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A Street

Publications and source records attributed to A Street.

At least 55 records · Page 3Linked to original sources
PubMed1999

Laboratory testing, diagnosis, and management of von Willebrand disease. Current practice in Australasia. RCPA Quality Assurance Program in Haematology Scientific Haemostasis Advisory Panel.

We report an evaluation of current laboratory and clinical practice for the diagnosis and management of von Willebrand disease (VWD) for a wide geographic area including Australia, New Zealand, and parts of Southeast Asia. This assessment has been undertaken in conjunction with the RCPA Quality Assurance Program (QAP) in Haematology. This external QAP currently comprises around 550 participating laboratories, of which some 450 perform coagulation testing, and from which 32 laboratories were identified to be actively involved in testing for VWD. These laboratories were targeted and their current laboratory and clinical practice evaluated by using various questionnaires. Our overall findings indicate a wide variation in laboratory test practice for VWD-based investigations. There was considerable variation among laboratories in the tests and test methods used, the control and calibration material used, the reported test reference intervals and units used, and the composite test panels used to diagnose VWD. However, substantial consensus in the clinical evaluation process, as undertaken by hematologists, also was identified. Despite the observed variations, most laboratory professionals seemed to understand the complexities involved in the diagnosis and subclassification of VWD, and the laboratories can provide an effective diagnostic service.

Asia, Southeastern↗
PubMed1999

Is hospital performance related to expenditure on management?

OBJECTIVES: Reducing the costs of management appears an easy target for those seeking to generate savings or to promote better spending in the National Health Service (NHS). However, an assessment of the appropriate amount of spending on management requires an evaluation of how much management contributes to organizational performance. METHODS: Using routinely available NHS acute hospital data, an econometric analysis was undertaken to test the hypothesis that there is a relationship between the proportion of a hospital's income spent on management and the performance of the hospital measured along three dimensions: the achievement of financial targets; performance against waiting time standards defined in the Patient's Charter; and costs of service provision. RESULTS: No general relationship was found between management costs and hospital performance. However, there was some evidence of a quadratic relationship between management spending and the amount of operating surplus generated and performance against the three-month waiting time standard for an inpatient admission specified in the Patient's Charter. These results suggest that performance returns reach an optimum when management expenditure is around 5-6% of hospital income. CONCLUSIONS: The evidence is not yet strong enough to draw a general conclusion that management costs in NHS acute hospitals are too high or that an undiscriminating reduction in management costs would have no detrimental effects on hospital performance. However, the findings should prompt managers to identify ways in which their activities are productive and how these can be measured, and what distinguishes effective from ineffective management.

Data Collection↗
PubMed1998

Primary cares. Messages from the frontline.

The biggest hurdle in the establishment of primary care groups is practices' reluctance to co-operate. GPs will want compensation for the time spent on administration. There is little awareness of the fact that PCG budgets may run out. The development of PCGs is expected to lead to an increase in salaried GPs. Current IT systems are seen as inadequate for PCGs.

Budgets↗
PubMed1998

Seven deaths in Darwin: case studies under the Rights of the Terminally Ill Act, Northern Territory, Australia.

BACKGROUND: During the 9 months between July, 1996, and March, 1997, the provision of euthanasia for the terminally ill was legal in the Northern Territory of Australia. Seven patients made formal use of the Rights of the Terminally Ill (ROTI) Act; four died under the Act. We report their clinical details and the decision-making process required by the Act. METHODS: We taped in-depth interviews with the general practitioner who provided euthanasia. Further information was available from public texts created by patients, the media, and the coroner. FINDINGS: All seven patients had cancer, most at advanced stages. Three were socially isolated. Symptoms of depression were common. Having met criteria of the Act, some patients deferred their decision for a time before proceeding with euthanasia. Medical opinions about the terminal nature of illness differed. INTERPRETATION: Provision of opinions about the terminal nature of illness and the mental health of the patient, as required by the ROTI Act, created problematic gatekeeping roles for the doctors involved.

Aged↗
PubMed1998

Cost effectiveness of shortening screening interval or extending age range of NHS breast screening programme: computer simulation study.

OBJECTIVE: To compare the cost effectiveness of two possible modifications to the current UK screening programme: shortening the screening interval from three to two years and extending the age of invitation to a final screen from 64 to 69. DESIGN: Computer simulation model which first simulates life histories for women in the absence of a screening programme for breast cancer and then assesses how these life histories would be changed by introducing different screening policies. The model was informed by screening and cost data from the NHS breast screening programme. SETTING: North West region of England. MAIN OUTCOME MEASURES: Numbers of deaths prevented, life years gained, and costs. RESULTS: Compared with the current breast screening programme both modifications would increase the number of deaths prevented and the number of life years saved. The current screening policy costs 2522 pounds per life year gained; extending the age range of the programme would cost 2612 pounds and shortening the interval 2709 pounds per life year gained. The marginal cost per life year gained of extending the age range of the screening programme is 2990 pounds and of shortening the screening interval is 3545 pounds. CONCLUSIONS: If the budget for the NHS breast screening programme were to allow for two more invitations per woman, substantial mortality reductions would follow from extending the age range screened or reducing the screening interval. The difference between the two policies is so small that either could be chosen.

Age Factors↗
PubMed1998

Epithelial carcinogenesis in the mouse: correlating the genetics and the biology.

Tumour formation relies on a complex combination of genetic and environmental factors. In particular, the contributions from inherited predisposition genes as well as carcinogens, for example from cigarettes or in the diet, are amongst the major contributors to tumorigenesis. Since the study of such processes in particularly difficult in human cancers, the availability of a well-defined model system is of obvious benefit. The mouse skin model of multistage carcinogenesis offers an excellent tool for the study of the target cells, the target genes and the biological events associated with neoplasia. In this system, tumorigenesis occurs in a series of defined stages, each of which is characterized by specific and reproducible alterations in genes such as H-ras, cyclin D1, p53 and p16INK4A. Additional changes occur in the production of, or response to, factors such as transforming growth factor beta (TGF beta). These genetic and biological alterations are mirrored in human tumours of epithelial origin. Hence, research into the general principles of tumour initiation, promotion and progression in the context of the mouse skin model is likely to prove valuable in the continual search for new methods for the diagnosis, prevention, and therapeutic treatment of human cancers.

Animals↗
PubMed1998

Nursing assessments in New Zealand mental health.

During 1992 a new Mental Health Act was implemented in New Zealand. The Act created a new role, that of the duly authorised officer (DAO) which has been mainly carried out by community mental health nurses. During 1994 a multisite qualitative research study was undertaken to describe the newly structured mental health nursing role and examine the issues related to it. A key issue which emerged was the concern that the nursing role had been defined and resourced by other groups (legal, medical and management) on the basis of its visible tasks rather than the invisible components of professional nursing knowledge and expertise. The legal descriptions of the DAO role negated the highly developed assessment skills of mental health nurses, suggesting that nurses are there for advice and assistance. Yet expert clinical judgement was pivotal to the effective functioning of the new role. This paper argues that the initial nursing mental health crisis assessment which is carried out in the community is a highly skilled nursing activity which must be recognized and resourced accordingly.

Community Mental Health Services↗
PubMed1998

Exploring the discursive construction of menopause for Thai women.

The terms 'menopause' and 'mid-life women' have become the subjects of both the medical gaze and a billion-dollar industry built by pharmaceutical companies to manage the 'problems' of menopause. Menopause is a discursive construction, a label that has become endowed with a large number of taken-for-granted assumptions about physical and psychological symptoms, self-image and health status. These assumptions are based on the medical interests, social preoccupations, research and subsequent drug-marketing strategies conducted in western societies. Thai society is structured around a different philosophy, which has created different meanings for the mid-life woman. This paper explores the Western discourses of menopause and the colonizing effect when the assumptions underpinning these are imposed on Thai women.

Adult↗
PubMed1997

Breaking down language barriers in clinical practice.

Communication is an essential component of skilled nursing-practice. As 20 per cent of Australians are born overseas and come from a non-English speaking background (NESB), effective communication becomes a challenge for nurses who do not share the same language. Nursing use of an interpreter service is an essential component of practice in a multicultural community. This was one of the findings of a two-year participatory action research study which explored the practice of nurses caring for non-English speaking families. The intention of this paper is to explore this crucial aspect of the findings; nursing use of interpreters and the strategies instigated by the nurses to work more effectively with them.

Australia↗
PubMed1997

Rostering: placing the nurse in the picture.

A funded study to investigate best practice in nursing rosters in a busy metropolitan Melbourne children's hospital, identified the complexity of the shiftwork issues when the people who work them are placed centre stage. This paper explores a key finding of the study, which strongly endorses the need to take account of scientific knowledge on health and safety issues of shiftwork, but argues that the personal, socio-cultural and environmental perspective of the nurse needs to be given more attention by the various stakeholders involved with rostering.

Benchmarking↗
PubMed1997

Individual differences in self-appraisals and responses to dating violence scenarios.

Previous research suggests that certain types of self-appraisals may predispose individuals to be more or less tolerant of relationship violence. The current study investigates two such appraisals, self-esteem and self-attributions, as correlates of women's responses to hypothetical episodes of relationship violence by their dating partners. Undergraduate women involved in dating relationships (N = 145) reported global self-esteem, attributions for hypothetical partner aggression, and probable responses to the aggression. Results showed that self-esteem and self-attributions emerged as correlates of intentions to forgive violence, whereas only self-attributions emerged as a correlate of intentions to dissolve the relationship. The association between self-attributions and intentions to exit a violent relationship was fully mediated by intentions to forgive the partner. Because self-appraisals may inform prevention programs for women who may experience relationship violence, clinical implications are discussed.

Adolescent↗
PubMed1996

The significance of age and duration of effect in social evaluation of health care.

To give priority to the young over the elderly has been labelled 'ageism'. People who express 'ageist' preferences may feel that, all else equal, an individual has greater right to enjoy additional life years the fewer life years he or she has already had. We shall refer to this as egalitarian ageism. They may also emphasise the greater expected duration of health benefits in young people that derives from their greater life expectancy. We may call this utilitarian ageism. Both these forms of ageism were observed in an empirical study of social preferences in Australia. The study lends some support to the assumptions in the QALY approach that duration of benefits and hence old age, should count in prioritising at the budget level in health care.

Age Factors↗
PubMed1996

Are waiting lists inevitable?

Waiting lists are a common phenomenon in markets in which non-price allocation of goods and services occurs. To the extent that waiting lists for in-patient health services are perceived to ration imperfectly, many propose policies which focus on reducing demand or increasing supply. Strategies aimed at increasing supply often create perverse incentives in that they reward hospitals with long waiting lists through the provision of additional resources. This paper describes how supply has been addressed in Victoria by changing the financial incentives relating to waiting lists. The success of this payment policy in reducing waiting lists to public hospitals is reported.

Diagnosis-Related Groups↗
PubMed1996

Experience with recombinant factor VIIa in Australia and New Zealand.

Recombinant factor VIIa (rFVIIa; NovoSeventrademark) was availablefor compassionate use in Australia and New Zealand from 1991 to 1994. Over this period there were 18 treatment episodes in 9 patients, age 8-66 years, with haemophilia A and high titre inhibitors cross-reacting with porcine factor VIII. There were no significant adverse effects. Treatment with rFVIIa resulted in a successful outcome in 8 potentially life-threatening (retroperitoneal, subdural, gastro-intestinal) bleeds. Elective cystoscopy, repair of a cranial flap, yttrium synovectomy and inguinal herniotomy were performed successfully, as was surgical decompression of a flexor pollicis longus bleed. Treatment of a patient with an infected haematoma had limited success, attributed to intermittent suboptimal doses. In 2 patients, satisfactory haemostasis was achieved for multiple dental extractions; subsequent oozing was attributed to suboptimal rFVIIa and/or antifibrinolytic therapy.

Adult↗