bluuebunny/crossref_metadata_2025 huggingface dataset:
Comparative outcomes of using fibrin glue in septoplasty and its effect on mucociliary activity
Authors: Habesoglu Tulay Erden , Kulekci Semra , Habesoglu Mehmet , Deveci Ildem , Deveci Senem , Toros Sema , Naiboglu Baris , Kinis Vefa , Egeli Erol
Published: February 2010

Objective

Our objective was to determine the efficacy of fibrin glue to prevent complications and nasal mucociliary clearance (MCC) after septoplasty compared with a nonabsorbable packing requiring removal (polyvinyl alcohol [PVA] sponge).

Study Design

Prospective clinical trial with planned data collection.

Setting

The study was conducted at Haydarpasa Numune Education and Research Hospital.

Methods

A total of 44 patients, who had septoplasty operations, were included in the study. We evaluated postoperative pain, sleep disturbance on the night of surgery, bleeding, septal hematoma, synechia, infection, and MCC values in the fibrin glue and PVA sponge groups.

Results

The pain scores in the fibrin glue group were significantly lower than in the PVA sponge group (P < 0.01). A statistically significant difference was noted in the number of patients who had mild bleeding in favor of the fibrin glue group (P < 0.05). In the fibrin glue group, 95.7 percent of patients reported that they had normal sleep; in the PVA sponge group, only 23.8 percent of patients reported normal sleep (P < 0.01). In the fibrin glue group, a significant decrease was noted in postoperative MCC values compared with preoperative values (P < 0.01). However, in the PVA sponge group, a significant increase was noted in postoperative clearance values compared with preoperative values (P < 0.01).

Conclusion

In our series of patients, we have seen no gross complications from fibrin glue usage. Fibrin glue can be readily used in septoplasty; it requires no special treatment, has an adequate hemostatic effect, and appears to promote the regeneration of mucociliary activity of the injured mucosa postoperatively.
Informational Efficiency and Liquidity Premium as the Determinants of Capital Structure
Authors: Chang Chun , Yu Xiaoyun
Published: February 2010

This paper investigates how a firm’s capital structure choice affects the informational efficiency of its security prices in the secondary markets. We identify two new determinants of a firm’s capital structure policy: the liquidity (adverse selection) premium due to investors’ anticipated losses to informed trading, and operating efficiency improvement due to information revelation from the firm’s security prices. We show that the capital structure decision affects traders’ incentives to acquire information and subsequently, the distribution of informed traders across debt and equity claims. When information is less imperative for improving its operating decisions, a firm issues zero or negative debt (i.e., holding excess cash reserves) in order to reduce socially wasteful information acquisition and the liquidity premium associated with it. When information is crucial for a firm’s operating decisions, the optimal debt level is one that achieves maximum information revelation at the lowest possible liquidity cost. Our model can explain why many firms consistently hold no debt. It also provides new implications for financial system design and for the relationship among leverage, liquidity premium, profitability, and the cost of information acquisition.
Corporate Governance and Liquidity
Authors: Chung Kee H. , Elder John , Kim Jang-Chul
Published: February 2010

We investigate the empirical relation between corporate governance and stock market liquidity. We find that firms with better corporate governance have narrower spreads, higher market quality index, smaller price impact of trades, and lower probability of information-based trading. In addition, we show that changes in our liquidity measures are significantly related to changes in the governance index over time. These results suggest that firms may alleviate information-based trading and improve stock market liquidity by adopting corporate governance standards that mitigate informational asymmetries. Our results are remarkably robust to alternative model specifications, across exchanges, and to different measures of liquidity.
Forecasting Volatility Using Long Memory and Comovements: An Application to Option Valuation under SFAS 123R
Authors: Jiang George J. , Tian Yisong S.
Published: February 2010

Horizon-matched historical volatility is commonly used to forecast future volatility for option valuation under the Statement of Financial Accounting Standards (SFAS) 123R. In this paper, we empirically investigate the performance of using historical volatility to forecast long-term stock return volatility in comparison with a number of alternative forecasting methods. In analyzing forecasting errors and their impact on reported income due to option expensing, we find that historical volatility is a poor forecast for long-term volatility and that shrinkage adjustment toward comparable-firm volatility only slightly improves its performance. Forecasting performance can be improved substantially by incorporating both long memory and comovements with common market factors. We also experiment with a simple mixed-horizon realized volatility model and find its long-term forecasting performance to be more accurate than historical forecasts but less accurate than long-memory forecasts.
Exploitable Predictable Irrationality: The FIFA World Cup Effect on the U.S. Stock Market
Authors: Kaplanski Guy , Levy Haim
Published: February 2010

In a recently published paper, Edmans, García, and Norli (2007) reveal a strong association between results of soccer games and local stock returns. Inspired by their work, we propose a novel approach to exploit this effect on the aggregate international level with the following three unique features: i) The aggregate effect does not depend on the games’ results; hence, the effect is an exploitable predictable effect. ii) The aggregate effect is based on many games; hence, it is very large and highly significant. We find that the average return on the U.S. market over the World Cup’s effect period is – 2.58%, compared to +1.21% for all-days average returns over the same period length. iii) Exploiting the aggregate effect is involved with trading in a single index for a relatively long period.
Admirably perverse: tectonic expression and the puzzles of Galerie Goetz
Authors: Jones Peter Blundell
Published: February 2010

The Galerie Goetz is a small art gallery built between 1989 and 1992, one of the early works of Herzog & de Meuron which helped to win them such commissions as Tate Modern and launched their spectacular international career. At first sight this box-like building standing at the far end of a villa garden in a Munich suburb seems rather dead-pan and understated: from the street [2] you register only the upper floor, a box measured out in five bays, for the ground level is perfectly obscured by the garden fence, an apparently banal element carefully remade by the architects.
Acoustic properties of gas hydrate–bearing consolidated sediments and experimental testing of elastic velocity models
Authors: Hu Gao W. , Ye Yu G. , Zhang Jian , Liu Chang L. , Diao Shao B. , Wang Jia S.
Published: February 2010

Although elastic velocities (Vp, Vs) can be used to assess the distribution and concentration of marine gas hydrates in situ and several existing models relate hydrate saturation to acoustic velocity, the accuracy of these models is uncertain because of the difficulty in determining hydrate saturations and velocities of intact hydrate‐bearing sediments. In this paper, the acoustic properties of gas hydrate–bearing consolidated sediments were investigated experimentally. Hydrate saturation (Sh) and acoustic velocities were measured in one system by time domain reflectometry and ultrasonic methods, respectively, during gas hydrate formation and subsequent dissociation in a water‐saturated artificial core. Acoustic velocities change little at low hydrate saturations (0% to ∼10%), whereas they increase rapidly when hydrate saturation is between 10% and 30%. We verified two commonly used models, i.e., the weighted equation (WE) and the Biot‐Gassmann theory modified by Lee (BGTL). In the 0% to 40% hydrate saturation range, the WE model is consistent with the measured Vp data, while a combination of the WE and the Vp/Vs ratio in the BGTL predicts Vs corresponding to the observed data. As hydrate saturation is more than 30%, however, the BGTL is more suitable for predicting both Vp and Vs. This suggests that gas hydrate may be treated as a component within a matrix of consolidated sediments when hydrate saturation exceeds 30%. However, when Sh is less than 30%, the hydrate locates in the pore fluid or partly adheres to the sediment frame.
Breaking of unsteady lee waves generated by diurnal tides
Authors: Nakamura T. , Isoda Y. , Mitsudera H. , Takagi S. , Nagasawa M.
Published: February 2010

Diapycnal mixing caused through breaking of large‐amplitude internal lee waves generated by sub‐inertial diurnal tides, which are modulated with a 18.6‐year period, is hypothesized to be fundamental to both the intermediate‐layer ventilation and the bi‐decadal oscillation around the North Pacific Ocean. The first observational evidence of such wave breaking is presented here. The breaking wave observed had ∼200 m height and ∼1 km width, and its associated diapycnal mixing was estimated to be ∼1.5 m2 s−1, with a temporal average ∼104 times larger than typical values in the open oceans. Our estimate suggests that a similar mixing process occurs globally, particularly around the Pacific and Antarctic Oceans.
Induced pluripotent stem cells: paths to new medicines
Authors: Deng Wenbin
Published: February 2010

The invention of iPSC in 2006 has been heralded as a major breakthrough. Wenbin Deng explains the enormous potential of these cells for research into human diseases and development, and discusses the technical and regulatory hurdles to be overcome for their therapeutic use.
TBCCD1, a new centrosomal protein, is required for centrosome and Golgi apparatus positioning
Authors: Gonçalves João , Nolasco Sofia , Nascimento Rute , Fanarraga Mónica Lopez , Zabala Juan Carlos , Soares Helena
Published: February 2010

In animal cells the centrosome is positioned at the cell centre in close association with the nucleus. The mechanisms responsible for this are not completely understood. Here, we report the first characterization of human TBCC‐domain containing 1 (TBCCD1), a protein related to tubulin cofactor C. TBCCD1 localizes at the centrosome and at the spindle midzone, midbody and basal bodies of primary and motile cilia. Knockdown of TBCCD1 in RPE‐1 cells caused the dissociation of the centrosome from the nucleus and disorganization of the Golgi apparatus. TBCCD1‐depleted cells are larger, less efficient in primary cilia assembly and their migration is slower in wound‐healing assays. However, the major microtubule‐nucleating activity of the centrosome is not affected by TBCCD1 silencing. We propose that TBCCD1 is a key regulator of centrosome positioning and consequently of internal cell organization.
Evolution and regulation of cellular periodic processes: a role for paralogues
Authors: Trachana Kalliopi , Jensen Lars Juhl , Bork Peer
Published: February 2010

Several cyclic processes take place within a single organism. For example, the cell cycle is coordinated with the 24 h diurnal rhythm in animals and plants, and with the 40 min ultradian rhythm in budding yeast. To examine the evolution of periodic gene expression during these processes, we performed the first systematic comparison in three organisms (Homo sapiens, Arabidopsis thaliana and Saccharomyces cerevisiae) by using public microarray data. We observed that although diurnal‐regulated and ultradian‐regulated genes are not generally cell‐cycle‐regulated, they tend to have cell‐cycle‐regulated paralogues. Thus, diverged temporal expression of paralogues seems to facilitate cellular orchestration under different periodic stimuli. Lineage‐specific functional repertoires of periodic‐associated paralogues imply that this mode of regulation might have evolved independently in several organisms.
Approaches to changing the use of time in a public hospital
Authors: Walker Rae , Adam Jenny
Published: February 2010

This article describes a qualitative study that used documentary sources and interviews witha cross-section of clinical managers and staff to identify the ways in which use of time changedin two clinical units following the introduction of casemix-based funding in Victoria.For staff at all levels within the hospital system, changes in the use of time were experiencedthat affected both the organisation of work and the care provided. The two units approachedthe management of time in different ways. From the introduction of casemix-based fundingto the conclusion of this study there were improvements in efficiency in both clinical units.The case studies are compared and the consequences of different approaches to managing timein clinical units are described.
High length-of-stay outliers under casemix funding of a remote rural community with a high proportion of Aboriginal patients
Authors: Russell-Weisz D , Hindle Don
Published: February 2010

The diagnosis related groups (DRG) classification was designed primarily to categorise patients of acuteshort-stay hospitals in urban areas. As one might expect, many studies have shown it is a less effectivepredictor of the needs - and consequently the costs of care - of remote and socio-economicallydisadvantaged communities.One way of improving the equity of funding involves separating the cases in each DRG into inlier andoutlier episodes, and making different resource allocations for each category. This paper summarises theoutlier payment model used by the Health Department of Western Australia, with emphasis on highlength of stay outliers. The model provides additional funds for high length of stay outliers, but fundinglevels are deliberately set below the actual estimated costs of care, on the assumption that some of theadditional costs are a consequence of poor care management.All high length of stay outlier episodes in the East Pilbara Health Service in 1997-98 were examined.It was found that the outliers were predominantly Aboriginal patients from remote communities withhigher than average needs for care as indicated by their greater tendency to have multiple conditionsrequiring treatment. The age distribution of high length of stay outliers was quite different from thatfound in most Australian hospitals, in that there was a higher proportion of young children.It is concluded that, although the ideas on which the funding model is based are sound, revisions ofdetail need to be considered to reduce the risk that the burden of cost containment will fall to adisproportionate degree on the most disadvantaged groups of patients.
WESTCOP: a disease management approach to coronary artery disease
Authors: Scott Ian , Harper Catherine , Clough Aleesa
Published: February 2010

Disease management is a systematic approach to improving care of populations of patients with specificclinical conditions. Critical to success are the formation of collaborative teams of health carestakeholders, development and promulgation of clinical practice guidelines, and performancemeasurement and feedback to providers as a process of continuous practice improvement.This article describes a disease management program for patients with coronary artery disease in aprovincial health district with a population of 180,000. It discusses the rationale and methods behindthe operationalisation of the main program elements, benefits achieved to date and challengesconfronted.
EQuIP accreditation: Feedback from a Sydney teaching hospital
Authors: Fairbrother Greg , Gleeson Maureen
Published: February 2010

The Australian Council on Healthcare Standards' new Evaluation and Quality ImprovementProgram (EQuIP) accreditation model reflects the worldwide trend towards incorporatingcontinuous quality improvement and patient-focused care goals into hospital/health serviceaccreditation. We conducted a post-EQuIP feedback survey among senior clinical andmanagerial staff at a Sydney teaching hospital and identified significant levels of negativefeedback among respondents. Principal concerns were related to perceptions that the processwas unnecessarily unwieldy and that it offered little value in terms of patient care deliveryfor the significant amount of human resources it consumed.
Nurse-managed analgesia for renal colicpain in the emergency department
Authors: Kelly Anne-Maree
Published: February 2010

A retrospective chart review was conducted of patients with acute renal colic for the years 1993 and1997, in order to compare analgesia ordering and administration practices before and afterimplementation of a nurse-managed, titrated intravenous (IV) narcotic policy.The study demonstrated a significant and sustained change in analgesia administration practices awayfrom the intramuscular (IM) route in favour of the IV route. For renal colic, in 1993, 76% of patientsreceived IM narcotic analgesia compared to 3% in 1997. In contrast, IV narcotic (with or withoutadjuvant NSAID) was used in 3% of the patients in 1993 compared to 95% in 1997.
Evidence-based priority setting
Authors: Astley Julie , Wake-Dyster Wendy
Published: February 2010

This paper describes evidence-based priority setting and resource allocation undertaken by a Division of the Women's & Children's Hospital, Adelaide during 1998-1999. We describe the methods used to combine program budgeting marginal analysis (PBMA), evidence based and "community values" approaches into one decision-making framework.Previous organisational changes involving the formation of multidisciplinary team and program management were pivotal in setting a framework to successfully complete the priority setting process.
Introducing the routine use of outcomes measurement to mental health services
Authors: Callaly Tom , Hallebone Assoc. Prof. Erica L.
Published: February 2010

Significant progress has been made in preparing for the introduction of the routine use of outcome measurementinstruments to mental health services. However, limited attention has been paid to the linked issues of the practicalchallenge of their implementation and their possible uses in clinical practice.This paper reports on a qualitative study examining the views of clinicians, service managers, consumers and carerson how to effectively introduce a suite of measures to a public mental health service and use ratings generated by themin clinical practice. These findings are combined with practical experience gained in introducing a suite of outcomemeasures in order to suggest future strategies for implementation.
Organisational change: a methodologyto uncover the business idea
Authors: Barker Jo , Anderson Paul
Published: February 2010

A study was undertaken to identify the "Business Idea", as defined by van der Heijden (1996), in The FamilyPlanning Association of WA Inc (FPWA) which is a Non-Government Organisation (NGO) in Perth, WesternAustralia. This organisation was chosen as, along with many other NGOs, it was undergoing major changes in itsfunding, role and required outcomes.A qualitative interpretivist single case study methodology employing grounded theory research principles and methodswas used to study the Business Idea framework in this setting. Thirty-four members of FPWA's staff were interviewedand data was managed using NUD*IST4 and Decision Explorer data storage, data retrieval and graphicalreproduction facilities.Results indicated that images of the Business Idea model within FPWA were largely consistent across all staff levelsexcepting members of the Board of Management. Changes within the organisation were impacting heavily on staff,who needed to be assisted over the transitional phase. Strong leadership and corporate direction were identified asessential if the FPWA was to balance the strongly held sense of social justice amongst its staff with a need for greaterproductivity, efficiency and accountability across the organisation.
Hospital utilisation expectancies inNew Zealand, 1980-98
Authors: Cheung Jit , Katzenellenbogen Judith , Baxendine Sandra , Pool Ian , Jackson Gary
Published: February 2010

The need to synthesise mortality and morbidity information to achieve a more global and relevant measure of population health status is well recognised, with health expectancy indices being the most common approach used to date. Using New Zealand hospital discharge and mortality data over the 1980-98 period, we introduce readers to a newly developed health index, the Hospital Utilisation Expectancy (HUE). We describe how HUE changes with age and over time. New Zealand national and regional trends are described. The methodological strengths of the measure and its applications in the health sector are discussed.
The reasons for, and lessons learnedfrom, the closure of the Canterbury GPAfter-Hours Service
Authors: Bolton Patrick , Thompson Lindsay
Published: February 2010

This paper describes a trial of the Canterbury GP After-Hours Service (CGPAHS), a GP staffed after-hours servicewithin the Canterbury Hospital Emergency Department. It was decided not to continue the service beyond the twelve-monthtrial phase because the opportunity cost to do this was greater than existing alternative services.The efficiency of the service might have been improved had greater numbers of patients been referred to it, either fromthe adjacent emergency department or the local community. Reasons why the trial was not able to realise theseefficiencies are explored.
Emergency and primary care at a Melbourne hospital: reasons for attendance and satisfaction
Authors: Liaw Siaw-Teng , Hill Tina , Bryce Harry , Adams Geoffrey
Published: February 2010

The reasons for attendance, presenting health problems, functional status, pain and severity, and satisfactionwith emergency and primary care were examined using routinely collected data and an interviewer-assistedsurvey of patients. Patients attended, mostly after hours, because they believed their health problems requiredhospital-based management. GPs referred for admission and further evaluation. Ethnicity, employment status,gender and age contributed to differences in access, morbidity and pain scores. Pain scores, functional statusand English language skills influenced satisfaction.Culturally sensitive hospital- and community-based clinicians are important to promote better services, after-hourscare, referral and triage. It is essential to have appropriate policy and legislation, adequate infrastructureand resources, good communication strategies, telecommunication technology, explicit evidence-basedprotocols for shared care, referral and triage and ongoing training and support for clinicians and consumers.
A case study in using VET qualifications to rejuvenate learning and change in a complex and disparate rural Health Service
Authors: Hartley Ross
Published: February 2010

The Boggabri Health Service is typical of many rural and remote public health facilities. Twenty-four staff, only athird of whom work fulltime, service the needs of a population of 1601. Change from a focus on acute care to a modelof wellness through redevelopment as a Multi Purpose Service is providing staff with a unique opportunity forcontinuing professional development, particularly in regard to aged care standards, their core business.Use of flexible delivery and self-directed learning has transformed this facility from ignorance about the value ofundertaking vocational education and training (VET) to 80% enrolment in certificate and diploma qualifications,over a six month period from January 2001. Some twenty-five facilities comprise the New England Area HealthService, of which Boggabri is but one. The learning innovation demonstrated at Boggabri is being duplicated acrossother facilities. Interest in VET qualifications from staff at all levels is a remarkable renaissance.
Recognising the changing boundaries of illness in defining terms of chronic illness
Authors: Walker Christine
Published: February 2010

Definitions of chronic illness do not reflect the changing nature of chronic illnesses. When definitions in the literature,which guide and inform thinking in a field, remain static they are in danger of creating stereotypes. This can havean adverse influence on the care of people with chronic illness. Debates over the use of terms associated with chronicillness will lead to a better understanding of the place of chronic illness in the world of health and illness andultimately lead to services that better meet the needs of consumers.
Factors influencing the utilisation of health services by rural men
Authors: Buckley Dermot , Lower Tony
Published: February 2010

This research identified the barriers and enablers that influence the utilisation of health services by rural men in the Midwest region of Western Australia. The methodology was based on participatory action research, including qualitative assessments to determine the issues for a larger quantitative study. Four variables were identified as predictors for the use of health services: those who attended for preventive reasons; those not affected by seasonal work;men who thought a medical telephone line was not important; and those who did not consider privacy an important issue. Modification of health service delivery to men could potentially enhance appropriate utilisation of health services in rural areas.
Combining quantitative and qualitative research to engage stakeholders in developing quality indicators in general practice
Authors: Jeacocke David , Heller Richard , Smith Justine , Anthony Danielle , Stewart Williams Jenny , Dugdale Anni
Published: February 2010

In 2000,the Newcastle Institute of Public Health (NIPH) undertook a project that aimed to review,identify and where necessary, develop a range of indicators of quality service provision in general practice. We describe the way in which quantitative and qualitative research methods (including a Delphi style survey) were combined to investigate consensus amongst stakeholders in defining quality indicators. Over 500 general practice stakeholders were consulted. They included general practitioners (GPs)and their representative groups, academics, policy makers, and consumers. Several important lessons were learnt from the process, including the importance of involving a broad representative group of stakeholders, informing workshop participants in advance, providing adequate response times for the Delphi surveys and using videoconferencing technologies.
Private health insurance: the problem child faces adulthood
Authors: Cormack Mark
Published: February 2010

Since its election to office in 1996, reform of Private Health Insurance (PHI) has been the most obvious health policy focus of the Howard Government. The reform process has focussed on price, product, promotion, legislation and regulation. It has resulted in one of thelargest new Commonwealth health outlays in recent memory. Health insurance funds have emerged as activepurchasers of care, not just passive reimbursers of costs. PHI fund reserves have moved from precarious liquidity tohealthy surplus. Private hospitals are busier than ever before, but margins are slim. Anecdotally, public hospitals report little benefit to date. Waiting lists have not been reduced, and their budgets are unchanged as a result of the $2 Bn allocated under the 30% Rebate scheme. The paper begins by describing the origins of the PHI reform. Its objectives, policy initiatives, results to date and criticisms are analysed. Criticisms include the actual and opportunity costs. Specific concerns remain as to its effectiveness to date in reducing pressure on public hospitals, and perceived lack of equity for certain client groups. Themost significant result is that much of the reform package is here to stay including the expensive and much criticised 30% rebate. Like Medicare before it, the PHI reforms have achieved bipartisan support. The paper concludes by describing future implications for Government, industry, consumers and the medical profession.
The effects of increased market competition on hospital services in Shandong and Henan Provinces
Authors: Forbes Ian , Hindle Don , Degeling Pieter , Zhang Kai , Xu Lingzhong , Meng Qingyue , Wang Jian
Published: February 2010

The Chinese government began a major reform of the hospital sector in the early 1980s. The main aim was to increase productivity by phasing out prospective global budgets from the government, and encouraging between-hospital competition for the business of user-pay and insured patients. This goal was to be achieved without unreasonable prejudice to the financial sustainability of hospitals or to the fairness of access and service provision. We explored the effects of these changes by analysing data for four levels of hospital in two of the most populousprovinces between 1985 and 1999. We used data envelope analysis, and found that the majority of hospitalsexperienced a decline in productivity. Social efficiency (measured by the level of provision of unnecessary services) alsodeclined, especially in the largest hospitals that could easily increase the use of expensive technologies. Most hospitals increased their economic sustainability, measured as the ratio between revenue and expenditures. However, the lowest-levelhospitals experienced stable or reduced sustainability due to their inability to compete with marketing by higher-levelhospitals. We conclude that, although there were many benefits, the overall impact of the introduction of market forces may have been negative. An important factor was that not all aspects (such as supplier-induced demand) were adequatelycontrolled by government agencies. We suggest ways of alleviating the most problematic elements of current arrangements.
Funding Victoria's public hospitals: The casemix policy of 2000-2001
Authors: McNair Peter , Duckett Stephen
Published: February 2010

On 1 July 1993 Victoria became the first Australian state to use casemix information to set budgets for its public hospitals commencing with casemix funding for inpatient services. Victoria's casemix funding approach now embracesinpatient, outpatient and rehabilitation services.
HealthConnect: a trial of an after-hours telephone triage service
Authors: Bolton Patrick , Ganon Sharryn , Aro David
Published: February 2010

This paper describes HealthConnect, an after-hours telephone triage and advice service which operated for 15 months in 2000 and 2001. We describe the service, discuss utilisation and implementation issues, and conclude with a description of the key lessons learned from the trial. The service received over of 12000 calls, of which over half were for information rather than immediately seeking care.Continuing marketing appears to be required in order to ensure ongoing demand for services of this kind. Qualityassurance is essential to ensure that an optimal service is provided, and staff recruitment and training are critical tothis. A national standardised approach to services of this kind is desirable to provide a consistent service to consumers and realise economies of scale.
Entry One: striving for best practice in professional assessment
Authors: English Justin M , Mykyta Lu
Published: February 2010

The aim of this study was to develop a best practice model of professional assessment to ensure efficient and effectivedelivery of home-based services to frail and disabled elders. In 2000, an innovative model of professional assessment was introduced by one of Australia's largest providers of home-based care in order to reduce multiple assessments and to reduce the utilisation of assessment as a gatekeeping tool for limiting access to services. Data was analysed from arandom sample of 1500 clients drawn from a population of 5000 as well as through the use of a survey tooladministered to the Organisation's assessment staff and other key stakeholders. Results revealed that, contrary to popular belief, carer advocacy plays a significant role in the professional assessment process to the point that clients with carers received significantly more services and service time that clients withoutsuch support. However, if not monitored, assessment can also be used as a gate-keeping tool as opposed to one that can provide significant benefits to the consumers through comprehensive need articulation. We argue that the "professional" approach does not preclude empowerment and that assessment should not be used as a gate-keeping tool.
Sex in prisons - a management guide
Authors: Awofeso Niyi , Naoum Raymond
Published: February 2010

Prisons are invariably unisex institutions where, besides many deprivations, heterosexual expression in its normal sense is absent. It is this characteristic that make prisons settings potentially fertile grounds for sexual aberrations. Since definite and accurate data concerning sexual activities among prison inmates are difficult to obtain, the phenomenon of sexual practices in prisons has traditionally been a topic of much speculation. However, the descriptions and explanations of most authors on the subject are often contradictory, and some of the best information are from unpublished sources.This article is an attempt to subsume many fragmented explanations about seven main types of sexual issues in prisons (i.e. consensual homosexuality, masturbation, transsexualism, prostitution, conjugal visits, sex between prisoners and prison staff, and rape among prison inmates) under more general criminological and management concepts. Suggestions for prison administrators on how to manage these complex issues in the best interests of security and inmates' health are also provided.
Why is IT important?
Authors: Cohen Brian
Published: February 2010

Healthcare organisations are under pressure to offer improved patient care while at the same time attempting to reduce or, at best, manage costs. Technology has always played an important role in medicine, helping with devices and improving investigations and treatments. In many cases, this technology has helped to boost revenues at the same time. Information Technology (IT) has been applied traditionally within the administrative areas of the organisation. More recently, it is being used within the clinical area and is therefore confronting healthcare professionals with both opportunities and challenges in carrying out their tasks. This paper attempts to cut through the jargon and hype surrounding trends in Information Technology and focus onaspects with which the organisation should be concerned.
An evaluation of a smoke free environment policy in two Sydney Hospitals
Authors: Jean Boomer Melanie , Rissel Chris
Published: February 2010

The Central Sydney Area Health Service introduced an Area-wide Smoke Free Environment Policy in May 2000, prohibiting smoking (except in designated areas) and requiring nursing and medical staff to manage nicotine withdrawal in their patients. This study assessed one aspect of the policy implementation process, by following up 68 hospitalised smokers after discharge, who were recruited through pre-admission clinics from two hospitals. Thirty-five percent of smokers recalled being told about the policy, 22% recalled being told information about designated smoking areas and 19% smoked whilst hospitalised. More than a third of inpatient smokers had problems with not smoking, or smoked while in hospital.
The impact of the variation in death certification and coding practices on trends in mortality from ischaemic heart disease
Authors: Chen Linping , Walker Sue , Tong Shilu
Published: February 2010

This review examines the literature relating to the effect of death certification practices, coding and the terminology used by certifiers on trends in mortality from ischaemic heart disease (IHD). The review identifies factors that affect mortality trends in a number of countries and discusses methods for assessing the impact of these issues on trends in mortality from IHD. The review found that although the magnitude of the effects of the issues on trends in mortality from ischaemic heart disease varied among countries and sub-populations, miscertification and the resultant assignment of misleading ICD codes, particularly for ill-defined cardiovascular conditions, were important factors affecting the IHD mortality trends. In light of these findings, it is essential to monitor regularly the accuracy of death certificates for IHD and consider necessary adjustments in analysing mortality trends from IHD.
Extract from SARS in Hong Kong: From Experience to Action
Authors: Expert Committee SARS
Published: February 2010

This extract is reprinted from the report of the SARS Expert Committee (pp 159 - 164) with permission. Thefull report is available on the Committee's website at www.sarsexpertcom.gov.hk. The summary report is alsoavailable on the Royal Australasian College of Medical Administrators website at www.racma.org.auH
Implementing DRGs in Slovenia: why the Australian variant was selected
Authors: Hindle Don
Published: February 2010

Slovenia is embarking on an ambitious health sector reform program, a small part of which involves implementingthe categorization of acute inpatients by DRG for payment purposes. I summarise the leading DRG variants, anddescribe the process of selecting one of them.I argue that the Slovenian decision to use the Australian DRG variant as a starting point was sensible in terms of cost,speed of implementation, and usefulness of the resultant information. More time and effort could have been spent onthe appraisal process, but I suspect it would not have led to a different outcome.
A comparison of two measures of hospital foodservice satisfaction
Authors: Wright Olivia , Capra Sandra , Aliakbari Judith
Published: February 2010

There are few published papers on patient satisfaction with food or nutrition services in either acute or chronic health care settings. The aim of this study was to evaluate two questionnaires for measuring patient satisfaction with hospital foodservice, the "Parkside Inpatient Questionnaire" and the "Wesley Hospital Foodservice Patient Satisfaction Questionnaire". Data were collected from 540 patients at a Queensland Public Hospital.Results indicated the Wesley Hospital Foodservice Patient Satisfaction Questionnaire obtained more positive patient feedback and was more reliable at measuring patient satisfaction (?=0.89) than the Parkside Inpatient Questionnaire (?=0.75), thus it is a more effective foodservice quality management tool.
Reporting hospital adverse events using The Alfred Hospital's morbidity data
Authors: Carroll Rhonda , McLean Jenny , Walsh Michael
Published: February 2010

Hospital morbidity data were analysed to determine their usefulness for reporting adverse events. The entire ICD-10-AM classification system was reviewed in conjunction with the Australian Coding Standards to identify external causecodes and code prefixes associated with adverse events.For the 50,712 separations registered at The Alfred from July 2000-June 2001, 4,740 external cause codes wereassociated with adverse events. Place of occurrence code CY92.22 was considered the best indicator of the number ofseparations associated with adverse events. Approximately 4% of all separations were associated with adverse eventsoccurring during an episode of care.Results suggest that hospital morbidity data are useful for monitoring adverse events at hospital level. Reliable reportingacross the health care industry requires consistent reporting requirements at state and national levels and the adoptionof standard code prefixes nationally.
Innovations in aged care: study tours for Japanese health professionals-sharing insights
Authors: Thornton Robert
Published: February 2010

With Australian health care management is becoming of increasing interest to Asian organisations,and there have been many advances made in the conduct of informative tours. This article presents a summary of key points to be considered when planning and implementing study tours for health professionals from Japan, especially in the context of aged care. By providing an outline of Japanese culture and traditions,is provided and the mostly anecdotal experience will serve to inform readers about how to conduct such tours so that to meet the learners' needs are met while also preserving the dignity of the aged persons involved. The key issues to be addressed are described using the mnemonic of S.T.U.D.Y.T.O.U.R.S. - where the key letters stand for Specifications, Translation, Understanding culture, Delivery of education, Yen, Timing, Organisation, Unique needs, Residents' values and Safety.The intent of the article is to encapsulate the many factors to be planned and implemented to achieve the outcomes required by the Japanese visitors and to ensure both the necessary professional and financial rewards for the Australian hosts.
Performance measurement for community health services: opportunities and challenges
Authors: Jolley Gwyn
Published: February 2010

This paper presents findings from a study that investigated performance measurement for primary health care servicesdelivered by the community health sector, and assessed the effectiveness and value of a performance measurementapproach in the evaluation of these services. Eleven semi-structured interviews were conducted with key stakeholdersin South Australia. The findings indicate that three major steps are needed to move forward in the use of performancemeasurement in the community health sector. These steps are i) development of a policy and strategy statement forcommunity health, ii) identification of performance domains and indicators, and iii) development of appropriatedata systems.
Development and evaluation of a consumer's guide to residential aged care
Authors: Edwards Helen , Courtney Mary , Spencer Lyndall
Published: February 2010

This three-phase study aimed to develop and evaluate an information guide for potential consumers of residential aged care.Phase 1 consisted of a series of six focus groups with 41 seniors to determine the information needs of potential consumers.Phase 2 comprised a 2 round Delphi survey in which a panel of 10 industry stakeholders prioritised the themes identified by the focus groups.Phase 3 consisted of a pilot test and evaluation of the prototype information booklet by 19 seniors and their families. A feature of the guide is that its contents were identified by seniors themselves as information they wanted to know about residential care.
A survey of workplace bullying in a health sector organisation
Authors: Rutherford Alison , Rissel Chris
Published: February 2010

The purpose of this study was to explore the
frequency, nature and extent of workplace bullying
in a health care organisation in New South Wales.
The survey methodology achieved a 79%
response rate (n = 311). Overall, 155 respondents
(50%) reported that they had experienced one or
more forms of bullying behaviour in the past 12
months. The largest reported source of workplace
bullying was peers or fellow workers (49%), followed
by clients (42%) and managers or supervisors
(38%). Only 36% of respondents who had
been bullied had formally reported the episode.
The level of bullying reported was unexpectedly
high and will require development of strategies to
address the issue.
Commentary: public and private intervention rates in obstetric practice
Authors: Dodd Jodie , Robinson Jeffrey
Published: February 2010

Dr Jodie Dodd is a maternal fetal medicine fellow, and Professor Jeffrey Robinson is head of Department of Obstetrics & Gynaecology, University of Adelaide.The paper by Shorten and Shorten published in the last edition of Australian Health Review highlights differences in intervention rates (induction of labour, caesarean section, use of epidural analgesia) between women receiving private obstetric care and those receiving public obstetric care (Shorten & Shorten 2004).Similarly, the authors highlight the more frequent occurrence of "less favourable birth outcomes such as emergency CS, instrumental birth, episiotomy and (perineal) tear requiring suturing" in women giving birth in private hospital settings. These differences persisted after controlling for the risk profile of the woman or development of complications during birth (Shorten & Shorten 2004). These findings are not new in Australia, having been reported previously by King (1993 and 2000), and Roberts and colleagues (2000 and 2002). However, Shorten and Shorten's link to subsidies for private insurance raises a new concern.The global interest in obstetric intervention rates and in particular rates of caesarean section has been underpinned by the assumption that there is in fact an "ideal" rate of intervention, where benefits outweigh risks. Much of this discussion developed after the World Health Organization published a statement to the effect that a caesarean section rate of 15% was appropriate (WHO 1985). However there has been little critique of the derivation of this figure and there is a lack of evidence in the scientific literature supporting it. The rate of any particular intervention should not be considered in isolation - what is important is how the intervention relates to increasing or decreasing maternal and infant mortality and morbidity.
Private care and public waiting
Authors: J Duckett Stephen
Published: February 2010

Waiting time for public hospital care is a regular
matter for political debate One political response
has been to suggest that expanding private sector
activity will reduce public waiting times. This paper
tests the hypothesis that increased private activity
in the health system is associated with reduced
waiting times using secondary analysis of hospital
activity data for 2001?02.
Median waiting time is shown to be inversely
related to the proportion of public patients.
Policymakers should therefore be cautious about
assuming that additional support for the private
sector will take pressure off the public sector and
reduce waiting times for public patients.
To be or not to be . . . a manager: the career choices of health professionals
Authors: Boucher Carlene J
Published: February 2010

This paper focuses on decisions made by professionals
working in the health industry who have, at
some stage in their career, considered taking on a
management role. It describes some of the factors
that appear to influence their decisions. The study,
based on 60 interviews with professionals working
in the health industry, identified six different categories
in terms of their approach and attitudes to
taking on management roles. The paper concludes
with an analysis of the implications for
people considering a management career in the
health industry.
Management of delirium: a clinical governance approach
Authors: Ann Kulh Mary , Mumford Virginia A , Sorensen Roslyn , Budge Marc M
Published: February 2010

This study assessed the management of delirium in
the Acute Care of the Elderly unit (ACE) at a
tertiary referral hospital as a case study of the
application of clinical governance principles. The
environment was found to be supportive of ongoing
clinical governance activities, both in clinical
organisation of work processes and orientation of
management. However, patient involvement, dissemination
and use of clinical pathways, performance
measurement and feedback, and maintaining
stability of care are areas requiring further development.
Although there is a clinical governance strategy
in place at the policy level, this has not always
filtered through to the level of clinical work.