offspring in better condition at birth grew faster, but offspring growth was not affected by sex, habitat or maternal traits.

5. Survival varied considerably between birth cohorts, some cohorts having a high‐survival rate and others having essentially no survivors. No difference in mass or body condition at birth was found between cohorts with ‘no survival’ and ‘good survival’. However, offspring survival in cohorts with good survival was positively correlated with mass at birth and negatively correlated with body condition at birth.

6. Thus, variation in offspring performance was influenced by direct environmental effects on survival and indirect environmental effects on growth, mediated by body condition at birth. Effects of maternal traits were entirely channelled through offspring traits.
Prevention and treatment of systemic glucocorticoid side effects
Authors: Moghadam‐Kia Siamak , Werth Victoria P.
Published: February 2010

Background  Systemic glucocorticoids are used in dermatologic practice for various diseases including connective tissue disorders, bullous diseases, and many other dermatologic conditions. Patients with these diseases are at times treated with long‐term courses of glucocorticoids, which place them at increased risk for glucocorticoid‐induced side effects. Therefore, dermatologists must be knowledgeable of risks related to glucocorticoid use and be familiar with guidelines to manage them.

Objective  To provide an update of recent advances in the prevention and treatment of major glucocorticoid‐induced side effects.

Methods  Review of the literature Results Data regarding the prevention and treatment of glucocorticoid‐induced side effects are presented.

Conclusion  This review should help dermatologists optimally manage and prevent glucocorticoid‐induced side effects.
Utility of percutaneous renal biopsy in chronic kidney disease
Authors: JOSEPH ANTHONY J , COMPTON SUSAN P , HOLMES LEWIS H , ANNAND ANDREW , SELF SALLY E , FITZGIBBON WAYNE R , ULLIAN MICHAEL E
Published: February 2010

Background:  We tested the hypothesis that patterns of serum creatinine concentrations (S‐cr) prior to percutaneous renal biopsy (PRB) predict the utility of PRB in safely making renal diagnoses, revealing treatable disease, and altering therapy in chronic kidney disease patients.

Methods:  PRB specimens (170 patients) were assigned to 1 of 5 groups: S‐cr never greater than 0.11 mM for at least 6 months prior to PRB (Group 1); S‐cr greater than 0.11 mM but less than 0.18 mM during the 6 months prior to PRB (Groups 2); S‐cr less than 0.18 mM during the 6 months prior to PRB but greater than 0.18 mM prior to these 6 months (Group 3); S‐cr greater than 0.18 mM for less than 6 months prior to PRB (Group 4); S‐cr greater than 0.18 mM for more than 6 months prior to PRB (Group 5).

Results:  Histopathology chronicity score (0–9) increased with increasing group number: 2.1 (Group 1); 4.4 (Group 2); 4.5 (Group 3); 5.4 (Group 4); 7.0 (Group 5). Post‐PRB bleeding was more common with increasing group number. New therapy was instituted after PRB most frequently in Group 4 (62%) and least frequently in Group 5 (24%).

Conclusion:  After more prolonged elevations of S‐cr, PRB may be less safe and less likely to reveal treatable disease and opportunities for therapy.
Statistical aspects of fatigue life and endurance limit
Authors: WALLIN K.
Published: February 2010

Based on the assumption that the fatigue life and endurance limit is mainly controlled by the materials particle distribution, different possible statistical distributions to describe the fatigue have been assessed. Some distributions lead to high statistical uncertainty or physically non‐realistic size effects. It is shown that, if the maximum particle size distribution is described by a Frechet distribution, both the fatigue life, as well as the endurance limit are described by a Weibull distribution.
Complex state‐dependent games between owls and gerbils
Authors: Berger‐Tal Oded , Mukherjee Shomen , Kotler Burt P. , Brown Joel S.
Published: February 2010

Ecology Letters(2010) 13: 302–310

Predator–prey interactions are often behaviourally sophisticated games in which the predator and prey are players. Past studies teach us that hungrier prey take higher risks when foraging and that hungrier predators increase their foraging activity and are willing to take higher risks of injury. Yet no study has looked at the simultaneous responses of predator and prey to their own and each other’s hunger levels in a controlled environment. We looked for evidence of a state‐dependent game between predators and their prey by simultaneously manipulating the hunger state of barn owls, and Allenby’s gerbils as prey. The owls significantly increased their activity when hungry. However, they did not appear to respond to changes in the hunger state of the gerbils. The gerbils reacted strongly to the owls’ state, as well as to their own state when the risk was perceived as high. Our study shows that predator–prey interactions give rise to a complex state‐dependent game.