Economic evaluation of the proposed surgical scheme at Auburn Hospital: Final report, CHERE Project Report No 19

Background Public hospitals have experienced budget constraints but as demand for admissions has been growing at the same time, occupancy levels have been increasing. As emergency and urgent admissions are given priority, the effect has been not just longer waiting times and larger waiting lists for non-urgent admissions, but also frequent cancellations of elective surgery, thus adding to patients? waiting time. Consequently, there have been a number of attempts to reduce elective surgical waiting lists. The Auburn Elective Surgical Program (AESP) was a pilot program funded by the NSW Health Department, to improve elective surgery for patients in Western Sydney Area Health Service (WSAHS). The program commenced 19th July 2001 and ended 15th November 2001. Initially, the program targeted three specific surgical procedures, laparoscopic cholecystectomy, hernia repair, and haemorrhoidectomy, and was expanded to include thyroidectomy, ligation and stripping of varicose veins and endoscopy. The program sought to improve the effectiveness and efficiency of administrative and clinical aspects of elective surgery by: > Using spare operating theatre capacity at Auburn Hospital; > the use of a new booking and waiting list system, managed by a nurse co-ordinator, which offered suitable patients a definite date for surgery; > increasing surgical sessions by paying participating surgeons on a fee for service basis; > however, surgery could be performed by a surgeon other than their treating surgeon; > re-structuring elective surgical sessions to eliminate meal breaks; > planning post discharge care so that surgery could be performed on a day only basis. The Centre for Health Economics Research and Evaluation (CHERE) was commissioned to undertake an independent evaluation of the AESP. This study has examined the throughput, health outcomes, costs and patient satisfaction. Throughput data on the program were defined as time spent on the waiting list, number of failures to attend planned surgery, average length of stay, and number of surgical interventions. Health consequences were defined as complications, unplanned readmissions to hospital, wound infection after surgery, mortality, percentage of same day admissions and conversion rate to open cholecystectomy. Costs were estimated from a health service perspective. Patient acceptability was assessed by the proportion of eligible patients having their surgery under the AESP, and patient satisfaction by questionnaire.Economic evaluation, waiting times, hospitals

Review of Positron Emission Tomography at Royal Prince Alfred Hospital, CHERE Project Report No 18

This report is a review of the clinical uses, impacts on clinical management, clinical outcome and resource use of Positron Emission Tomography (PET) at Royal Prince Alfred Hospital (RPAH).Positron emission tomography

Needles in haystacks: using fast-response LA chambers and ICP-TOF-MS to identify asbestos fibres in malignant mesothelioma models

Malignant mesothelioma is an aggressive cancer associated with exposure to asbestos. Diagnosis of mesothelioma and other related lung diseases remains elusive due to difficulties surrounding identification and quantification of asbestos fibres in lung tissue. This article presents a laser ablation-inductively coupled plasma-mass spectrometry (LA-ICP-MS) method to identify asbestos fibres in cellular models of mesothelioma. Use of a high-speed laser ablation system enabled rapid imaging of the samples with a lateral resolution of 3 μm, whilst use of a prototype time-of-flight ICP-MS provided pseudo-simultaneous detection of the elements between mass 23 (Na) and mass 238 (U). Three forms of asbestos fibre (actinolite, amosite and crocidolite) were distinguished from a non-asbestos control (wollastonite) based on their elemental profile, which demonstrated that LA-ICP-MS could be a viable technique for identification of asbestos fibres in clinical research samples

Threatened North African seagrass meadows have supported green turtle populations for millennia

"Protect and restore ecosystems and biodiversity" is the second official aim of the current UN Ocean Decade (2021 to 2030) calling for the identification and protection of critical marine habitats. However, data to inform policy are often lacking altogether or confined to recent times, preventing the establishment of long-term baselines. The unique insights gained from combining bioarchaeology (palaeoproteomics, stable isotope analysis) with contemporary data (from satellite tracking) identified habitats which sea turtles have been using in the Eastern Mediterranean over five millennia. Specifically, our analysis of archaeological green turtle (Chelonia mydas) bones revealed that they likely foraged on the same North African seagrass meadows as their modern-day counterparts. Here, millennia-long foraging habitat fidelity has been directly demonstrated, highlighting the significance (and long-term dividends) of protecting these critical coastal habitats that are especially vulnerable to global warming. We highlight the potential for historical ecology to inform policy in safeguarding critical marine habitats

BHPR research: qualitative1. Complex reasoning determines patients' perception of outcome following foot surgery in rheumatoid arhtritis

Background: Foot surgery is common in patients with RA but research into surgical outcomes is limited and conceptually flawed as current outcome measures lack face validity: to date no one has asked patients what is important to them. This study aimed to determine which factors are important to patients when evaluating the success of foot surgery in RA Methods: Semi structured interviews of RA patients who had undergone foot surgery were conducted and transcribed verbatim. Thematic analysis of interviews was conducted to explore issues that were important to patients. Results: 11 RA patients (9 ♂, mean age 59, dis dur = 22yrs, mean of 3 yrs post op) with mixed experiences of foot surgery were interviewed. Patients interpreted outcome in respect to a multitude of factors, frequently positive change in one aspect contrasted with negative opinions about another. Overall, four major themes emerged. Function: Functional ability & participation in valued activities were very important to patients. Walking ability was a key concern but patients interpreted levels of activity in light of other aspects of their disease, reflecting on change in functional ability more than overall level. Positive feelings of improved mobility were often moderated by negative self perception ("I mean, I still walk like a waddling duck”). Appearance: Appearance was important to almost all patients but perhaps the most complex theme of all. Physical appearance, foot shape, and footwear were closely interlinked, yet patients saw these as distinct separate concepts. Patients need to legitimize these feelings was clear and they frequently entered into a defensive repertoire ("it's not cosmetic surgery; it's something that's more important than that, you know?”). Clinician opinion: Surgeons' post operative evaluation of the procedure was very influential. The impact of this appraisal continued to affect patients' lasting impression irrespective of how the outcome compared to their initial goals ("when he'd done it ... he said that hasn't worked as good as he'd wanted to ... but the pain has gone”). Pain: Whilst pain was important to almost all patients, it appeared to be less important than the other themes. Pain was predominately raised when it influenced other themes, such as function; many still felt the need to legitimize their foot pain in order for health professionals to take it seriously ("in the end I went to my GP because it had happened a few times and I went to an orthopaedic surgeon who was quite dismissive of it, it was like what are you complaining about”). Conclusions: Patients interpret the outcome of foot surgery using a multitude of interrelated factors, particularly functional ability, appearance and surgeons' appraisal of the procedure. While pain was often noted, this appeared less important than other factors in the overall outcome of the surgery. Future research into foot surgery should incorporate the complexity of how patients determine their outcome Disclosure statement: All authors have declared no conflicts of interes