Colorectal multidisciplinary meetings: how do they affect the timeliness of treatment?

BACKGROUND: The aim of this study is to determine whether multidisciplinary team (MDT) meetings alter the length of time to treatment (LOTT) for patients with colorectal cancer. METHODS: We conducted a retrospective audit of all patients with colorectal cancer from the Geelong Hospital (TGH) mandatory colorectal database from 1 January 2006 to 3 February 2011. To be included, patients had to have had elective surgical intervention for primary colorectal adenocarcinoma. A comparison of historical controls was conducted between patients discussed in MDT meetings and those managed prior to the introduction of MDT meetings (3 October 2006) to determine the LOTT in days from definitive diagnosis (colonoscopy) to definitive management (surgery, radiotherapy or chemotherapy). RESULTS: In total, the median LOTT for the historical control and MDT era patient populations were 19.5 and 20 days, respectively. Within the MDT era, we noticed significantly longer times to treatment for patients with rectal cancer who were seen in an MDT meeting prior to definitive management than patients who did not have an intervening MDT meeting (P < 0.001). With a difference of 7.5 days, the clinical significance of these findings remains contentious. However, it is worthwhile recognizing this trend in patients who are exhibiting symptoms due to near obstruction or significant bleeding. The LOTT for colon cancer patients remained unchanged. CONCLUSION: The introduction of MDT meetings to TGH has prolonged the LOTT for patients with rectal cancer. These findings pave the way for further revision of the efficiency of MDT meeting at TGH.

The burden of severe obesity and the efficiency and equity of treatment

 Severe obesity rates have doubled during the last twenty years, particularly in disadvantaged Australians. Paradoxically, disadvantaged Australians are the least likely group to receive treatment using bariatric surgery. Health care costs for individuals with severe obesity are double the population average. These costs are decreased after bariatric surgery, particularly in individuals with diabetes.

The origins, development and perceived effectiveness of horticulture-based therapy in Victoria

 This study found that horticulture based therapy in Victoria provides a wide range of benefits in health and community settings. Programs were largely informal and provided by dedicated individuals. A higher profile and professional systems and structure would assist therapeutic horticulture to reach its potential in Victoria.

Understanding the effectiveness of cathodic protection under disbonded coatings

© 2015 Elsevier Ltd. All rights reserved. Factors affecting the effectiveness of cathodic protection under disbonded coatings were studied using a partially covered two dimensional electrode array that simulates a crevice under a disbonded coating and allows for the mapping of electrochemical currents under the influence of cathodic protection (CP). This technique enabled the study of the effects of major factors, including crevice gap size, solution conductivity and applied CP potential on the distribution and evolution of CP currents over the electrode array surface. The effect of each of these factors on the overall current distribution profile has been explained using a new electrochemical model. This model suggests that, despite the detrimental effect of cathodic shielding, the steel under disbonded areas could still be protected, independent of the crevice geometry and solution resistivity, by means of concentration polarization instead of direct electrochemical polarization. A set of conditions for maintaining CP potentials more negative than -850 mVCSE along disbonded coating areas was deduced from the proposed model and validated against potential profiles available in the literature. The possible practical implications of the current mapping technique used in this study for developing in-situ CP monitoring sensors has also been discussed.

Effectiveness, costs, and cost-effectiveness of recruitment strategies for a mammographic screening program to detect breast cancer

BACKGROUND AND PURPOSE: Since effective and affordable recruitment methods are essential for the widespread implementation of mammographic screening for detection of breast cancer, we studied the effectiveness, the costs, and the cost-effectiveness of various recruitment strategies in the population targeted by a pilot Australian program that offered free mammography screening between 1988 and 1990. METHODS: We evaluated three public recruitment strategies--local newspaper articles, community promotion, and promotion to physicians--and five personal strategies--invitation letters with or without specified appointment times, either alone or with a follow-up letter, or telephone call to nonattenders. The effectiveness of public recruitment strategies was estimated from monthly attendance rates by Poisson regression analysis, while the probability of attendance in response to personal strategies was calculated using logistic regression analysis. Costs were determined by resource usage studies. The cost-effectiveness ratios for personal strategies were determined using decision analysis. RESULTS: The costs in 1988-1989 Australian dollars per woman recruited were $22 for local newspaper articles and $106 for community promotion. No detectable increase in attendance resulted from promotion to physicians. When the cost of reserving an appointment was considered, the most cost-effective personal recruitment strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders. This strategy recruited 35.6% of women in the sample targeted and cost $10.52 per attendee. In comparison, the most effective personal recruitment strategy was a letter with a specified appointment time followed by a second letter to nonattenders, which recruited 44.1% of women at an average cost of $19.99 and a marginal cost of $59.71 per additional attendee. CONCLUSIONS: Personal recruitment strategies were more cost-effective than public strategies. The most cost-effective personal strategy was an invitation letter without a specified appointment time, followed by a second letter to nonattenders.

Cost-effectiveness of recruitment methods in a population-based epidemiological study: the Melbourne Visual Impairment Project

The cost-effectiveness of five recruitment methods was evaluated to determine the best method of encouraging eligible persons to participate in the Melbourne Visual Impairment Project (a population-based epidemiological study). The evaluation was divided into two phases. Phase 1 included one of two types of initial contact, by direct personal contact or by telephone. Phase 2 involved recruiting residents after an attempt had been made by either the telephone or the doorstep approach, and included a second attempt by a field interviewer, subsequent attempts by senior field staff, and finally, financial incentives. The cost-effectiveness of each method was determined by dividing the approach's cost by the effectiveness ratio. We identified 269 eligible households with 356 eligible residents. An 89 per cent response rate was achieved at the examination centre, comprising 61 per cent from Phase 1 and 28 per cent from Phase 2. Although both recruitment methods in Phase 1 were equally cost-effective, there was a significant difference in the effectiveness of each method in actually recruiting residents. The doorstep method was more costly per attender but was far more effective at 76 per cent recruitment than the telephone method at 47 per cent (P < 0.001). We have demonstrated a practical two-stage approach (the doorstep method in Phase 1 and follow-up strategies in Phase 2) to population-based recruitment involving the middle to elderly age group that should be relevant to many epidemiological studies.

Quantifying the effects of major factors affecting the effectiveness of cathodic protection of pipelines

electrical interference signals on CP and steel corrosion using newly designed electrochemical corrosion cells; as well as to monitoring cathodic disbondment of coatings using electrochemical impedance spectroscopy. Typical results from using these new techniques for measuring stray current corrosion and for probing the cathodic disbondment of pipeline coatings have been briefly discussed.

Long-term cost-effectiveness of weight management in primary care

Background:  As obesity prevalence and health-care costs increase, Health Care providers must prevent and manage obesity cost-effectively.

Methods:  Using the 2006 NICE obesity health economic model, a primary care weight management programme (Counterweight) was analysed, evaluating costs and outcomes associated with weight gain for three obesity-related conditions (type 2 diabetes, coronary heart disease, colon cancer). Sensitivity analyses examined different scenarios of weight loss and background (untreated) weight gain.

Results:  Mean weight changes in Counterweight attenders was −3 kg and −2.3 kg at 12 and 24 months, both 4 kg below the expected 1 kg/year background weight gain. Counterweight delivery cost was £59.83 per patient entered. Even assuming drop-outs/non-attenders at 12 months (55%) lost no weight and gained at the background rate, Counterweight was ‘dominant’ (cost-saving) under ‘base-case scenario’, where 12-month achieved weight loss was entirely regained over the next 2 years, returning to the expected background weight gain of 1 kg/year. Quality-adjusted Life-Year cost was £2017 where background weight gain was limited to 0.5 kg/year, and £2651 at 0.3 kg/year. Under a ‘best-case scenario’, where weights of 12-month-attenders were assumed thereafter to rise at the background rate, 4 kg below non-intervention trajectory (very close to the observed weight change), Counterweight remained ‘dominant’ with background weight gains 1 kg, 0.5 kg or 0.3 kg/year.

Conclusion:  Weight management for obesity in primary care is highly cost-effective even considering only three clinical consequences. Reduced healthcare resources use could offset the total cost of providing the Counterweight Programme, as well as bringing multiple health and Quality of Life benefits.

The effectiveness of a brief intervention using a pedometer and step-recording diary in promoting physical activity in people diagnosed with type 2 diabetes or impaired glucose tolerance

Issue addressed: To evaluate the effectiveness of a brief intervention using a pedometer and step-recording diary on promoting physical activity in people with type 2 diabetes or impaired glucose tolerance (IGT). Methods: People with type 2 diabetes or IGT who attended the Illawarra Diabetes Service were invited to participate. Participants in the intervention group received a pedometer and a diary to record their daily steps for a two-week period. Both the intervention and comparison group received advice on physical activity. Physical activity levels were measured using the Active Australia Survey at baseline, and at two and 20 weeks. Results: A total of 226 participants were recruited. At two-week follow-up the mean self-reported minutes of walking was significantly higher in the intervention group than the comparison group (223 minutes versus 164 minutes; p=0.01), as was the percentage of intervention participants achieving recommended levels of moderate-intensity physical activity (63.5% versus 41.8%, p=0.02) and the percentage of intervention participants achieving adequate levels of total physical activity (68.9% versus 48.0%, p=0.04). There were no differences between study groups for any physical activity measure at 20-week follow-up. Conclusions: A pedometer and a step-recording diary were useful tools to promote short-term increase in physical activity in people diagnosed with type 2 diabetes or IGT. Future studies need to examine whether a longer intervention, individualised physical activity counselling and support for achieving step goals could result in increasing physical activity over the long term.