Public problems: private solutions? Short-term contracting of inpatient hospital care

Executive summary Public patients are routinely being treated in Australian private hospitals. Some jurisdictions have large-scale, planned programs where private or not-for-profit hospitals are contracted by the public sector to treat public inpatients (for example, Queensland’s Surgery Connect program). Often, however, ‘contracting’ is done on an ad hoc or short-term basis where private hospitals are asked, at relatively short notice, to treat public patients in order to relieve pressure on public hospitals. The findings from this project stem from interviews with 24 senior health executives across Australia. Interviewees were public and private hospital executives and government bureaucrats. All had experience in hospital contracting. The focus of the interviews was their experiences with contracting: why and how contracting arrangements were developed, what worked, what didn’t, and what changes to policy and practice were made over time. Interviewees were also asked about their views on the merits of contracting, whether it should be done more often, and if so, what needed to be done to make sure it worked well. While the views of these senior health executives on this topic were diverse, several clear messages emerged that are pertinent to policymakers working in this area. They are: The way we are doing contracting currently in Australia tends to be ad hoc, and this is enormously frustrating to hospital executives in both the public and private sectors. Without greater certainty about the type and volume of patients to be treated, and how long contract arrangements will remain in place, it is unlikely that the full benefits of contracting (such as more timely access to care for public patients, and the more efficient use of resources) will be realised. Some private hospital executives are unconvinced of the merits of contracting because they believe it reduces the value of private health insurance and the incentives to develop other private sources of revenue. Their views on contracting raise broader policy questions about the relative roles of public and private hospitals in Australia. These questions need to be addressed if governments intend to expand to use of contracting in the hospital sector. State and territory governments (referred to as states) need to develop clear and consistent policies on contracting in the hospital sector. This includes developing fee schedules for different types of services and processes for establishing and negotiating contracts with the private sector. At the same time state-level policies need to be flexible enough to allow local (or regional) health services to make decisions about when, where and how contracting is done in their area. Without significant local level involvement in decision-making, it is difficult to ensure that contracting arrangements between local public and private hospitals (which tend to be more convenient for patients) will work in the longer-term. Hospital executives have suggested numerous options for reform that have the potential to improve the way we do contracting in Australia. They range from small-scale reforms, such as contracting over longer time-periods and setting up brokers to facilitate contracting, to larger-scale ones such as establishing contestable funding pools; co-location of public and private hospitals; public-private partnerships; and implementing new hospital financing models (such as Medicare Select). These options, and more, need to be given serious consideration by policymakers if they are to improve the efficiency and effectiveness of our hospital systems

Could Fire and Rescue Services identify older people at risk of falls?

Protecting or improving the efficiency and effectiveness of services while reducing costs in response to public sector funding reductions is a significant challenge for all public service organisations. Preventing falls in older people is a major public health objective. We propose here an innovative model of community partnership with Fire and Rescue Services assisting falls prevention services to enhance the safety and well-being of older people in local communities through early identification of those who are at risk of injury from a fall or accidental domestic fire

Exploring Differences in Measurement and Reporting of Classroom Observation Inter-Rater Reliability

Although inter-rater reliability is an important aspect of using observational instruments, it has received little theoretical attention. In this article, we offer some guidance for practitioners and consumers of classroom observations so that they can make decisions about inter-rater reliability, both for study design and in the reporting of data and results. We reviewed articles in two major journals in the fields of reading and mathematics to understand how researchers have measured and reported inter-rater reliability in a recent decade. We found that researchers have tended to report measures of inter-rater agreement above the .80 threshold with little attention to the magnitude of score differences between raters. Then, we conducted simulations to understand both how different indices for classroom observation reliability are related to each other and the impact of reliability decisions on study results. Results from the simulation studies suggest that mean correlations with an outcome are slightly lower at lower levels of percentage of exact agreement but that the magnitude of score differences has a more dramatic effect on correlations. Therefore, adhering to strict thresholds for inter-rater agreement is less helpful than reporting exact point estimates and also examining measures of rater consistency. Accessed 2,893 times on https://pareonline.net from April 05, 2018 to December 31, 2019. For downloads from January 1, 2020 forward, please click on the PlumX Metrics link to the right

In vivo investigation of hyperpolarized [1,3-13C2]acetoacetate as a metabolic probe in normal brain and in glioma.

Dysregulation in NAD+/NADH levels is associated with increased cell division and elevated levels of reactive oxygen species in rapidly proliferating cancer cells. Conversion of the ketone body acetoacetate (AcAc) to β-hydroxybutyrate (β-HB) by the mitochondrial enzyme β-hydroxybutyrate dehydrogenase (BDH) depends upon NADH availability. The β-HB-to-AcAc ratio is therefore expected to reflect mitochondrial redox. Previous studies reported the potential of hyperpolarized 13C-AcAc to monitor mitochondrial redox in cells, perfused organs and in vivo. However, the ability of hyperpolarized 13C-AcAc to cross the blood brain barrier (BBB) and its potential to monitor brain metabolism remained unknown. Our goal was to assess the value of hyperpolarized [1,3-13C2]AcAc in healthy and tumor-bearing mice in vivo. Following hyperpolarized [1,3-13C2]AcAc injection, production of [1,3-13C2]β-HB was detected in normal and tumor-bearing mice. Significantly higher levels of [1-13C]AcAc and lower [1-13C]β-HB-to-[1-13C]AcAc ratios were observed in tumor-bearing mice. These results were consistent with decreased BDH activity in tumors and associated with increased total cellular NAD+/NADH. Our study confirmed that AcAc crosses the BBB and can be used for monitoring metabolism in the brain. It highlights the potential of AcAc for future clinical translation and its potential utility for monitoring metabolic changes associated with glioma, and other neurological disorders

DIT Library Services: An Evolving Learning Environment

DIT Library Services: an evolving learning environment The library as a place of learning has seen progressive change. DIT Library Services is listening and responding to the student need for a library service that supports all their learning requirements and learning styles. A service designed to reach them at their point of need

Coastal blue space and depression in older adults. ESRI Research Bulletin 2018/12

The coastline appeals to people for the many leisure activities available near it and the attractive views it offers. Property prices and rents are higher near the coast and in properties with sea views, providing direct evidence that people value these amenities. But there is also research suggesting that access to “blue space” (being near the coast or having a good view of the sea) can confer specific health benefits. To test this suggestion, this paper examined whether living close to the coastline in Ireland or having a larger view of the sea from one’s residence was associated with lower risk of depression among people aged 50+. How might blue space assist mental health? Previous research emphasises three possibilities: • Encouragement of physical activity (e.g. swimming, walking on beaches), which in turn is linked to mental and physical well-being; • Facilitating increased social interaction, leading to greater sense of belonging and social cohesion; and • Acting directly as therapeutic or salutogenic (health and well-being promoting) places. Our study examined how depression risk varied within a large sample of older adults in Ireland, allowing for many factors thought to affect this risk, including coastal proximity and views

In vivo detection of γ-glutamyl-transferase up-regulation in glioma using hyperpolarized γ-glutamyl-[1-13C]glycine.

Glutathione (GSH) is often upregulated in cancer, where it serves to mitigate oxidative stress. γ-glutamyl-transferase (GGT) is a key enzyme in GSH homeostasis, and compared to normal brain its expression is elevated in tumors, including in primary glioblastoma. GGT is therefore an attractive imaging target for detection of glioblastoma. The goal of our study was to assess the value of hyperpolarized (HP) γ-glutamyl-[1-13C]glycine for non-invasive imaging of glioblastoma. Nude rats bearing orthotopic U87 glioblastoma and healthy controls were investigated. Imaging was performed by injecting HP γ-glutamyl-[1-13C]glycine and acquiring dynamic 13C data on a preclinical 3T MR scanner. The signal-to-noise (SNR) ratios of γ-glutamyl-[1-13C]glycine and its product [1-13C]glycine were evaluated. Comparison of control and tumor-bearing rats showed no difference in γ-glutamyl-[1-13C]glycine SNR, pointing to similar delivery to tumor and normal brain. In contrast, [1-13C]glycine SNR was significantly higher in tumor-bearing rats compared to controls, and in tumor regions compared to normal-appearing brain. Importantly, higher [1-13C]glycine was associated with higher GGT expression and higher GSH levels in tumor tissue compared to normal brain. Collectively, this study demonstrates, to our knowledge for the first time, the feasibility of using HP γ-glutamyl-[1-13C]glycine to monitor GGT expression in the brain and thus to detect glioblastoma