Primary, allied health, geriatric, pain and palliative healthcare service utilisation by aged care residents, 2012-2017.

OnlinePublObjectives To examine the incidence and trends in primary care, allied health, geriatric, pain and palliative care service use by permanent residential aged care (PRAC) residents and the older Australian population. Methods Repeated cross-sectional analyses on PRAC residents (N = 318,484) and the older (≥65 years) Australian population (N ~ 3.5 million). Outcomes were Medicare Benefits Schedule (MBS) subsidised primary care, allied health, geriatric, pain and palliative services between 2012-13 and 2016-17. GEE Poisson models estimated incidence rates and incidence rate ratios (IRR). Results In 2016-17, PRAC residents had a median of 13 (interquartile range [IQR] 5-19) regular general medical practitioner (GP) attendances, 3 (IQR 1-6) after-hours attendances and 5% saw a geriatrician. Highlights of utilisation changes from 2012-13 to 2016-17 include the following: GP attendances increased by 5%/year (IRR = 1.05, 95% confidence interval [CI] 1.05-1.05) for residents compared to 1%/year (IRR = 1.01, 95%CI 1.01-1.01) for the general population. GP after-hours attendances increased by 15%/year (IRR = 1.15, 95%CI 1.14-1.15) for residents and 9%/year (IRR = 1.08, 95%CI 1.07-1.20) for the general population. GP management plans increased by 12%/year (IRR = 1.12, 95%CI 1.11-1.12) for residents and 10%/year (IRR = 1.10, 95%CI 1.09-1.11) for the general population. Geriatrician consultations increased by 28%/year (IRR = 1.28, 95%CI 1.27-1.29) for residents compared to 14%/year (IRR = 1.14, 95%CI 1.14-1.15) in the general population. Conclusions The utilisation of most examined services increased in both cohorts over time. Preventive and management care, by primary care and allied health care providers, was low and likely influences the utilisation of other attendances. PRAC residents' access to pain, palliative and geriatric medicine services is low and may not address the residents' needs.Maria C. Inacio, Luke Collier, Tracy Air, Kailash Thapaliya, Maria Crotty, Helena Williams, Steve L. Wesselingh, Andrew Kellie, David Roder, Adrienne Lewis, Gillian Harvey, Janet K. Sluggett, Monica Cations, Tiffany K. Gill, Jyoti Khadka, Gillian E. Caughe

Assessing PAH exposure in feral finfish from the Northwest Atlantic

Polycyclic aromatic hydrocarbon (PAH) concentrations were examined in small finfish (<30 cm) represented by capelin, sand lance, American plaice, yellowtail flounder and herring collected opportunistically in various NAFO divisions. Analyses were performed on whole fish and in a portion of the samples; concentrations in internal organs were compared to the rest of the carcass. The effect of pool size, size differences within and between species, lipid content and location were examined to interpret PAH concentrations. Measurements were carried out before the development of the Hibernia oil fields and represent baseline levels for future comparison. Limits in assessing future risk that could be due to discharges of produced water or accidental oil spills are also discussed. Increasing knowledge on the bioaccumulation of PAH, on the production of bile metabolites, the formation of DNA-adducts and of the potential toxic effects associated with PAH will lead to better ecosystem management and protection for future generations. Crown Copyright © 2005

Learning from Post-project Reviews : A Cross-Case Analysis

Every new product development (NPD) project should not only deliver a successful new product but also should generate learning for the organization. Postproject reviews (PPRs) are recognized by both practitioners and academics as an appropriate mechanism to stimulate and capture learning in NPD teams. However, relatively few companies use PPRs, and those that do use them often fail to do so effectively. Although they are widely perceived to be a useful tool, empirical research on how PPRs are typically organized and the learning that results is limited. The present article addresses this gap in the extant knowledge and describes five in-depth case studies, which were conducted at leading companies in Germany. A detailed investigation was made of how PPRs are conducted and of the type of learning that can result. Three main sources of data were used for each case: company documentation, in-depth interviews with managers responsible for NPD, and observation of an actual PPR. The different data sources enabled extensive triangulation of data to be conducted and a high degree of reliability and validity to be achieved. The analysis enabled a number of key characteristics of the way PPRs are managed to be identified. Various characteristics of PPRs influence their utility, such as the time at which they take place and the way discussions are moderated. In addition, the data show that participants in the discussions at PPRs often use metaphors and stories, which indicates that PPRs have the potential to generate tacit knowledge. Interestingly, the data also show that there are various different ways in which metaphors and stories appear to stimulate discussions on NPD projects. Based on the cross-case analysis, a wide range of implications are identified. Researchers need to investigate PPRs further to identify how they can generate tacit and explicit knowledge and support project-to-project learning. The generation of tacit knowledge in NPD is a topic that particularly needs further investigation. The research also led to a range of recommendations for practitioners. Companies need to strongly communicate the purpose and value of PPRs, to run them effectively to stimulate the maximum possible learning, and to disseminate the findings widely. PPRs have the potential to create and transfer knowledge amongst NPD professionals, but, as they are seldom currently used, many companies are missing an important opportunity