It's what's expected: genetic testing for inherited conditions, CHERE Discussion Paper No 46

The development of new genetic technology brings with it responsibility for evaluating the effectiveness and efficiency of testing programs, including gaining an understanding of the value of information. This study examined the factors individuals took into account when making decisions about having a genetic test for Tay Sachs Disease. Fifteen people participated in an in-depth interview as they attended a clinic for genetic testing. A thematic analysis of the data was undertaken. Participants were most influenced to have testing by personal factors: e.g. ethnic background and desire to have children. Disease characteristics were also important. The results informed the development of a Stated Preference Discrete Choice (SPDCM) experiment. Participants were motivated to have testing by a need for reassurance and certainty. Thus, information was an important outcome for them. The results of the SPDCM experiment indicate that participants valued information positively thus providing support for the findings of the qualitative research.Genetic testing, Tay Sachs disease, Discrete choice experiment

Price Stickiness and Inflation

A recent model of firms’ pricing behaviour by Laurence Ball and Gregory Mankiw has novel implications for the effect of relative price shocks on inflation. This paper examines these implications and establishes the importance of expected inflation for this story. We derive the model relationship between expected inflation, the economy-wide distribution of industry price changes and actual inflation, and show that both Australian and US industry-price data strongly support this derived relationship. The inflationary impact of relative price shocks depends strongly on expected inflation. When expected inflation is high, a rise in the economy-wide dispersion of shocks is inflationary in the short-run. By contrast, when expected inflation is low, a rise in the dispersion of shocks has minimal impact on inflation. Economy-wide relative price shocks, like terms of trade shocks, are an unavoidable feature of the economic landscape. Their disruptive effect on inflation is minimal, however, when average inflation, and therefore average expected inflation, is kept low.

Perceptions and recall of treatment for prostate cancer: A survey of two populations

Background: The complexity of prostate cancer care can impact on patient understanding and participation in shared decision-making. This study used a survey-based approach to investigate patients’ recall of their prostate cancer treatment, and more broadly, to understand the perceptions of patients and the general population of prostate cancer treatment. Method: The survey was completed by 236 patients with prostate cancer (PCa cohort) and 240 participants from the general population of Australia (GenPop cohort). Free-text comments from both cohorts were analysed using content analysis. The PCa cohort reported which treatments and image-guidance related procedures they had received. These patient-reports were compared to medical records and analysed using proportion agreement, kappa statistics and regression analysis. Results: 135 (57%) PCa and 99 (41%) GenPop respondents provided at least one comment. Five major themes were identified by both cohorts: sharing experiences of treatment; preferences insights and reflections; mindsets; general commentary on the survey; and factors missing from the survey. There was overall good treatment recall amongst the PCa cohort, with proportions of correct recall ranging from 97.3% for chemotherapy to 66.8% for hormone therapy. There was a tendency for younger patients (<70 years old) to recall their hormone treatment more correctly. Conclusion: Participant comments suggest the complexity of prostate cancer diagnosis and treatment, and the varying perceptions and experiences of participants with prostate cancer. Patients’ recall overall was good for both treatment and image-guidance related procedures/approaches, however the poorer recall of hormone therapy requires further investigation

NSW breast and cervical screening program review, CHERE Project Report No 14

breast screening, cervical screening

The Australian Health Care System, CHERE Discussion Paper No 38

Australia is a federation of states, which provides its residents with universal access to health care and has managed to control total health care expenditure to around 8.4% of GDP in 1996/97. This has not only been achieved through a strong centrally funded health care system, but Australia also has a substantial private health care sector, being second only to the United States in the OECD in terms of private financing of health care. Against a background of complex Federal and State government relationships and responsibilities, the Australian health care system has developed into a multi-faceted system, characterised by a complex interaction between governments on the one hand, and public and private purchase and delivery of health care services on the other. The question remains as to the capacity of such a mixed system to achieve some level of technical and allocative efficiency, whilst maintaining universality and equity of access. This paper focuses on exploring these tensions in the context of the relationship between the various levels of government, the public and private systems, and the tenuous balance that exists in striving to achieve the broader objectives of efficiency and equity.health care, Australia

Men’s perceptions and preferences regarding prostate cancer radiation therapy: A systematic scoping review

Purpose: To assess the literature on men’s preferences and perceptions regarding prostate cancer radiation therapy. Methods: A scoping review was undertaken as per JBI guidelines. Searches were conducted in PubMed, CINAHL, Scopus and Science Direct with search terms including “prostate cancer,” “radiotherapy,” “radiation therapy,” “radiation oncology,” “patient preferences,” “patient perceptions” and “patient experience.” The resultant studies were mapped and grouped according to the emergent themes and pathway stages. Results: A total of 779 titles and abstracts were screened by two independent reviewers. Fifty-two full-text studies were reviewed, with 27 eligible for inclusion. There were 4 pre-treatment, 13 during treatment and 10 post-treatment studies covering broad themes of information needs (n = 3), preferences and decisions (n = 6), general experiences (n = 8), side effects (n = 6), and support (n = 4). There were a mix of methodologies, including 11 qualitative, 14 quantitative (including four preference studies), one mixed methods and one narrative review. Conclusion: There were only four preference studies, with the remaining 23 reporting on perceptions. Overall, there is a paucity of literature regarding patient preferences and perceptions of prostate cancer radiation therapy, particularly when considering how many clinical and technical studies are published in the area. This highlights opportunities for future research

Neoliberalism as Liberation: The Statehood Program and the Remaking of the Palestinian National Movement

The Palestinian statehood-by-2011 program, framed through neoliberal institution building, redefines and diverts the Palestinian liberation struggle. Focusing on its economic aspects, and in particular the underlying neoliberal thought that goes beyond narrow economic policy applications, this essay argues that the program cannot succeed either as the midwife of independence or as a strategy for Palestinian economic development. Its weaknesses, the authors contend, derive not only from neoliberalism’s inability to deliver sustainable and equitable economic growth worldwide, but also because neoliberal “governance” under occupation, however “good,” cannot substitute for the broader struggle for national rights nor ensure the Palestinian right to development

Predicting Infectious ComplicatioNs in Children with Cancer : an external validation study

Background:The aim of this study was to validate the 'Predicting Infectious ComplicatioNs in Children with Cancer' (PICNICC) clinical decision rule (CDR) that predicts microbiologically documented infection (MDI) in children with cancer and fever and neutropenia (FN). We also investigated costs associated with current FN management strategies in Australia.Methods:Demographic, episode, outcome and cost data were retrospectively collected on 650 episodes of FN. We assessed the discrimination, calibration, sensitivity and specificity of the PICNICC CDR in our cohort compared with the derivation data set.Results:Using the original variable coefficients, the CDR performed poorly. After recalibration the PICNICC CDR had an area under the receiver operating characteristic (AUC-ROC) curve of 0.638 (95% CI 0.590-0.685) and calibration slope of 0.24. The sensitivity, specificity, positive predictive value and negative predictive value of the PICNICC CDR at presentation was 78.4%, 39.8%, 28.6% and 85.7%, respectively. For bacteraemia, the sensitivity improved to 85.2% and AUC-ROC to 0.71. Application at day 2, taking into consideration the proportion of MDI known (43%), further improved the sensitivity to 87.7%. Length of stay is the main contributor to cost of FN treatment, with an average cost per day of AUD 2183 in the low-risk group.Conclusions:For prediction of any MDI, the PICNICC rule did not perform as well at presentation in our cohort as compared with the derivation study. However, for bacteraemia, the predictive ability was similar to that of the derivation study, highlighting the importance of recalibration using local data. Performance also improved after an overnight period of observation. Implementation of a low-risk pathway, using the PICNICC CDR after a short period of inpatient observation, is likely to be safe and has the potential to reduce health-care expenditure

Home-based care of low-risk febrile neutropenia in children-an implementation study in a tertiary paediatric hospital

BACKGROUND: Home-based management of low-risk febrile neutropenia (FN) is safe, improves quality of life and reduces healthcare expenditure. A formal low-risk paediatric program has not been implemented in Australia. We aimed to describe the implementation process and evaluate the clinical impact. METHOD: This prospective study incorporated three phases: implementation, intervention and evaluation. A low-risk FN implementation toolkit was developed, including a care-pathway, patient information, home-based assessment and educational resources. The program had executive-level endorsement, a multidisciplinary committee and a nurse specialist. Children with cancer and low-risk FN were eligible to be transferred home with a nurse visiting daily after an overnight period of observation for intravenous antibiotics. Low-risk patients were identified using a validated decision rule, and suitability for home-based care was determined using disease, chemotherapy and patient-level criteria. Plan-Do-Study-Act methodology was used to evaluate clinical impact and safety. RESULTS: Over 18 months, 292 children with FN were screened: 132 (45%) were low-risk and 63 (22%) were transferred to home-based care. Compared with pre-implementation there was a significant reduction in in-hospital median LOS (4.0 to 1.5 days, p < 0.001) and 291 in-hospital bed days were saved. Eight (13%) patients needed readmission and there were no adverse outcomes. A key barrier was timely screening of all patients and program improvements, including utilising the electronic medical record for patient identification, are planned. CONCLUSION: This program significantly reduces in-hospital LOS for children with low-risk FN. Ongoing evaluation will inform sustainability, identify areas for improvement and support national scale-up of the program

Multi-messenger observations of a binary neutron star merger

On 2017 August 17 a binary neutron star coalescence candidate (later designated GW170817) with merger time 12:41:04 UTC was observed through gravitational waves by the Advanced LIGO and Advanced Virgo detectors. The Fermi Gamma-ray Burst Monitor independently detected a gamma-ray burst (GRB 170817A) with a time delay of ~1.7 s with respect to the merger time. From the gravitational-wave signal, the source was initially localized to a sky region of 31 deg2 at a luminosity distance of 40+8-8 Mpc and with component masses consistent with neutron stars. The component masses were later measured to be in the range 0.86 to 2.26 Mo. An extensive observing campaign was launched across the electromagnetic spectrum leading to the discovery of a bright optical transient (SSS17a, now with the IAU identification of AT 2017gfo) in NGC 4993 (at ~40 Mpc) less than 11 hours after the merger by the One- Meter, Two Hemisphere (1M2H) team using the 1 m Swope Telescope. The optical transient was independently detected by multiple teams within an hour. Subsequent observations targeted the object and its environment. Early ultraviolet observations revealed a blue transient that faded within 48 hours. Optical and infrared observations showed a redward evolution over ~10 days. Following early non-detections, X-ray and radio emission were discovered at the transient’s position ~9 and ~16 days, respectively, after the merger. Both the X-ray and radio emission likely arise from a physical process that is distinct from the one that generates the UV/optical/near-infrared emission. No ultra-high-energy gamma-rays and no neutrino candidates consistent with the source were found in follow-up searches. These observations support the hypothesis that GW170817 was produced by the merger of two neutron stars in NGC4993 followed by a short gamma-ray burst (GRB 170817A) and a kilonova/macronova powered by the radioactive decay of r-process nuclei synthesized in the ejecta