Pretreatment malnutrition and quality of life - association with prolonged length of hospital stay among patients with gynecological cancer: A cohort study

Background Length of hospital stay (LOS) is a surrogate marker for patients' well-being during hospital treatment and is associated with health care costs. Identifying pretreatment factors associated with LOS in surgical patients may enable early intervention in order to reduce postoperative LOS. Methods This cohort study enrolled 157 patients with suspected or proven gynecological cancer at a tertiary cancer centre (2004-2006). Before commencing treatment, the scored Patient Generated - Subjective Global Assessment (PG-SGA) measuring nutritional status and the Functional Assessment of Cancer Therapy-General (FACT-G) scale measuring quality of life (QOL) were completed. Clinical and demographic patient characteristics were prospectively obtained. Patients were grouped into those with prolonged LOS if their hospital stay was greater than the median LOS and those with average or below average LOS. Results Patients' mean age was 58 years (SD 14 years). Preoperatively, 81 (52%) patients presented with suspected benign disease/pelvic mass, 23 (15%) with suspected advanced ovarian cancer, 36 (23%) patients with suspected endometrial and 17 (11%) with cervical cancer, respectively. In univariate models prolonged LOS was associated with low serum albumin or hemoglobin, malnutrition (PG-SGA score and PG-SGA group B or C), low pretreatment FACT-G score, and suspected diagnosis of cancer. In multivariable models, PG-SGA group B or C, FACT-G score and suspected diagnosis of advanced ovarian cancer independently predicted LOS. Conclusions Malnutrition, low quality of life scores and being diagnosed with advanced ovarian cancer are the major determinants of prolonged LOS amongst gynecological cancer patients. Interventions addressing malnutrition and poor QOL may decrease LOS in gynecological cancer patients.

Load compensation for systems with non-stiff source using state feedback

Various load compensation schemes proposed in literature assume that voltage source at point of common coupling (PCC) is stiff. In practice, however, the load is remote from a distribution substation and is supplied by a feeder. In the presence of feeder impedance, the PWM inverter switchings distort both the PCC voltage and the source currents. In this paper load compensation with such a non-stiff source is considered. A switching control of the voltage source inverter (VSI) based on state feedback is used for load compensation with non-stiff source. The design of the state feedback controller requires careful considerations in choosing a gain matrix and in the generation of reference quantities. These aspects are considered in this paper. Detailed simulation and experimental results are given to support the control design.

Ramifications of development projects deemed “state significant”

Purpose, Design/methodology / approach The acknowledgement of state significance in relation to development projects can result in special treatment by regulatory authorities, particularly in terms of environmental compliance and certain economic and other government support measures. However, defining just what constitutes a “significant project”, or a project of “state significance”, varies considerably between Australian states. In terms of establishing threshold levels, in Queensland there is even less clarity. Despite this lack of definition, the implications of “state significance” can nevertheless be considerable. For example, in Queensland if the Coordinator-General declares a project to be a “significant project” under the State Development and Public Works Organisation Act 1971, the environmental impact assessment process may become more streamlined – potentially circumventing certain provisions under The Integrated Planning Act 1997. If the project is not large enough to be so deemed, an extractive resource under the State Planning Policy 2/07 - Protection of Extractive Resources 2007 may be considered to be of State or regional significance and subsequently designated as a “Key Resource Area”. As a consequence, such a project is afforded some measure of resource protection but remains subject to the normal assessment process under the Integrated Development Assessment System, as well as the usual requirements of the vegetation management codes, and other regulations. Findings (Originality/value) & Research limitations / implications This paper explores the various meanings of “state significance” in Queensland and the ramifications for development projects in that state. It argues for a streamlining of the assessment process in order to avoid or minimise constraints acting on the state’s development. In so doing, it questions the existence of a strategic threat to the delivery of an already over-stretched infrastructure program.

Hospital beds : A primer for counting and comparing

There is considerable public, political and professional debate about the need for additional hospital beds in Australia. However, there is no clarity in regard to the definition, meaning and significance of hospital bed counts. Relative to population, there has been a total decline in bed availability in Australia over the past 15 years of 14.6% (22.9% for public hospital beds). This decline is partly offset by reductions in length of stay and changes to models of care; however, the net effect is increased bed occupancy which has in turn resulted in system-wide congestion. Future bed capability needs to be better planned to meet growing demands while at the same time continuing trends for more efficient use. Future planning should be based in part on weighted bed capability matched to need.