Search PubMed⌕ Search

Biomedical subjects

L Malcolm

Publications and source records attributed to L Malcolm.

At least 55 records · Page 3Linked to original sources
PubMed1989

Comparative costs of cataract surgery in a public and a private hospital.

A total of 119 patients undergoing cataract surgery in Wellington and Wellcare hospitals were studied for their demographic characteristics and the costs of their surgery. There were no significant age or sex differences between public and private sector patients and, although there were marital, ethnic and socioeconomic factors which were associated with a slightly longer stay in the public sector, these explain only a small proportion of the difference of 5.0 days in public as compared with 2.5 days stay in the private sector. The pattern of care adopted by the consultant and ward staff and medical profile affected the length of stay. The costs of the surgery were identical at $2560, including GST, in both public and private hospitals. Higher ward costs in public were offset by higher surgical costs in the private sector. A study of the marginal costs, on a day by day basis, indicated that a reduction in length of stay to 3.6 days, which has already occurred since the study, would lead to an 11% increase in throughout of cataract patients within a fixed budget. These costing data will be routinely provided by the RUS (resource utilisation system) now being implemented in New Zealand hospitals and will be an important tool for service management in making decisions about both quality of care and cost containment.

Aged↗
PubMed1989

Bed availability as a significant influence on rates of committal to New Zealand's psychiatric hospitals.

Analysis of the data on committal to psychiatric institutions shows that there is a wide variation in risk of committal between hospital board areas and that this risk is strongly related to the availability of psychiatric institutional beds. The risk of remaining in an institution as a committed patient is even more strongly related to bed availability. These findings, which suggest that committal may be less related to objective clinical criteria than to other external factors, are of concern in view of the revision to compulsory treatment procedures currently before Parliament.

Bed Occupancy↗
PubMed1989

Murine models of autoimmune diabetes: nonspecific cytotoxic lymphocytes derived from pancreatic islets in the presence of IL-2.

Our aim was to derive T lymphocyte lines that specifically recognize islet antigens in murine models of autoimmune diabetes. Islets of Langerhans infiltrated with lymphocytes were isolated either from mice previously injected with multiple low doses of streptozotocin or from NOD-WEHI mice and were cultured in the presence of the T cell growth factor, interleukin 2 (IL-2). With islets from both models of autoimmune diabetes, rapidly proliferating, large granular lymphocytes emerged after 7-10 days and destroyed the islets and other cells such as fibroblasts in the cultures. Cytotoxicity assays showed that these cells were capable of destroying both P815 and YAC-1 tumor cells. In contrast to lymphocytes present initially in the islet infiltrates which express predominantly the L3T4 marker, the large granular lymphocytes were shown to be Ly-2 positive. They also expressed the alpha beta T cell receptor and contained mRNA for the alpha beta T cell receptor demonstrable by in situ hybridization. While morphologically similar to NK cells these large granular lymphocytes bear T cell markers and destroy a broader range of targets. They may represent a minor population of T lymphocytes particularly responsive to IL-2 although other studies show that T cells generally can develop a similar phenotype after prolonged culture with IL-2. The lack of target cell specificity indicates that these IL-2-stimulated large granular lymphocytes are unlikely to mediate the immunopathogenesis of diabetes in these animal models.

Animals↗
PubMed1988

Recent trends in the availability, distribution, utilisation and cost of general practitioner services.

GMS data for the 1983-4 and 1986-7 years were analysed to determine the availability, distribution and utilisation of general practitioners in New Zealand. In 1986-7 there were 1724 full time equivalents (FTE) general practitioners, one per 1923 population, an annual increase in availability of 2.8% over the three years studied. The rate of availability appears to be increasing rapidly and, from Medical Council data, was around 6% for the 1986-7 year. Wide variation exists in availability, the highest being in central Auckland with one general practitioner per 1351 population, the lowest being in Invercargill with one per 2500. Utilisation increased by just over 1% annually to 3.9 services per person. The median workload in 1986-7 was 7184 services per general practitioner equivalent to a GMS income of $31,454. Each general practitioner was associated with government expenditure of about $359,000 but received only about $33,670 of this, less than one seventh of that paid by government for pharmaceuticals. Radical changes are proposed to redress inefficiencies, inequities and the perverse incentives which continue to increase in this almost totally unmanaged but fundamentally important area of health care.

Costs and Cost Analysis↗
PubMed1987

Expression of T cell antigen receptor and immunoglobulin genes in lymphoid organs visualized by in situ hybridization.

In situ hybridization techniques were used to detect expression within lymphoid tissues of genes encoding T cell receptor (TCR) alpha, beta and gamma chains, as well as immunoglobulin kappa light chain. Transcripts of these genes were specifically detected in frozen sections of thymus, spleen and lymph node but not in non-lymphoid tissues. Differences in the level of beta chain gene transcription were observed within and between the thymus cortex and medulla, with approximately 60% and 34% of cells in these areas labelled, respectively. Expression of the TCR alpha chain genes was more homogeneous, while amongst the cells transcribing the gamma chain gene, there was a subpopulation of 0.2% of heavily labelled cortical thymocytes. Labelling of T cell dependent areas of spleen and lymph nodes was observed with each of the TCR probes, but neither alpha nor beta gene expression was seen in lymphoid tissues of athymic nude mice. The gamma chain gene was, however, expressed in both spleen and lymph nodes of these mice. These results indicate that TCR gene expression is not limited to a small subpopulation of T cell precursors. They are discussed in relation to T cell differentiation within the thymus.

Animals↗
PubMed1987

Progress towards achieving health for all New Zealanders by the year 2000.

New Zealand has been faced in recent years with a serious failure to maintain its relative position, in comparison to other OECD countries, in its social, economic and health status indicators. Although health costs so far have been successfully controlled, through a largely capitation funded service, its health organisational problems are typical of developed countries including major problems of equity and efficiency. Despite these problems some important recent initiatives give optimism for future health improvement. These include the spread of the service concept through service development groups and moves towards decentralisation through area health boards. Population-based funding of hospital and area health boards, supplemented with service planning guidelines, has proved to be an important lever for change. Maori health initiatives are beginning to show the way to improving the status of this disadvantaged section of society and perhaps for other New Zealanders as well. Important issues yet to be faced include establishing an effective central organisation for the health services, education and training for leadership and a more central place for the still largely fragmented and isolated primary health care services.

Delivery of Health Care↗
PubMed1982

IncD, a genetic locus in F responsible for incompatibility with several plasmids of the IncFI group.

Cloning of mini-F DNA segments has led to the identification and mapping of a locus, incD, involved in incompatibility reactions with many IncFI plasmids. The cloned incD locus expressed incompatibility with F, R386, and six other IncFI plasmids but not with ColV3-K30 or pHH507 which lack sequence homology with the incD region. A sequence of 360 bp (48.66-49.02 FKB) was found to be sufficient for expression of incD incompatibility. Multicopy vectors containing incD are compatible with each other, but can be displaced by mini-F plasmids deleted for incD. These results indicate that incD-mediated incompatibility reactions require the presence of replication genes to which incD is normally linked. The degree of incompatibility exercised by incD is moderate compared with that of other inc loci in F, suggesting that incD is involved in an aspect of plasmid maintenance, such as partition, different from the functions of the other inc loci.

Bacteriocin Plasmids↗
PubMed1982

Molecular homology and incompatibility in the IncFI plasmid Group.

The usual grounds for the inclusion of a plasmid in a particular incompatibility group are its mutual incompatibility with a type plasmid of that group, and, in some cases, the demonstration of shared regions of specific homology, presumed to be related to DNA replication. We have found that some plasmids classified as IncFI on genetical grounds share no homology with the previously described incompatibility regions of F on the basis of hybridization of specific radioactive probes to restriction enzyme digests of DNA from these plasmids. Others show homology with some or all of the regions of the F plasmid that can express incompatibility. The incompatibility behaviour of these plasmids has been examined to determine the relationship between the possession of regions of homology and the expression of incompatibility. Three plasmids, ColV3-K30, pHH507 and Entp307, show homology only with the secondary replicon of F and appear to use sequences homologous with the secondary F replicon in their replication. The results are consistent with the propositions that some contemporary IncFI plasmids arose by the integration of several replicons, and, in general, the replicon not being used for replicon expresses its incompatibility, as does the replicon being used for replication. We conclude that incompatibility of two plasmids with F does not necessarily demonstrate relatedness of the plasmids to each other, and that inclusion within the IncFI group can result from the possession of any of several combinations of inc sequences.

Base Sequence↗
PubMedDate not supplied

Service management: a New Zealand model for shifting the balance from hospital to community care.

New Zealand's health system has undergone a radical reform in recent years. A central feature of this reform is the area health board, a partly elected and partly appointed body responsible for all health services for its defined population. Within the area health board, the organizational structure which is based upon general management is moving away from institutional towards service or programme management. This is involving clinicians in the management process as service managers, within an accountability structure which cuts across the traditional hospital/community service boundaries. This is a major paradigm shift in health services management which could have major implications for a shift from hospital to community-based care and from secondary to primary health care.

Community Health Services↗
PubMedDate not supplied

New Zealand's health providers in an emerging market.

Services have almost completely replaced hospitals as the organisational units in the reformed New Zealand health care system. Within the secondary service provider sector service management, the decentralisation of general management to budget-holding clinical groupings has been an important factor in achieving a population focus, cost containment, accountability and integration. It is being further developed within the 23 newly formed Crown health enterprises (CHEs), the main providers of secondary, hospital and related services. The CHEs are evolving roles beyond a narrow definition of 'providers', taking initiatives to collaborate with other providers, or rejecting those elements of competition that might interfere with effective local co-ordination of services. Service management is also being extended to the demand-driven, fee-for-service primary care sector, where inflation-adjusted expenditure over the last decade has grown at more than 6%, compared with zero growth in the capitation-financed secondary sector. This is being achieved in both general practice and community budget-holder groupings through what might be called managed primary health care. The current health reform process has also created four regional health authorities (RHAs), responsible, within capped and capitated budgets, for the fully integrated purchasing of services from both primary and secondary providers. The success of these innovative arrangements, which could be of international significance, will depend upon the quality of the developing relationships between providers and their purchasing RHAs.

Budgets↗
PubMedDate not supplied

Integration, accountability and decentralisation of Crown Health Enterprise decision making.

New Zealand is possibly moving further than any other western country in achieving a decentralised, integrated, accountable and population-based health system. However, this progress owes as much or more to the reforms implemented through the area health board system, particularly general and service management, than the current reform process. Services have largely replaced hospitals as organizational entities. The leading edge of CHE service development should not be high-tech services but primary health care (PHC). Progressive CHEs are implementing a PHC service as a structure for managing their own PHC services and to begin the necessary dialogue with GPs and other non-government PHC providers.

Continuity of Patient Care↗