Economic analysis of a community-based falls prevention program

Objectives: To undertake a cost–benefit analysis of ‘Stay on Your Feet’, a community-based falls prevention program targeting older people at all levels of risk in New South Wales, Australia. Hospital separations were monitored in the intervention region, a control region and for the state of New South Wales as a whole. Changing admission patterns over the intervention period were used to assess the impact of the program.

Methods: Cost–benefit analysis compared the costs of the program with two estimates of savings from avoided hospital admissions. The first compared the cost of hospital admissions in the intervention region to a control region of similar demographics, while the second compared hospital utilization in the intervention region with the state of New South Wales as a whole using falls-related hospital diagnosis related group (DRG) codes.

Results: The total direct costs of the program were estimated at A$781 829. Both methods identified clear overall net benefits ranging from A$5.4 million for avoided hospitalizations alone to A$16.9 million for all avoided direct and indirect costs. The confidence intervals around these estimates were small. The average overall benefit to cost ratio for the intervention as a whole was 20.6:1.

Conclusions: These findings suggest that well-designed community-based interventions targeting falls prevention among older people are highly cost effective and a wise investment for all levels of government. The models used are conservative and are likely to underestimate the real benefit of the intervention, which may have lasted for some time beyond the life of the program.

Hospital malnutrition : prevalence, identification and impact on patients and the healthcare system

Malnutrition is a debilitating and highly prevalent condition in the acute hospital setting, with Australian and international studies reporting rates of approximately 40%. Malnutrition is associated with many adverse outcomes including depression of the immune system, impaired wound healing, muscle wasting, longer lengths of hospital stay, higher treatment costs and increased mortality. Referral rates for dietetic assessment and treatment of malnourished patients have proven to be suboptimal, thereby increasing the likelihood of developing such aforementioned complications. Nutrition risk screening using a validated tool is a simple technique to rapidly identify patients at risk of malnutrition, and provides a basis for prompt dietetic referrals. In Australia, nutrition screening upon hospital admission is not mandatory, which is of concern knowing that malnutrition remains under-reported and often poorly documented. Unidentified malnutrition not only heightens the risk of adverse complications for patients, but can potentially result in foregone reimbursements to the hospital through casemix-based funding schemes. It is strongly recommended that mandatory nutrition screening be widely adopted in line with published best-practice guidelines to effectively target and reduce the incidence of hospital malnutrition.

Chlamydia screening for pregnant women aged 16-25 years attending an antenatal service: a cost-effectiveness study

OBJECTIVE: Determine the cost-effectiveness of screening all pregnant women aged 16-25 years for chlamydia compared with selective screening or no screening. DESIGN: Cost effectiveness based on a decision model. SETTING: Antenatal clinics in Australia. SAMPLE: Pregnant women, aged 16-25 years. METHODS: Using clinical data from a previous study, and outcomes data from the literature, we modelled the short-term perinatal (12-month time horizon) incremental direct costs and outcomes from a government (as the primary third-party funder) perspective for chlamydia screening. Costs were derived from the Medicare Benefits Schedule, Pharmaceutical Benefits Scheme, and average cost-weights reported for hospitalisations classified according to the Australian refined diagnosis-related groups. MAIN OUTCOME MEASURES: Direct costs of screening and managing chlamydia complications, number of chlamydia cases detected and treated, and the incremental cost-effectiveness ratios were estimated and subjected to sensitivity analyses. RESULTS: Assuming a chlamydia prevalence rate of 3%, screening all antenatal women aged 16-25 years at their first antenatal visit compared with no screening was $34,931 per quality-adjusted life-years gained. Screening all women could result in cost savings when chlamydia prevalence was higher than 11%. The incremental cost-effectiveness ratios were most sensitive to the assumed prevalence of chlamydia, the probability of pelvic inflammatory disease, the utility weight of a positive chlamydia test and the cost of the chlamydia test and doctor's appointment. CONCLUSION: From an Australian government perspective, chlamydia screening of all women aged 16-25 years old during one antenatal visit was likely to be cost-effective compared with no screening or selective screening, especially with increasing chlamydia prevalence. TWEETABLE ABSTRACT: Chlamydia screening for all pregnant women aged 16-25 years during an antenatal visit is cost effective.

Perioperative mortality rates in Australian public hospitals : the influence of age, gender and urgency

INTRODUCTION: A decline in surgical deaths has been observed in Australia since the introduction of the Australian and New Zealand Audit of Surgical Mortality (ANZASM). The current study was conducted to determine whether the perioperative mortality rate (POMR) has also declined. METHODS: This study is a retrospective review of the POMR for surgical procedures in Australian public hospitals between July 2009 and June 2013, using data obtained from the Australian Institute of Health and Welfare. Operative procedures contained in the Australian Refined Diagnosis Related Groups were selected and the POMR was modelled using urgency of admission, age and gender as explanatory covariates. RESULTS: The POMR in Australian public hospitals reduced by 15.4 % over the 4-year period. The emergency admissions POMR dropped from 1.40 to 1.12 %, and the elective admissions POMR from 0.09 to 0.08 %. The binary logistic regression model used to predict patient mortality showed emergency admissions to have a higher POMR than elective, being more evident at older ages. For emergency admissions, the difference in POMR between females and males increased with age, from about 55 years onwards, with females being lower. For elective surgeries, the difference between males and females was of little practical importance across ages. CONCLUSIONS: The reduction in the POMR in Australia confirms the reduction in surgical deaths reported to ANZASM. Continuing to monitor POMR will be important to ensure the safest surgery in Australia. Further investigations into case-mix will allow better risk adjustment and comparison between regions and time-periods, to facilitate continuous quality improvement.

Amalgamation of health services in South-West Victoria: reinvention or survival?

In Australia 'the hospital' has long been considered the cornerstone of small, rural health services. However, this premise has been altered significantly by the introduction of casemix loading and diagnostic-related groups that promote a rationalised output-based model of management. In the light of these changes, many rural health services have struggled to reinvent themselves by establishing a range of service models such as Multi-purpose Service (MPS) and Health Streams, while maintaining traditional models (i.e. bush nursing centres, nursing homes and aged-care facilities). These changes are about survival. This paper analyses one such case in south-west Victoria, the Macarthur and District Community Outreach Service, and compares the outcomes with other similar Victorian rural health research projects. Particular attention is paid to the nature of the health services, the management of change and the proposed health outcomes for the local rural communities. In conclusion, it is argued that this study adds to the body of knowledge surrounding the construction of models of community health and development programming, These models impact upon future rural and remote area initiatives throughout Australia.

Emotional intelligence and teaching : further validation evidence

Further evidence is presented to demonstrate the validity of a new measure of emotional intelligence: Reactions to Teaching Situations (RTS). Using criterion-related groups of high and low scorers on the RTS, it is shown that high scorers give more responses coded as emotional intelligence in their answers to sentence completion tasks relating to ten situations found in teaching. The questions of convergent and discriminant validity is tackled by examination of correlations of emotional intelligence scores and scores on the Multiple Intelligences Checklist for Adults (MICA) and information processing preferences as measured by the Myers-Briggs Type Indicator (MBTI). The results confirm that emotional intelligence (as assessed by the RTS) bears significant relationships to both intrapersonal and interpersonal intelligences and also to linguistic intelligence, but emotional intelligence shows no significant relationships with the MBTI preferences.

Effectiveness of pain management in hospital in the home programs

Alternative health care delivery models such as HITH facilitate the care of patients requiring acute treatments in their own homes. There are over 570 Diagnostic Related Groups managed in HITH programs and many of these are known to have associated physical pain. The impact of the home environment on patients’ experience of pain or how pain is managed is poorly understood. The purpose of this presentation is to
present the background and preliminary findings of a study that aims to increase our understanding of the issues related to providing optimal pain management for acute care patients who are transferred to Hospital in the Home. This knowledge will enable the development of effective practice guidelines to improve patient outcomes. More specifically, the aims are:
• To identify whether patients are transferred to HITH in pain or develop
   significant pain while in the program
• To identify the frequency and intensity of pain experienced by patients in 3      HITH programs.
• To describe patients’ experience of pain in the home environment.
• To investigate whether patients receive adequate pain relief once                      transferred to HITH.
• To explore the strategies patients use to manage pain at home.

The study will be carried out over 12 months in three HITH units in Victoria: Box Hill Hospital, Alfred Hospital and Epworth Hospital. The design is a descriptive survey of patients’ experience of pain and pain management using a modified version of The American Pain Society’s Patient Outcome Questionnaire. 360 consecutive surgical patients transferred to HITH care in the three participating programs will be interviewed by telephone between 48 and 72 hours of admission to the program.

The findings of this study will identify issues in providing optimum pain management for patients receiving acute care in non-traditional treatment environments.

Clinical pharmacy input for hospital inpatients according to disease state

This study measured the clinical activities performed and times taken by hospital pharmacists to provide medication monitoring services to individual medical and surgical patients. Linking these data to hospital Patient Administration Systems showed how clinical pharmacy manpower needs are guided by patient partition, disease complexity and Diagnosis Related Group classification.

Staying healthy : the case of cotton and cane growers in Australia

Farmers and fishers have always been exposed to the vagaries of climate and global economic forces. However, in recent years there has been an accumulation of factors which are having a particularly severe impact upon rural Australia. The global financial crisis has negatively affected commodity prices and the viability of some rural communities is under threat. There is evidence to suggest that climate change is already impacting adversely on many primary producers and their ability to farm using traditional methods. Furthermore, many parts of rural Australia are still experiencing the effects of long-term drought and associated problems. Together, these circumstances can rightly be conceived of as 'difficult times'. Key areas recently identified in a decline in mental health among farmers include: increasing isolation, ongoing drought, increased government regulations, and a widening of the schism between urban and rural Australians. While there is a body of literature on behaviour around illness in the context of the stress of ' difficult times', there is little on preventative behaviours in these circumstances. This chapter reports preliminary findings from an exploratory research projects that investigates the process by which farmers and fishers achieve and maintain good physical and mental health in the context of 'difficult times'. The research takes a multiple case study approach, with five Australian sites, each with a different industry base, representing communities undergoing 'difficult times'. This chapter focuses on two of the sites and data obtained from interviews with farmers in the cotton and sugar industries. It discusses the behavioural choices that they make to maintain good physical health and mental wellbeing. These include choices about nutrition, physical activity, social connections such as participation in community, social or farm-related groups, opportunities for relaxation and regular medical check-ups.

The use of insects and associated arthropods in legal cases : a historical and practical perspective

 Forensic entomology has generally been recognised among law enforcement and the wider community as a science employed in the estimation of time since death. The utility of this science in contributing to the provision of time frames resulting in the focusing of valuable investigative resources has certainly been of the greatest importance. However, arthropods have been exploited extensively for their ability to provide information in a multitude of other situations, including cases of neglect, the food industry, and information relating to the cause and manner of death. This chapter will discuss the realm of information obtainable from insects and related groups in the forensic context, including and beyond the recognised time since death applications. Two areas of current research, molecular forensic entomology and entomotoxicology, will be discussed for their potential impact in the field.

Unsupervised DRG upcoding detection in healthcare databases

Diagnosis Related Group (DRG) upcoding is an anomaly in healthcare data that costs hundreds of millions of dollars in many developed countries. DRG upcoding is typically detected through resource intensive auditing. As supervised modeling of DRG upcoding is severely constrained by scope and timeliness of past audit data, we propose in this paper an unsupervised algorithm to filter data for potential identification of DRG upcoding. The algorithm has been applied to a hip replacement/revision dataset and a heart-attack dataset. The results are consistent with the assumptions held by domain experts.

Ontogenetic and seasonal variation in the Diel Vertical Migration of the Copepods Metridia lucens and Metridia longa

Plankton samples collected and analyzed by the Continuous Plankton Recorder survey were used to examine the length of time spent near the surface in the North Atlantic and the North Sea by three closely related groups of zooplankton (copepodite stages 1-4 Metridia spp., copepodite stages 5-6 Metridia lucens, and copepodite stages 5-6 Metridia longa). For all three groups, the mean daily length of time spent near the surface in each month of the year covaried seasonally with day length. In addition, the amount of time spent near the surface varied significantly between the three groups, being longest for the copepods of smallest body size (C 1-C4 Metridia spp.) and shortest for the copepods of largest body size (C5-C6 M. longa). These results support the suggestion that diel vertical migration serves to reduce the risk of mortality from visually orienting predators

Knowledge about sports-related concussion: is the message getting through to coaches and trainers?

Aim The need for accurate diagnosis and appropriate return-to-play decisions following a concussion in sports has prompted the dissemination of guidelines to assist managing this condition. This study aimed to assess whether key messages within these guidelines are reflected in the knowledge of coaches and sports trainers involved in community sport. Methods An online knowledge survey was widely promoted across Australia in May–August 2012 targeting community Australian Football (AF) and Rugby League (RL) coaches and sports trainers. 260 AF coaches, 161 AF sports trainers, 267 RL coaches and 228 RL sports trainers completed the survey. Knowledge scores were constructed from Likert scales and compared across football codes and respondent groups. Results General concussion knowledge did not differ across codes but sports trainers had higher levels than did coaches. There were no significant differences in either concussion symptoms or concussion management knowledge across codes or team roles. Over 90% of respondents correctly identified five of the eight key signs or symptoms of concussion. Fewer than 50% recognised the increased risk of another concussion following an initial concussion. Most incorrectly believed or were uncertain that scans typically show damage to the brain after a concussion occurs. Fewer than 25% recognised, and >40% were uncertain that younger players typically take longer to recover from concussion than adults. Conclusions The key messages from published concussion management guidelines have not reached community sports coaches and sports trainers. This needs to be redressed to maximise the safety of all of those involved in community sport.

Differentiating sub-groups of online depression-related communities using textual cues

Depression is a highly prevalent mental illness and is a comorbidity of other mental and behavioural disorders. The Internet allows individuals who are depressed or caring for those who are depressed, to connect with others via online communities; however, the characteristics of these online conversations and the language styles of those interested in depression have not yet been fully explored. This work aims to explore the textual cues of online communities interested in depression. A random sample of 5,000 blog posts was crawled. Five groupings were identified: depression, bipolar, self-harm, grief, and suicide. Independent variables included psycholinguistic processes and content topics extracted from the posts. Machine learning techniques were used to discriminate messages posted in the depression sub-group from the others.Good predictive validity in depression classification using topics and psycholinguistic clues as features was found. Clear discrimination between writing styles and content, with good predictive power is an important step in understanding social media and its use in mental health.

Translating guidelines for the diagnosis and management of sports-related concussion into practice

Sports injuries are a significant clinical and public
health concern. There is a growing call to improve the translation of available evidence-based and expert- informed sports injury prevention interventions into sustained use in practice by physicians and others (eg, athletic trainers, coaches, and parents) who care for injured athletes. This article provides a brief overview of the current sport injury prevention implementation literature before focusing specifically on the translation of guidelines (including consensus and position statements) developed to assist physicians and others diagnose and manage athletes with sport-related concussion and the associated return-to-play decisions. The outcomes of more than 20 published studies indicate that physician, athletic trainer, coach, parent,
and athlete knowledge, use of, and compliance with sport-related concussion guidelines are limited. More concerted, coordinated, and theory-informed efforts are required to facilitate the widespread dissemination, translation, and implementation of such guidelines. An example is provided of how implementation drivers could be used to inform the development of a comprehensive, multilevel implementation strategy targeting the individual, organizational, and system-level changes necessary to support the translation of available sport-related concussion guidelines in both the clinical and sports settings.