Commercial-in-confidence: An obituary to transparency?

This article addresses the issue of accountability and transparency in relation to the use of commercial-in-confidence clauses to withhold information. The issue is contentious. On the one hand some like the Senate Finance and Public Administration Reference Committee (SFPARC) argue that: 'Put simply there can be no accountability if there is no information' (SFPARC 2000). On the other hand, an alternative view is: 'I think that the sanctity of contract... [is] a fundamental pillar of our legal system, and if private businesses enter into contracts with governments that specify confidentiality, then that ought to be respected' (Paterson 1999). This paper is an abridged version of a keynote address to CPA Australia (Queensland Division) Audit Intensive Day 2000, Brisbane Hilton, 10 November 2000.

Effectiveness of introduced biocontrol insects on the weed Parthenium hysterophorus (Asteraceae) in Australia

Six species of insects and a rust fungus have been successfully established for biocontrol of the weed Parthenicum hysterophorus L. in Queensland, Australia. Effectiveness of biocontrol insects was evaluated at two properties in Queensland during 1996-97 based on an exclusion experiment using insecticides. Parthenium-infested plots with and without biocontrol insects were sampled at monthly intervals and the impact of biocontrol insects on parthenium at individual plant and whole population levels monitored. Biocontrol insects were more effective at Mt Panorama (central Queensland) than at Plain Creek (north Queensland). At Mt Panorama, the leaf-feeding beetle Zygogramma bicolorata Pallister caused 96% defoliation and the stem-galling moth Epiblema strenuana Walker affected 100% of the plants, resulting in reductions of 90% in weed density, 40% in plant height, and 82% in flower production. Exclusion of biocontrol insects resulted in a 52% increase in seedling emergence and a seven-fold increase in the soil seed bank in the following season. At Plain Creek, E. strenuana was the only prominent agent. It affected 92% of the plants and prevented 32% of plants from producing any flowers, reduced plant height by 40% and flower production by 49%, but did not reduce the plant biomass, weed density or soil seed bank. However, exclusion of biocontrol insects resulted in an eight-fold increase in the soil seed bank in the following season.

Audit and comprehensive health assessment programme in the primary healthcare of adults with intellectual disability: a pilot study

International research has demonstrated significant shortcomings in the health of adults with intellectual disability (ID). Because general practitioners (GPs) are the main providers of primary healthcare for this population, strategies to improve general practice care are an important aspect of rectifying these shortcomings. The present pilot study aimed to determine the effect of various interventions on health maintenance activities and to assess their acceptability to GPs, with a view to informing larger scale studies. The GPs were recruited through an earlier questionnaire-based postal survey. The GPs identified all their adult patients with ID, then obtained consent for participation from three patients randomly selected by the investigators. The GPs completed two self-evaluation forms and case note audits 12 months apart, read a synopsis of the relevant literature provided by the researchers, and completed a comprehensive health assessment (CHA) of their three patients. Forty-five GPs agreed to participate in the CHA programme (CHAP), and 15 completed the project. Thirty-eight patients completed the project. The number of patient-GP dyads who completed the project was too small to demonstrate statistically significant changes in health issues over time. The GPs found that the synopsis of the literature was the best intervention for increasing knowledge and was also the most practical to use in general practice. The CHAP was the intervention that prompted the most action from the GP which would not have been undertaken otherwise. The CHAP appeared to provide a superior review process compared to the other interventions used in the present study. The numbers of health maintenance activities found to be overdue and the number of health issues detected as a result of the process were considerable. The CHAP served as a communication tool and an educative instrument, providing a basis for future studies and strategies to improve the general practice care of adults with ID.

The effectiveness of splinting as perceived by the parents of children with Juvenile Ideopathic Arthritis

Juvenile idiopathic arthritis (JIA) is an important disease of childhood with farreaching effects on the child and family. Splinting is a major treatment modality used by occupational therapists for children with JIA. Parents play a central role in whether, when and how splints are used with their children on a daily basis. This paper describes a qualitative research project, which was undertaken to evaluate an occupational therapy service for children with JIA whose treatment had involved splinting. Using semi-structured interviews, the study investigated five mothers' perceptions of the effectiveness of splinting for their children. The interviews revealed five major points. First, the informants generally believed the splinting to be effective. Secondly, the children involved generally resisted wearing splints because they were physically uncomfortable and made them feel different to other children. Thirdly, the mothers used a variety of strategies to ensure that their children wore the splints. Fourthly, the perception of having a positive and supportive relationship with the therapist enhanced the mothers' ability to adhere to splinting. Lastly, the mothers' grief at having a child with JIA influenced their ability to understand and attend to information about specific interventions such as splinting. Practical responses to these findings are outlined.

Pro re nata medication for psychoses: an audit of practice in two metropolitan hospitals

Objective: To examine the use of pro re nata (PRN) (as needed) medication in hospitalized patients with psychotic disorders. Methods: Retrospective chart reviews were conducted at two large public psychiatry units situated in inner city general hospitals. Pro re nata medication prescription, administration and outcomes were examined during inpatient episodes of care for 184 consecutive admissions of patients diagnosed with a psychotic disorder. Patient demographics, diagnoses, and regularly prescribed medication were also recorded. All admissions were drawn from a three-month period from December 1998-February 1999. Results: The most prevalent diagnoses were schizophrenia related disorders (n = 111) and mania (n = 34). Substance use disorders (n = 49) were the most common comorbid dis-orders. Pro re nata medication was administered during the acute phase of 82% of admissions. Drugs prescribed Pro re nata were mostly typical antipsychotics, benzodiazepines and/or anti-cholinergics. Coprescription of typical antipsychotics PRN with regularly scheduled atypical antipsychotics was common (64%). Pro re nata medications accounted for 31% of the total antipsychotic dose and 28% of the total anxiolytic dose administered during acute treatment. Higher daily doses of PRN medication were given to manic patients, males, younger patients and those with substance use disorders. Pro re nata prescriptions usually specified a maximum daily dose (87%) but rarely gave indications for use (6%). Adminis-tration records frequently lacked a specified reason for use (48%) or a notation of outcome (64%). Unit staff noted medication-related morbidity in 37% of patients receiving PRN medication, compared to 3% of patients receiving only regularly scheduled medication. Extrapyramidal symptoms (EPS) were most frequently associated with administration of PRN haloperidol (Relative Risk vs other PRN medications = 5.61, 95% CI = 2.36-13.73). Conclusions: Pro re nata medications comprised a significant part of the treatment which psychotic patients received. The common practice of coprescribing PRN typical antipsychotics with scheduled atypical antipsychotics is potentially problematical since administration of PRN medication is associated with significant medication related morbidity. Preferential use of benzodiazepines as PRN agents may minimize this morbidity and foster subsequent compliance with regularly prescribed antipsychotics.

Standardised audit of hip fractures in Europe

The objectives of this study were to evaluate the outcomes of our patients admitted with hip fractures, and to benchmark these results with other hospitals, initially in Europe and subsequently in Australia. The Standardised Audit of Hip Fractures in Europe (SAHFE) questionnaires was used as the data gathering instrument. The participants were all patients admitted to Redcliffe Hospital with a fractured neck of femur prior to surgery. This paper reports the results of the first 70 consecutive patients admitted to Redcliffe Hospital with a fractured neck of femur from November 1st 2000. The main outcome measures were mobility, independence, residence prior to fracture; type of fracture and surgical repair; and time to surgery, survival rates and discharge destination. Results: 43 patients were admitted from home, but only 13 returned home directly from the orthopaedic ward. It is hoped that most of the 26 transferred to the rehabilitation ward will ultimately return home. 7 patients died, these were aged 82 to 102, and all had premorbid disease. Delays in surgery were apparent for 13 patients, mainly due to administrative problems. Conclusions: We support the recommendation in the Fifteenth Scottish Intercollegiate Guidelines Network Publication on the management of hip fractures, that all units treating this condition should enter an audit to evaluate their management. (author abstract)

Debiasing the outcome effect: The role of instructions in an audit litigation setting

The outcome effect occurs where an evaluator, who has knowledge of the outcome of a judge's decision , assesses the quality of the judgment of that decision maker. If the evaluator has knowledge of a negative outcome, then that knowledge negatively influences his or her assessment of the ex ante judgment. For instance, jurors in a lawsuit brought against an auditor for alleged negligence are informed of an undetected fraud, even though an unqualified opinion was issued. This paper reports the results of an experiment in an applied audit judgment setting that examined methods of mitigating the outcome effect by means of instructions. The results showed that simply instructing or warning the evaluator about the potential biasing effects of outcome information was only weakly effective. However, instructions that stressed either (1) the cognitive non-normativeness of the outcome effect or (2) the seriousness and gravity of the evaluation ameliorated the effect significantly. From a theoretical perspective, the results suggest that there may both motivational and cognitive components to the outcome effect. In all, the findings suggest awareness of the outcome effect and use of relatively nonintrusive instructions to evaluators may effectively counteract the potential for the outcome bias.

Effectiveness of Three Seed-Trap Designs

Vegetation monitoring is essential to evaluate management and assess condition. However, methods that have been used cannot assess the viability of the community or provide indicators of future condition. Seed traps can be used to measure reproductive potential of a vegetation community via seed rain. This study evaluates three different seed-trap designs and compares their effectiveness in terms of the diversity and abundance of seed captured, the presence of seed-predating insects, cost, manufacturing ease and serviceability. Field trials were conducted in open, grassy woodlands in south-western and south-eastern Queensland. The results showed that the tall funnel-trap design was the least effective, while the wet wind trap and pitfall funnel trap proved more effective. On the basis of the results of this study, further investigations are recommended for testing trap performance in different vegetation communities, seed predation in relation to seed production and variation in seed production over time. Seed traps that monitor seed rain are potentially useful in assessing the health and viability of a vegetation community. Used in conjunction with other monitoring methods, they may offer valuable insights about the dynamics of entire communities and/or individual species, and therefore appropriate management strategies.

The effectiveness of parent management training to increase self-efficacy in parents of children with Asperger syndrome

This study was a trial of an intervention programme aimed to improve parental self-efficacy in the management of problem behaviours associated with Asperger syndrome. The intervention was compared across two formats, a I day workshop and six individual sessions, and also with a non-intervention control group. The results indicated that, compared with the control group, parents in both intervention groups reported fewer problem behaviours and increased self-efficacy following the interventions, at both 4 weeks and 3 months follow-up. The results also showed a difference in self-efficacy between mothers and fathers, with mothers reporting a significantly greater increase in self-efficacy following intervention than fathers. There was no significant difference between the workshop format and the individual sessions.

A clinical audit of the prescribing of celecoxib and rofecoxib in Australian rural general practice

Aims The new cyclooxygenase-2 (COX-2) selective inhibitors, celecoxib (Celebrex®) and rofecoxib (Vioxx®), have been widely prescribed since their launch. No reviews currently appear in the literature of prescribing patterns in Australia. This paper describes a self-audit of the clinical use of selective COX-2 inhibitor therapy undertaken with rural general practitioners (GPs) in Australia. Methods A structured audit form was developed and distributed to interested GPs. The form was self-administered and focused on issues about COX-2 inhibitors and the types of patients who were receiving them, e.g. indications, patient demographics, risk factors and drug interactions. Results A total of 627 patients were recruited (569 celecoxib and 58 rofecoxib). A range of doses was prescribed. Osteoarthritis was the most common indication (68.1%). Risk factors known for the nonselective nonsteroidal anti-inflammatory drugs were identified in 65.1% of patients, with the most common being advanced age, hypertension and previous peptic ulcer disease. Potential drug interactions were common. A variety of reasons for initiation of therapy was identified; these included perceived increased efficacy, safety and failure of other treatment. Conclusions These results show that COX-2 inhibitors are being prescribed for patients with multiple risk factors that may place the patient at increased risk of adverse drug reactions to a COX-2 inhibitor. The perception of improved safety and efficacy was common and is of concern. Limitations of the study include the reliance on self-reporting.

General practitioner attitudes to case conferences: how can we increase participation and effectiveness?

Objectives: To identify general practitioners' views on the barriers to using case conferencing (as outlined in the Medical Benefits Schedule (MBS) Enhanced Primary Care package) and to develop a set of principles to encourage greater GP participation in case conferences. Design: Qualitative study, involving semistructured questions administered to focus groups of GPs, conducted between April and July 2001 as part of a broader study of case coordination in palliative care. Participants: 29 GPs from urban, regional, and rural areas of Queensland. Principal findings: Many of the GPs' work practices militated against participation in traditionally structured case conferences. GPs thought the range of MBS item numbers should be expanded to cover alternative methods of liaison (eg, phone consultations with other service providers). The onerous bureaucratic processes required to claim reimbursement were an additional disincentive. Conclusions: GPs would probably be more likely to participate in case conferences if they were initiated by specialist services and arranged more flexibly to suit GP work schedules.