Cost-effectiveness analysis of a hospital electronic medication management system

OBJECTIVE: To conduct a cost-effectiveness analysis of a hospital electronic medication management system (eMMS). METHODS: We compared costs and benefits of paper-based prescribing with a commercial eMMS (CSC MedChart) on one cardiology ward in a major 326-bed teaching hospital, assuming a 15-year time horizon and a health system perspective. The eMMS implementation and operating costs were obtained from the study site. We used data on eMMS effectiveness in reducing potential adverse drug events (ADEs), and potential ADEs intercepted, based on review of 1 202 patient charts before (n = 801) and after (n = 401) eMMS. These were combined with published estimates of actual ADEs and their costs. RESULTS: The rate of potential ADEs following eMMS fell from 0.17 per admission to 0.05; a reduction of 71%. The annualized eMMS implementation, maintenance, and operating costs for the cardiology ward were A$61 741 (US$55 296). The estimated reduction in ADEs post eMMS was approximately 80 actual ADEs per year. The reduced costs associated with these ADEs were more than sufficient to offset the costs of the eMMS. Estimated savings resulting from eMMS implementation were A$63-66 (US$56-59) per admission (A$97 740-$102 000 per annum for this ward). Sensitivity analyses demonstrated results were robust when both eMMS effectiveness and costs of actual ADEs were varied substantially. CONCLUSION: The eMMS within this setting was more effective and less expensive than paper-based prescribing. Comparison with the few previous full economic evaluations available suggests a marked improvement in the cost-effectiveness of eMMS, largely driven by increased effectiveness of contemporary eMMs in reducing medication errors.

A prospective observational study of prevalence and outcomes of patients with Gold Standard Framework criteria in a tertiary regional Australian Hospital

OBJECTIVES: Report the use of an objective tool, UK Gold Standards Framework (GSF) criteria, to describe the prevalence, recognition and outcomes of patients with palliative care needs in an Australian acute health setting. The rationale for this is to enable hospital doctors to identify patients who should have a patient-centred discussion about goals of care in hospital.

DESIGN: Prospective, observational, cohort study.

PARTICIPANTS: Adult in-patients during two separate 24 h periods.

MAIN OUTCOME MEASURES: Prevalence of in-patients with GSF criteria, documentation of treatment limitations, hospital and 1 year survival, admission and discharge destination and multivariate regression analysis of factors associated with the presence of hospital treatment limitations and 1 year survival.

RESULTS: Of 626 in-patients reviewed, 171 (27.3%) had at least one GSF criterion, with documentation of a treatment limitation discussion in 60 (30.5%) of those patients who had GSF criteria. Hospital mortality was 9.9%, 1 year mortality 50.3% and 3-year mortality 70.2% in patients with GSF criteria. One-year mortality was highest in patients with GSF cancer (73%), renal failure (67%) and heart failure (60%) criteria. Multivariate analysis revealed age, hospital length of stay and presence of the GSF chronic obstructive pulmonary disease criteria were independently associated with the likelihood of an in-hospital treatment limitation. Non-survivors at 3 years were more likely to have a GSF cancer (25% vs 6%, p=0.004), neurological (10% vs 3%, p=0.04), or frailty (45% vs 3%, p=0.04) criteria. After multivariate logistic regression GSF cancer criteria, renal failure criteria and the presence of two or more GSF clinical criteria were independently associated with increased risk of death at 3 years. Patients returning home to live reduced from 69% (preadmission) to 27% after discharge.

CONCLUSIONS: The use of an objective clinical tool identifies a high prevalence of patients with palliative care needs in the acute tertiary Australian hospital setting, with a high 1 year mortality and poor return to independence in this population. The low rate of documentation of discussions about treatment limitations in this population suggests palliative care needs are not recognised and discussed in the majority of patients.

TRIAL REGISTRATION NUMBER: 11/121.

The longitudinal effects of adolescent volunteering on secondary school completion and adult volunteering

 This study explores the longitudinal effect of adolescent volunteering behaviour on young adult volunteering and the completion of secondary school. Utilising data from the Australian sample of the International Youth Development Study, frequency of volunteering in Grade 9 (mean age = 15 years) and in young adulthood (mean age = 21 years), and completion of secondary school were measured. Mixed effect logistic regression analyses revealed that adolescent volunteering was associated with an increased likelihood of volunteering in young adulthood (Odds Ratio [OR] 1.29; 95% Confidence Interval [CI] 1.20–1.39; N = 2,648) and of Grade 12 completion (OR 1.14; CI 1.03–1.28; N = 2,648), after controlling for family socioeconomic status and adolescent school adjustment. These findings suggest that adolescent volunteering may lead to further involvement in young adult volunteering and have a positive effect on school completion.

Dual-axis hormonal covariation in adolescence and the moderating influence of prior trauma and aversive maternal parenting

Adversity early in life can disrupt the functioning of the hypothalamic-pituitary-adrenal and hypothalamic-pituitary-gonadal axes and increase risk for negative health outcomes. The interplay between these axes and the environment is complex, and understanding needs to be advanced by the investigation of the multiple hormonal relationships underlying these processes. The current study examined basal hormonal associations between morning levels of cortisol, testosterone, and dehydroepiandrosterone in a cohort of adolescents (mean age 15.56 years). The moderating influence of childhood adversity was also examined, as indexed by self-reported trauma (at mean age 14.91), and observed maternal aggressive parenting (at mean age 12.41). Between-person regressions revealed significant associations between hormones that were moderated by both measures of adversity. In females, all hormones positively covaried, but also interacted with adversity, such that positive covariation was typically only present when levels of trauma and/or aggressive parenting were low. In males, hormonal associations and interactions were less evident; however, interactions were detected for cortisol-testosterone - positively covarying at high levels of aggressive parenting but negatively covarying at low levels - and DHEA-cortisol - similarly positively covarying at high levels of parental aggression. These results demonstrate associations between adrenal and gonadal hormones and the moderating role of adversity, which is likely driven by feedback mechanisms, or cross-talk, between the axes. These findings suggest that hormonal changes may be the pathway through which early life adversity alters physiology and increases health risks, but does so differentially in the sexes; however further study is necessary to establish causation.

Marginal efficiencies of long chain-polyunsaturated fatty acid use by barramundi (Lates calcarifer) when fed diets with varying blends of fish oil and poultry fat

An experiment was conducted with barramundi (Lates calcarifer) juveniles to examine the marginal efficiency of utilisation of long chain-polyunsaturated fatty acids (LC-PUFA). A series of five diets with blends of fish (anchovy) oil and poultry fat (F100:P0, F60:P40, F30:P70, F15:P85, F0:P100) were fed to 208. ±. 4.1. g fish over a 12-week period. The replacement of fish oil with poultry fat had no impact on growth performance (average final weight of 548.3. ±. 10.2. g) or feed conversion (mean = 1.14. ±. 0.02). Analysis of the whole body composition showed that the fatty acid profile reflected that of the fed diet. However it was also shown that there was a disproportional retention of some fatty acids relative to others (notably LOA, 18:2n-6 and LNA, 18:3n-3). By examining the body mass independent retention of different fatty acids with differential levels of intake of each, the marginal efficiencies of the use of these nutrients by this species were able to be determined. The differential retention of fatty acids in the meat was also examined allowing the determination of oil blending strategies to optimise meat n-3 LC-PUFA levels.

Integration of design for reverse logistics and harvesting of information: a research agenda

The literature is replete with treatises advocating the immense benefits of reverse logistics (RL) systems for organisations in terms of alleviating environmental concerns and enhancing the level of productivity. Nevertheless, implementing RL in organisations is fraught with complications with its success largely riding on fulfilling the requirements prescribed by the critical success factors (CSFs) of RL. Despite the voluminous body of knowledge on RL in the extant literature, operational aspects of RL have overshadowed some central strategic prerequisites for the success of RL systems. Drawing upon an integrative literature review, this paper provides an insight into different aspects of the implementation of RL practices. The central role of the integration of design for reverse logistics (DfRL) and harvesting of information (HoI) in the effective implementation of RL systems is then established and clarified through developing a conceptual framework. The paper concludes by putting forward an agenda for research.

Randomized controlled trial of proactive web-based alcohol screening and brief intervention for university students

BACKGROUND: University students drink more heavily than their nonstudent peers and are often unaware that their drinking is risky and exceeds normative levels. We tested the efficacy of a proactive Web-based alcohol screening and brief intervention program. METHODS: A randomized controlled trial was conducted at an Australian university in 2007. Invitations were sent to 13 000 undergraduates (age range, 17-24 years) to complete a Web-based Alcohol Use Disorders Identification Test. Of 7237 students who responded, 2435 scored in the hazardous/harmful range (> or =8) and were randomized, and 2050 (84%) completed at least 1 follow-up assessment. Intervention was 10 minutes of Web-based motivational assessment and personalized feedback. Controls received only screening. Follow-up assessments were conducted at 1 and 6 months with observers and participants blinded to allocation. Outcome measures were drinking frequency, typical occasion quantity, overall volume, number of personal problems, an academic problems score, prevalence of binge drinking, and prevalence of heavy drinking. RESULTS: Mean (SD) baseline Alcohol Use Disorders Identification Test scores for control and intervention groups were 14.3 (5.1) and 14.2 (5.1), respectively. After 1 month, participants receiving intervention drank less often (rate ratio [RR], 0.89; 95% confidence interval [CI], 0.83-0.94), smaller quantities per occasion (RR, 0.93; 95% CI, 0.88-0.98), and less alcohol overall (RR, 0.83; 95% CI, 0.78-0.90) than did controls. Differences in alcohol-related harms were nonsignificant. At 6 months, intervention effects persisted for drinking frequency (RR, 0.91; 95% CI, 0.85-0.97) and overall volume (RR, 0.89; 95% CI, 0.82-0.96) but not for other variables. CONCLUSION: Proactive Web-based screening and intervention reduces drinking in undergraduates, and such a program could be implemented widely.

The effect of marine and non-marine phospholipid rich oils when fed to juvenile barramundi (Lates calcarifer)

An experiment was conducted to assess the response of juvenile barramundi (Lates calcarifer) to four diets containing either marine- or non-marine derived neutral lipid (NL) or polar lipid (PL) sources for eight weeks in a 2 × 2 factorial design. The four diets contained 8.2% added lipid composed of a 1% fish oil base with 7.2% test lipid (n - 3 NL: Fish oil, n - 3 PL: Krill oil, n - 6 NL: Soybean oil, n - 6 PL: Soybean lecithin). The results demonstrated that the different lipid sources (either n - 3 or n - 6 omega series from either NL or PL class) had significant effects on growth performance and feed utilisation with some interaction terms noted. Growth was negatively affected in the n - 6 NL fish and the feed conversion (FCR) was highest in the n - 6 PL fish. Digestibility of total lipid and some specific fatty acids (notably 18:2n - 6 and 18:3n - 3) were also negatively affected in the n - 6 PL fish. Analysis of the whole body neutral lipid fatty acid composition showed that these mirrored those of the diets and significant interaction terms were noted. However, the whole body polar lipid fatty acids appeared to be more tightly regulated in comparison. The blood plasma biochemistry and hepatic transcription of several fatty acid metabolism genes in the n - 6 PL fed and to a lesser extent in the n - 6 NL fed fish demonstrated a pattern consistent with modified metabolic function. These results support that there are potential advantages in using phospholipid-rich oils however there are clear differences in terms of their origin. Statement of relevance: Juvenile barramundi may benefit from dietary phospholipid.

Coassembled nanostructured bioscaffold reduces the expression of proinflammatory cytokines to induce apoptosis in epithelial cancer cells

The local inflammatory environment of the cell promotes the growth of epithelial cancers. Therefore, controlling inflammation locally using a material in a sustained, non-steroidal fashion can effectively kill malignant cells without significant damage to surrounding healthy cells. A promising class of materials for such applications are the nanostructured scaffolds formed by epitope containing minimalist self-assembled peptides (SAPs), as they are bioactive on a cellular length scale, whilst presenting as an easily handled hydrogel. Here, we show that the assembly process distributes an anti-inflammatory polysaccharide, fuccoidan, localised to the nanofibers to function as an anti-inflammatory biomaterial for cancer therapy. We show that it supports healthy cells, whilst inducing apoptosis in cancerous endothelial cells, as demonstrated by the downregulation of the proinflammatory gene and protein expression pathways associated with epithelial cancer progression. Our findings highlight an innovative material approach with potential applications as local epithelial cancer immunotherapy and drug delivery vehicles.

Asymmetric oil shocks and external balances of major oil exporting and importing countries

This study investigates the effects of oil price shocks on three measures of oil exporters' and oil importers' external balances: total trade balance, oil trade balance and non-oil trade balance. We employ three second-generation heterogeneous linear panel models and one recently developed non-linear panel estimation technique that allows for cross-sectional dependence. With respect to 28 major oil exporting countries, an increase in oil prices leads to an improved real oil trade balance, although it is detrimental to non-oil and total trade balances. This finding might be due to the expenditure effect arising from increases in proceeds from oil exports. A decrease in oil prices is found to be beneficial for both total and oil trade balances in these oil exporting countries. Forty major oil importers seem to be increasingly shielded from positive oil shocks over the 1970s and 1980s; however, they must worry about oil price declines. A decline in oil prices has a negative impact on both total and real oil trade balances resulting from increased oil imports in emerging economies. Hence, a decline in oil prices is beneficial to oil exporters due to the quantity effect outweighing the price effect, while for oil importers a stable oil price is more desirable than a price decline. These results are important to take into account if we are to gain a full understanding on the magnitude of the trade and macroeconomic effects of oil price changes and what the policy responses should be.

ePortfolios in business education: a national study of ePortfolio implementation 2013 to 2015

To be launched in March 2016, this study explores the transformative potential of ePortfolios in business education. Educators and higher education institutions are increasingly looking for innovative ways to enhance learning outcomes through technology. Given their potential to aid in the development of engaged, reflective lifelong learners, and develop and showcase employability skills, ePortfolios are increasingly being used around the globe.

This study shares the experience of, and lessons learned from, the implementation of ePortfolios in one general business management course and three accounting related courses at three higher education institutions. The recommendations and principles proposed provide benchmarks for best practice and practical guidance for embedding ePortfolios into business curricula.

Sequence-dependent structure/function relationships of catalytic peptide-enabled gold nanoparticles generated under ambient synthetic conditions

Peptide-enabled nanoparticle (NP) synthesis routes can create and/or assemble functional nanomaterials under environmentally friendly conditions, with properties dictated by complex interactions at the biotic/abiotic interface. Manipulation of this interface through sequence modification can provide the capability for material properties to be tailored to create enhanced materials for energy, catalysis, and sensing applications. Fully realizing the potential of these materials requires a comprehensive understanding of sequence-dependent structure/function relationships that is presently lacking. In this work, the atomic-scale structures of a series of peptide-capped Au NPs are determined using a combination of atomic pair distribution function analysis of high-energy X-ray diffraction data and advanced molecular dynamics (MD) simulations. The Au NPs produced with different peptide sequences exhibit varying degrees of catalytic activity for the exemplar reaction 4-nitrophenol reduction. The experimentally derived atomic-scale NP configurations reveal sequence-dependent differences in structural order at the NP surface. Replica exchange with solute-tempering MD simulations are then used to predict the morphology of the peptide overlayer on these Au NPs and identify factors determining the structure/catalytic properties relationship. We show that the amount of exposed Au surface, the underlying surface structural disorder, and the interaction strength of the peptide with the Au surface all influence catalytic performance. A simplified computational prediction of catalytic performance is developed that can potentially serve as a screening tool for future studies. Our approach provides a platform for broadening the analysis of catalytic peptide-enabled metallic NP systems, potentially allowing for the development of rational design rules for property enhancement.

Realising the potential: assessing professional learning through the integration of ePortfolios in Australian business education

This project will enable academic leadership of Australian Business and Management education programs to design into the curriculum, and best use, ePortfolios and associated technologies in assessing students' learning of highly valued professionally-based capabilities. The project will investigate and support the best ways of broadly and deeply embedding ePortfolios across entire undergraduate business and management education curricula. ePortfolios for enabling and assessing student learning is seen as a key means for integrating student learning across the curriculum and, therefore, creating a holistic learning experience. The project will work with Program Leaders across the sector through liaison with the Australian Business Deans Council (ABDC), Teaching and Learning Network to both draw in better practices and disseminate project findings as the project progresses through its key phases. These planned actions will lead to the progressive development of a Business Education ePortfolio Professional Learning Capabilities Assessment Framework.

Nicholas Colon, Jr, Proprietor Tele-FM Television and Advanced Television Techniques graduate, 1954.

This is a photograph showing Nicholas Colon, Jr. a New York Trade School, Advanced Television Techniques graduate with an unnamed worker at his Tele-FM Television company. Original caption reads, "Nicholas Colon, Jr. - Advanced Television Techniques 1954, operates and up-to-date and successful television service shop. He is on the executive board of CETA (Certified Electronic Technicians Association). He prefers to employ graduate technicians of the New York Trade School Advanced Television Techniques course." Black and white photograph with caption glued to reverse.