Priority setting in health: origins, description and application of the Australian Assessing Cost-Effectiveness initiative

This article reports on the ‘Assessing Cost–Effectiveness’ (ACE) initiative in priority setting from Australia. It commences with why priority setting is topical and notes that a wide variety of approaches are available. In assessing these various approaches, it is argued that a useful first step is to consider what constitutes an ‘ideal’ approach to priority setting. A checklist to guide priority setting is presented based on guidance from economic theory, ethics and social justice, lessons from empirical experience and the needs of decision-makers. The checklist is seen as an important contribution because it is the first time that criteria from such a broad range of considerations have been brought together to develop a framework for priority setting that endeavors to be both realistic and theoretically sound. The checklist will then be applied to a selection of existing approaches in order to illustrate their deficiencies and to provide the platform for explaining the unique features of the ACE approach. A case study (ACE-Cancer) will then be presented and assessed against the checklist, including reaction from stakeholders in the cancer field. The article concludes with an overview of the full body of ACE research completed to date, together with some reflections on the ACE experience.

Description and qualitative evaluation of Jigsaw, an integrated young persons' mental health program

Objective: The aim of this paper is to describe the establishment of an integrated young person’s mental health service and the findings of a qualitative evaluation conducted 2 years after its establishment.
Method: A qualitative evaluation of the service was undertaken using a semi-structured interview, a service satisfaction survey and partnership analysis tool.
Results: The major problems encountered in establishing the service were insufficient recognition of the cultural challenges in working together, difficulty in recruiting general practitioners, establishing a youth friendly environment and maintaining the quality of the relationship between partners.
Conclusion: Despite almost 3 years of preparation, many important aspects of change management were underestimated or inadequately attended to.

Impaction bone grafting of the glenoid in revision shoulder arthroplasty : classification, technical description and early results

Background Glenoid component fixation remains an issue in the long-term survival of total shoulder arthroplasty. As a consequence revision of the glenoid component is becoming increasingly more common and reconstructive techniques to preserve and restore bone stock are becoming more important.

Methods In this article we describe the combined technique of impaction grafting and glenoid component exchange together with a classification of the glenoid defect with a report on four sequential cases in patients with rheumatoid arthritis with an average age of 56 years. The minimum follow-up was 34 months (range 34 months to 62 months).

Results Patients reported excellent pain relief and some improvement in motion and function. The complication rate remains low. Radiological assessment using tomograms showed good incorporation of the bone graft and minimal signs of glenoid loosening.

Conclusion The results of this study confirm that at least in the short term impaction grafting techniques used to reconstitute the glenoid in revision surgery can be successful.

Distinguishing between mathematics classrooms in Australia, China, Japan, Korea and the USA through the lens of the distribution of responsibility for knowledge generation : public oral interactivity and mathematical orality

The research reported in this paper examined spoken mathematics in particular well-taught classrooms in Australia, China (both Shanghai and Hong Kong), Japan, Korea and the USA from the perspective of the distribution of responsibility for knowledge generation in order to identify similarities and differences in classroom practice and the implicit pedagogical principles that underlie those practices. The methodology of the Learner’s Perspective Study (LPS) documented the voicing of mathematical ideas in public discussion and in teacher-student conversations and the relative priority accorded by different teachers to student oral contributions to classroom activity. Significant differences were identified among the classrooms studied, challenging simplistic characterisations of ‘the Asian classroom’ as enacting a single pedagogy, and suggesting that, irrespective of cultural similarities, local pedagogies reflect very different assumptions about learning and instruction. We have employed spoken mathematical terms as a form of surrogate variable, possibly indicative of the location of the agency for knowledge generation in the various classrooms studied (but also of interest in itself). The analysis distinguished one classroom from another on the basis of “public oral interactivity” (the number of utterances in whole class and teacher-student interactions in each lesson) and “mathematical orality” (the frequency of occurrence of key mathematical terms in each lesson). Classrooms characterized by high public oral interactivity were not necessarily sites of high mathematical orality. In particular, the results suggest that one characteristic that might be identified with a national norm of practice could be the level of mathematical orality: relatively high mathematical orality characterising the mathematics classes in Shanghai with some consistency, while lessons in Seoul and Hong Kong consistently involved much less frequent spoken mathematical terms. The relative contributions of teacher and students to this spoken mathematics provided an indication of how the responsibility for knowledge generation was shared between teacher and student in those classrooms. Specific analysis of the patterns of interaction by which key mathematical terms were introduced or solicited revealed significant differences. It is suggested that the empirical investigation of mathematical orality and its likely connection to the distribution of the responsibility for knowledge generation are central to the development of any theory of mathematics instruction.