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0000-0002-5964-1721
Current Organisation
Sacred Heart Palliative Care and Rehabilitation Service
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Publisher: Wiley
Date: 18-03-2008
DOI: 10.1111/J.1365-2648.2007.04564.X
Abstract: This paper is a report of a systematic review and meta-analysis of strategies, other than antimicrobial coated catheters, hypothesized to reduce risk of catheter-related bloodstream infections and catheter colonization in the intensive care unit setting. Catheter-related bloodstream infections occur at a rate of 5 per 1000 catheter days in the intensive care unit setting and cause substantial mortality and excess cost. Reducing risk of catheter-related bloodstream infections among intensive care unit patients will save costs, reduce length of stay, and improve outcomes. A systematic review of studies published between January 1985 and February 2007 was carried out using the keywords 'catheterization - central venous' with combinations of infection*, prevention* and bloodstream*. All included studies were screened by two reviewers, a validated data extraction instrument was used and data collection was completed by two blinded independent reviewers. Risk ratios for catheter-related bloodstream infections and catheter colonization were estimated with 95% confidence intervals for each study. Results from studies of similar interventions were pooled using meta-analyses. Twenty-three studies were included in the review. The strategies that reduced catheter colonization included insertion of central venous catheters in the subclavian vein rather than other sites, use of alternate skin disinfection solutions before catheter insertion and use of Vitacuff in combination with polymyxin, neomycin and bacitracin ointment. Strategies to reduce catheter-related bloodstream infection included staff education multifaceted infection control programmes and performance feedback. A range of interventions may reduce risks of catheter-related bloodstream infection, in addition to antimicrobial catheters.
Publisher: Springer Science and Business Media LLC
Date: 2008
DOI: 10.1186/CC6840
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.AJIC.2006.09.006
Abstract: Health care-acquired urinary tract infection is common, and the risk factors should be understood by those who manage hospitalized patients and researchers interested in interventions and programs designed to reduce rates. We used multivariable logistic regression to identify factors that demonstrated a statistical association with infection. The incidence rate for infection was 1.66%, and risks increased for patients with prolonged length of stay (odd ratio [OR], 5.28 95% confidence interval [CI]: 2.46-11.34), urinary catheter (OR, 5.16 95% CI: 2.84-9.36), unresolved spinal injury (OR, 4.07 95% CI: 1.04-15.92), transfer to/from another hospital (OR, 2.9 95% CI: 1.39-6.04), some assistance for daily living prior to admission (OR, 2.58 95% CI: 1.51-4.41), underlying neurologic disease (OR, 2.59 95% CI: 1.49-4.49), previous stroke (OR, 1.94 95% CI: 1.03-3.67), and fracture or dislocation on admission (OR, 3.34 95% CI: 1.75-6.38). Male sex was protective (OR, 0.44 95% CI: 0.26-0.77). Our data describe a general hospital population and therefore have relevance to many hospital-based health care professionals. The statistical model is a good fit to the data and has good predictive power. We identify high-risk groups and confirm the need for good decision making for managing the risks of health care-acquired urinary tract infection. This requires information on the effectiveness of risk-reducing strategies and the changes to economic costs and health benefits that result and the synthesis of these data in appropriately designed economic models.
Publisher: SAGE Publications
Date: 15-09-2022
DOI: 10.1177/02692163221122326
Abstract: Paracentesis is commonly undertaken in patients with cancer-related ascites. To systematically investigate the symptomatic benefits and harms experienced by patients with cancer undergoing paracentesis using real-world data in the palliative care setting. Prospective, multisite, observational, consecutive cohort study. Benefits and harms of paracentesis were assessed between 01/07/2018 and 31/02/2021 as part of routine clinical assessments by treating clinicians at four timepoints: (T0) before paracentesis (T1) once drainage ceased (T2) 24 h after T1 and (T3) 28 days after T1 or next paracentesis, if sooner. Data were collected from 11 participating sites across five countries (Australia, England, Hong Kong, Malaysia and New Zealand) on 111 patients undergoing paracentesis via a temporary (73%) or indwelling (21%) catheter: 51% male, median age 69 years, Australia-modified Karnofsky Performance Score 50. At T1 ( n = 100), symptoms had improved for most patients (81%), specifically abdominal distension (61%), abdominal pain (49%) and nausea (27%), with two-thirds experiencing improvement in ⩾2 symptoms. In the remaining patients, symptoms were unchanged (7%) or worse (12%). At least one harm occurred in 32% of patients, the most common being an ascitic leak ( n = 14). By T3, 89% of patients had experienced some benefit and 36% some harm, including four patients who experienced serious harm, one of which was a fatal bowel perforation. Most patients obtained rapid benefits from paracentesis. Harms were less frequent and generally mild, but occasionally serious and fatal. Our findings help inform clinician-patient discussions about the potential outcomes of paracentesis in this frail population.
Publisher: Mary Ann Liebert Inc
Date: 10-2020
Publisher: Wiley
Date: 06-11-2016
DOI: 10.1111/AJCO.12783
Abstract: To evaluate the attitudes of patients with different cancers towards research biopsies outside a clinical trial. Patients with metastatic cancer completed a questionnaire that assessed patients' willingness to consider research biopsies. Research biopsies were ided into two groups: biopsies performed as stand-alone procedures (research purposes only biopsy, RPOB) or performed during a clinically indicated biopsy (additional pass biopsy, APB). Factors analyzed included biopsy timing, biopsy site, sociodemographic information and information about prior trial participation. Univariate and multivariable analyses were conducted using random-effects logistic regression. One hundred and sixty-five patients with cancer (40 melanoma, 37 colorectal, 32 breast, 30 lung, 26 prostate) completed the questionnaire. Patients with melanoma demonstrated the greatest willingness to consider a research biopsy compared to patients with other cancer types (P < 0.05). Patients' ethnicity, time since previous biopsies, time since metastatic diagnosis, and previous trial enrolment were all statistically significant for willingness to consider a research biopsy on univariate analysis. When adjusting for statistically significant variables on univariate analysis, the odds of patients considering APBs were 14.6 times greater than RPOBs (P < 0.0001). Patients were also more willing to consider having blood or skin taken for research purposes (P < 0.0001) compared to liver and bone biopsies. Patients with cancer show a greater willingness to consider APBs compared to RPOBs, and biopsies performed at less invasive body sites. There are differences in the attitudes of patients with different cancers towards research biopsies. Further research addressing motivations and barriers to research biopsies should be considered to increase the availability of this important resource.
Publisher: SAGE Publications
Date: 06-2006
Publisher: Wiley
Date: 03-10-2019
DOI: 10.1002/CNCR.32540
Publisher: Elsevier BV
Date: 07-2008
Publisher: Elsevier BV
Date: 05-2008
DOI: 10.1016/J.CCT.2007.10.005
Abstract: Physical activity and dietary behavior changes are important to both the primary prevention and secondary management of the majority of our most prevalent chronic conditions (i.e., cardiovascular disease, hypertension, type 2 diabetes, breast and colon cancer). With over 85% of Australian adults visiting a general practitioner each year, the general practice setting has enormous potential to facilitate wide scale delivery of health behaviour interventions. However, there are also many barriers to delivery in such settings, including lack of time, training, resources and remuneration. Thus there is an important need to evaluate other feasible and effective means of delivering evidence-based physical activity and dietary behaviour programs to patients in primary care, including telephone counseling interventions. Using a cluster randomized design with practice as the unit of randomization, this study evaluated a telephone-delivered intervention for physical activity and dietary change targeting patients with chronic conditions (type 2 diabetes or hypertension) recruited from primary care practices in a socially disadvantaged community in Queensland, Australia. Ten practices were randomly assigned to the telephone intervention or to usual care, and 434 patients were recruited. Patients in intervention practices received a workbook and 18 calls over 12 months. Assessment at baseline, 4-, 12- and 18-months allows for assessment of initial change and maintenance of primary outcomes (physical activity and dietary behavior change) and secondary outcomes (quality of life, cost-effectiveness, support for health behavior change). This effectiveness trial adds to the currently limited number of telephone-delivered intervention studies targeting both physical activity and dietary change. It also addresses some of the shortcomings of previous trials by targeting patients from a disadvantaged community, and by including detailed reporting on participant representativeness, intervention implementation and cost-effectiveness, as well as an evaluation of maintenance of health behavior change.
Publisher: Wiley
Date: 15-12-2020
DOI: 10.1002/CNCR.33371
Abstract: The objective of this study was to describe the perspective of patients with early breast cancer toward research biopsies. The authors hypothesized that more patients at academic sites than at community‐based sites would be willing to consider these procedures. In total, 198 patients with early stage breast cancer were recruited from 3 academic centers (n = 102) and from 1 community oncology practice (n = 96). The primary objective was to compare the proportion of patients willing to consider donating excess tissue biospecimens from surgery, from a clinically indicated breast biopsy, or from a research purposes‐only biopsy (RPOB) between practice types. Most patients (93% at academic sites, 94% at the community oncology site) said they would consider donating excess tissue from surgery for research. One‐half of patients from academic or community sites would consider donating tissue from a clinically indicated breast biopsy. On univariate analysis, significantly fewer patients from academic sites would consider an RPOB (22% at academic sites, 42% at the community site P = .003) however, this difference was no longer significant on multivariate analysis ( P = .96). Longer transportation times and unfavorable prior experiences were associated with less willingness to consider an RPOB on multivariate analysis. Significantly fewer patients from academic sites (14%) than from the community site (35%) would consider a research biopsy in a clinical trial ( P = .04). Contributing to scientific knowledge, return of results, and a personal request by their physician were the strongest factors influencing patients' willingness to undergo research biopsies. The current results rejected the hypothesis that more patients with early breast cancer at academic sites would be willing to donate tissue biospecimens for research compared with those at community oncology sites. These findings identify modifiable factors to consider in biobanking studies and clinical trials.
Publisher: Elsevier BV
Date: 03-2008
DOI: 10.1016/J.AJIC.2007.02.012
Abstract: Bloodstream infection related to a central venous catheter is a substantial clinical and economic problem. To develop policy for managing the risks of these infections, all available evidence for prevention strategies should be synthesized and understood. We evaluate evidence (1985-2006) for short-term antimicrobial-coated central venous catheters in lowering rates of catheter-related bloodstream infection (CRBSI) in the adult intensive care unit. Evidence was appraised for inclusion against predefined criteria. Data extraction was by 2 independent reviewers. Thirty-four studies were included in the review. Antiseptic, antibiotic, and heparin-coated catheters were compared with uncoated catheters and one another. Metaanalysis was used to generate summary relative risks for CRBSI and catheter colonization by antimicrobial coating. Externally impregnated chlorhexidine/silver sulfadiazine catheters reduce risk of CRBSI relative to uncoated catheters (RR, 0.66 95% CI: 0.47-0.93). Minocycline and rif icin-coated catheters are significantly more effective relative to CHG/SSD catheters (RR, 0.12 95% CI: 0.02-0.67). The new generation chlorhexidine/silver sulfadiazine catheters and silver, platinum, and carbon-coated catheters showed nonsignificant reductions in risk of CRBSI compared with uncoated catheters. Two decades of evidence describe the effectiveness of antimicrobial catheters in preventing CRBSI and provide useful information about which catheters are most effective. Questions surrounding their routine use will require supplementation of this trial evidence with information from more erse sources.
Publisher: BMJ
Date: 04-06-2020
DOI: 10.1136/BMJSPCARE-2020-002261
Abstract: Spiritual care allows palliative care patients to gain a sense of purpose, meaning and connectedness to the sacred or important while experiencing a serious illness. This study examined how Australian patients conceptualise their spirituality/religiosity, the associations between diagnosis and spiritual/religious activities, and views on the amount of spiritual support received. This mixed-methods study used anonymous semistructured questionnaires, which included the Functional Assessment of Chronic Illness Therapy-Spiritual Scale-12 (FACIT-SP-12) and adapted and developed questions examining religion/spirituality’s role and support. Participants numbered 261, with a 50.9% response rate. Sixty-two per cent were affiliated with Christianity and 24.2% with no religion. The mean total FACIT-SP-12 score was 31.9 (SD 8.6). Patients with Christian affiliation reported a higher total FACIT-SP-12 score compared with no religious affiliation (p=0.003). Those with Christian and Buddhist affiliations had higher faith subscale scores compared with those with no religious affiliation (p .001). Spirituality was very important to 39.9% and religiosity to 31.7% of patients, and unimportant to 30.6% and 39.5%, respectively. Following diagnosis, patients prayed (p .001) and meditated (p .001) more, seeking more time, strength and acceptance. Attendance at religious services decreased with frailty (p .001), while engagement in other religious activities increased (p=0.017). Patients who received some level of spiritual/religious support from external religious/faith communities and moderate to complete spiritual/religious needs met by the hospitals reported greater total FACIT-SP-12 spirituality scores (p .001). Respectful inquiry into patients spiritual/religious needs in hospitals allows for an attuned approach to addressing such care needs while considerately accommodating those disinterested in such support.
Publisher: American Society of Clinical Oncology (ASCO)
Date: 10-10-2014
Abstract: Palliative care is a fundamental component of cancer care. As part of the 2011 to 2012 Leadership Development Program (LDP) of the American Society of Clinical Oncology (ASCO), a group of participants was charged with advising ASCO on how to develop a service model integrating palliative care throughout the continuum of cancer care. This article presents the findings of the LDP group. The group focused on the process of palliative care delivery in the oncology setting. We identified key elements for models of palliative care in various settings to be potentially equitable, sustainable, feasible, and acceptable, and here we describe a dynamic model for the integrated, simultaneous implementation of palliative care into oncology practice. We also discuss critical considerations to better integrate palliative care into oncology, including raising consciousness and educating both providers and the public about the importance of palliative care coordinating palliative care efforts through strengthening affiliations and/or developing new partnerships prospectively evaluating the impact of palliative care on patient and provider satisfaction, quality improvement, and cost savings and ensuring sustainability through adequate reimbursement and incentives, including linkage of performance data to quality indicators, and coordination with training efforts and maintenance of certification requirements for providers. In light of these findings, we believe the confluence of increasing importance of incorporation of palliative care education in oncology education, emphasis on value-based care, growing use of technology, and potential cost savings makes developing and incorporating palliative care into current service models a meaningful goal.
Publisher: Elsevier BV
Date: 08-2007
DOI: 10.1016/J.JAD.2006.10.024
Abstract: Lost productivity from attending work when unwell, or "presenteeism", is a largely hidden cost of mental disorders in the workplace. Sensitive measures are needed for clinical and policy applications, however there is no consensus on the optimal self-report measure to use. This paper examines the sensitivity of four alternative measures of presenteeism to depression and anxiety in an Australian employed cohort. A prospective single-group study in ten call centres examined the association of presenteeism (presenteeism days, inefficiency days, Work Limitations Questionnaire, Stanford Presenteeism Scale) with Patient Health Questionnaire depression and anxiety syndromes. At baseline, all presenteeism measures were sensitive to differences between those with (N=69) and without (N=363) depression/anxiety. Only the Work Limitations Questionnaire consistently showed worse productivity as depression severity increased, and sensitivity to remission and onset of depression/anxiety over the 6-month follow-up (N=231). There was some evidence of in idual depressive symptoms having a differential association with different types of job demands. The study findings may not generalise to other occupational settings with different job demands. We were unable to compare responders with non-responders at baseline due to anonymity. In this community s le the Work Limitations Questionnaire offered additional sensitivity to depression severity, change over time, and in idual symptoms. The comprehensive assessment of work performance offers significant advantages in demonstrating both the in idual and economic burden of common mental disorders, and the potential gains from early intervention and treatment.
Publisher: BMJ
Date: 12-2020
DOI: 10.1136/BMJSPCARE-2020-002636
Abstract: While studies in palliative care use measures of spirituality and religious belief, there have been few validation studies of a screening tool that identifies unmet spiritual needs. A multidisciplinary research team developed and examined the usefulness, reliability and validity of a 17-item Spiritual Concerns Checklist (SCC) as a screening tool for unmet spiritual needs. A cohort of patients recruited from three palliative care services in Sydney and Melbourne, Australia completed anonymous questionnaires. Factor structure and item response theory were used to examine its properties concurrent validity employed the Functional Assessment of Chronic Illness Therapy—Spiritual Well-Being Scale (FACIT-Sp-12). Among 261 patients, while only 15% directly sought spiritual care, nearly 62% identified at least one spiritual concern. Existential needs (fear of the dying process 32% loss of control 31%), regret (20%), need for forgiveness (17%), guilt (13%), loss of hope (13%) and meaning (15%) were prominent concerns. Eleven concerns were present for more than 10% of the participants and 25% of religiously orientated participants expressed concerns. The 17-item SCC was unidimensional, with satisfactory reliability. Concurrent validity was evident in the reduced sense of meaning and peace on the FACIT-Sp-12. This preliminary Rasch analysis of the newly developed SCC has demonstrated its usefulness, reliability and validity. Our findings encourage refinement and ongoing development of the SCC with further investigation of its psychometric properties in varying populations.
Publisher: Frontline Medical Communications, Inc.
Date: 10-2014
DOI: 10.12788/JCSO.0077
Abstract: Little is known about the informational needs and quality of life (QOL) of patients with metastatic breast cancer (MBC) within the first year of their diagnosis. To describe the informational needs and QOL of patients with MBC within the first year of diagnosis, and to identify sociodemographic and medical factors that may be associated with informational needs and QOL. 52 patients (50 women, 2 men) enrolled within a year of diagnosis of MBC completed a cross-sectional, self-administered paper survey that included patient demographics, the Toronto Informational Needs Questionnaire-Breast Cancer (TINQ), the Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study Short Form-36 (SF-36). High informational need was defined as a TINQ score of ≥ 200. Of the total 52 patients, 69% (35/52) had high informational needs, 20% met the criteria for anxiety (HADS-Anxiety score, ≥ 11), and 8% met the criteria for depression. SF-36 scores were lower in all 8 subscales compared with the general population. Multivariate analyses showed that patients who were married or living as married (OR, 6.1 95% CI, 1.4-28.9) and patients with de novo MBC (OR, 2.8 95% CI, 0.5-14.3) or a shorter disease-free interval (DFI < 5 years OR, 24.2 95% CI, 3.1-187.4) were more likely to have more informational needs (C statistic, 0.824) than were patients with a longer DFI (≥ 5 years). This is a small cross-sectional study of a single academic institution. Patients with recently diagnosed MBC have high informational needs and decreased overall QOL. Additional research and supportive services meeting the informational and psychosocial needs of patients living with MBC are warranted.
Publisher: Mary Ann Liebert Inc
Date: 06-2017
Abstract: Intravenous lidocaine is effective in treating pain. Limited studies have assessed the effectiveness and safety of subcutaneous lidocaine infusions. We conducted a retrospective review of patients with cancer who received subcutaneous lidocaine infusions for pain. Patient characteristics, pain scores and opioid doses before and after lidocaine, and details of infusions were recorded. We identified three time periods of interest. T0 is defined as the 24-hour period immediately before commencing lidocaine treatment. T1 is defined as the 24-hour period before lidocaine was ceased. T2 is defined as the first 24-hour period after lidocaine was ceased. In addition, the overall impression of the effectiveness of lidocaine was subjectively evaluated by the authors. Twenty patients (13M F) received lidocaine. Two patients received it twice, totaling 22 episodes. The median lidocaine dose was 0.67 mg/kg/h with the median duration being 5.5 days. The median worst pain score at T0 and T1 was 8.5 and 5.5, respectively. The difference in the mean pain scores was 3.2 95% CI (2.1, 4.4 p < 0.001). In 15/22 episodes (68%), patients experienced a decrease in pain scores of more than 2. The median morphine oral equivalent (MOE) daily doses at T0, T1, and T2 were 425, 362.5, and 275 mg, respectively. The difference in the mean MOE between T0 and T1 was -126 (95% CI [-281, 28] p = 0.13). The difference in the mean MOE between T0 and T2 was -207 (95% CI [-370, -44] p = 0.025). Lidocaine was subjectively deemed effective in 10/22 episodes (45%). There were no documented adverse events attributed to lidocaine. Univariate analyses did not identify any subgroups likely to benefit from lidocaine. Subcutaneous lidocaine infusions may be used safely in cancer pain management and is effective in some patients.
Publisher: SAGE Publications
Date: 24-09-2019
Abstract: Spiritual care is integral to palliative care. It engenders a sense of purpose, meaning, and connectedness to the sacred or important and may support caregiver well-being. To examine caregivers’ spirituality, religiosity, spiritual well-being, and views on spiritual/religious support. A mixed-methods study across 4 Australian sites, recruiting caregivers of patients with a life expectancy of under 12 months. The anonymous semistructured questionnaire used included research team developed and adapted questions examining religion/spirituality’s role and support and views on hospitals supporting spiritual/religious requirements. It additionally included the Functional Assessment of Chronic Illness Therapy-Spiritual Well-Being Scale (FACIT-Sp-12). One hundred nine caregivers participated (47.4% responded). Median spiritual well-being was 30.5 on FACIT-Sp-12. Religious affiliation was associated with higher Faith subscores ( P .001). Spirituality was very important to 24.5%, religiosity to 28.2%, and unimportant to 31.4% and 35.9%, respectively. Caregivers prayed ( P = .005) and meditated ( P = .006) more following patients’ diagnoses, gaining comfort, guidance, and strength. Caregivers whose spiritual/religious needs were met to moderate/full extent by external religious/faith communities (23.8%) reported greater spiritual well-being ( P .001). Hospitals supported moderate/full caregiver spiritual needs in 19.3%. Pastoral care visits comforted 84.4% of those who received them (n = 32) but elicited discomfort in 15.6%. Caregivers also emphasized the importance of humane staff and organizational tone in supporting spiritual care. Hospital-based spiritual care providers should seek to identify those who seek pastoral or religiously orientated care. Genuine hospitality of showing concern for the other ensures the varied yet inevitably humanist requirements of the caregiver community are met.
Publisher: Cambridge University Press (CUP)
Date: 03-2007
DOI: 10.1086/512642
Abstract: To estimate the independent effect of a single lower respiratory tract infection, urinary tract infection, or other healthcare-acquired infection on length-of-stay and variable costs and to demonstrate the bias from omitted variables that is present in previous estimates. Prospective cohort study. A tertiary care referral hospital and regional district hospital in southeast Queensland, Australia. Adults aged 18 years or older with a minimum inpatient stay of 1 night who were admitted to selected clinical specialities. Urinary tract infection was not associated with an increase in length of hospital stay or variable costs. Lower respiratory tract infection was associated with an increase of 2.58 days in the hospital and variable costs of AU$24, whereas other types of infection were associated with an increased length of stay of 2.61 days but not with variable costs. Many other factors were found to be associated with increased length of stay and variable costs alongside healthcare-acquired infection. The exclusion of these variables caused a positive bias in the estimates of the costs of healthcare-acquired infection. The existing literature may overstate the costs of healthcare-acquired infection because of bias, and the existing estimates of excess costs may not make intuitive sense to clinicians and policy makers. Accurate estimates of the costs of healthcare-acquired infection should be made and used in appropriately designed decision-analytic economic models (ie, cost-effectiveness models) that will make valid and believable predictions of the economic value of increased infection control.
Publisher: CSIRO Publishing
Date: 2013
DOI: 10.1071/AH11126
Abstract: The provision of health services in Australia currently is primarily financed by a unique interaction of public and private insurers. This commentary looks at a loophole in this framework, namely that private insurers have to date been able to avoid funding healthcare for some of their policy holders, as it is not a requirement to use private insurance when treatment occurs in Australian public hospitals.
Publisher: Elsevier BV
Date: 08-2013
Publisher: Springer Science and Business Media LLC
Date: 11-2005
DOI: 10.1007/S10549-005-5828-9
Abstract: The purpose of this research was to estimate the cost-effectiveness of two rehabilitation interventions for breast cancer survivors, each compared to a population-based, non-intervention group (n = 208). The two services included an early home-based physiotherapy intervention (DAART, n = 36) and a group-based exercise and psychosocial intervention (STRETCH, n = 31). A societal perspective was taken and costs were included as those incurred by the health care system, the survivors and community. Health outcomes included: (a) 'rehabilitated cases' based on changes in health-related quality of life between 6 and 12 months post-diagnosis, using the Functional Assessment of Cancer Therapy-Breast Cancer plus Arm Morbidity (FACT-B+4) questionnaire, and (b) quality-adjusted life years (QALYs) using utility scores from the Subjective Health Estimation (SHE) scale. Data were collected using self-reported questionnaires, medical records and program budgets. A Monte-Carlo modelling approach was used to test for uncertainty in cost and outcome estimates. The proportion of rehabilitated cases was similar across the three groups. From a societal perspective compared with the non-intervention group, the DAART intervention appeared to be the most efficient option with an incremental cost of $1344 per QALY gained, whereas the incremental cost per QALY gained from the STRETCH program was $14,478. Both DAART and STRETCH are low-cost, low-technological health promoting programs representing excellent public health investments.
Publisher: Cambridge University Press (CUP)
Date: 02-2007
DOI: 10.1086/510787
Abstract: To present a hypothetical model of the change in economic costs and health benefits to society that result from nosocomial infection control programs. We use a modeling framework to represent how 2 types of costs change with nosocomial infection control programs: costs incurred by the hospital sector and community health services, as well as the private costs to patients. We also demonstrate how to value the health benefits of nosocomial infection control programs, using quality-adjusted life years. Hypothetical modeling to incorporate the societal perspective. A cohort of 50,000 simulated patients at risk of surgical site infection following total hip replacement. A total of 8 hypothetical interventions that change costs and health outcomes among the cohort by preventing cases of surgical site infection following total hip replacement. We demonstrate that when infection control interventions reduce economic costs and increase health benefits, they should be adopted without further question. If, however, interventions increase economic costs and increase health benefits, then the trade—off between costs and benefits should be examined. Decision-makers should assess the cost per unit of health benefit from infection control programs, consider the impact on health budgets, and compare infection control with alternative uses of scarce healthcare resources.
Publisher: Elsevier BV
Date: 07-2008
DOI: 10.1016/J.JHIN.2008.04.022
Abstract: The aim of this study was to estimate the economic costs of healthcare-acquired surgical site infection (HA-SSI) and show how they are distributed between the in-hospital and post-discharge phases of care and recovery. A quantitative model of the epidemiology and economic consequences of HA-SSI was used, with data collected from a prospective cohort of surgical patients and other relevant sources. A logical model structure was specified and data applied to model parameters. A hypothetical cohort of 10 000 surgical patients was evaluated. We found that 111 cases of infection would be diagnosed in hospital and 784 cases would first appear after discharge. Of the total costs incurred, either 31% or 67% occurred during the hospital phase, depending on whether production losses incurred after discharge were included. Most of the costs incurred by the hospital sector arose from lost bed-days and only a small proportion arose from variable costs. We discuss the issues relating to the size of these costs and provide data on where they are incurred. These results can be used to inform subsequent cost-effectiveness analyses that evaluate the efficiency of programmes to reduce the risks of HA-SSI.
Publisher: Elsevier BV
Date: 07-2013
Publisher: Informa UK Limited
Date: 2008
DOI: 10.1080/09638280701654690
Abstract: This prospective study used the framework of ICF components to investigate the magnitude and direction of association between body functions (depression/anxiety symptoms), activity (limitations in work activities), participation (sickness absence), and environment (psychosocial aspects) in the workplace setting. A cohort of employees completed a self-report survey at baseline and 6 months follow-up, with analysis restricted to those with at least one health condition (n = 204). Self-report measures of depression/anxiety symptoms, limitations in work activities, sickness absences, and psychosocial work environment were mapped to the corresponding ICF component. The prospective association between these components was modelled using relative risks (RR) estimated from log-binomial regression. Depression/anxiety symptoms were more likely to be an outcome of other ICF components, rather than a risk factor. Sickness absence, limitations in work activities, and work environment all conferred a greater than two-fold risk of depression/anxiety symptoms 6 months later. The ICF offers a valuable approach to understanding the contextual influences on employee mental health and work disability. Further application of the ICF framework to mental health should improve the environmental components and encourage a wider adoption of the ICF by mental health researchers and practitioners.
Publisher: Elsevier BV
Date: 05-2018
Publisher: Oxford University Press (OUP)
Date: 03-08-2015
DOI: 10.1634/THEONCOLOGIST.2015-0112
Abstract: Tissue from research biopsies provides access to insights into tumor biology. We aimed to determine medical oncologists’ (MOs’) attitudes toward research biopsies in patients with metastatic breast cancer (MBC). A total of 309 breast MOs from National Cancer Institute (NCI)-designated cancer centers were invited to complete a self-administered survey about their attitudes toward approaching patients for research purpose-only biopsies (RPOBs), performed as a standalone procedure, or additional biopsies, performed with a clinically indicated biopsy. The MOs were asked to predict what proportion of their MBC patients would consider undergoing research biopsies. Of the 309 MOs, 221 (72%) responded. Of these 221 MOs, 30 were ineligible, leaving 191 eligible responders. Nearly all the MOs reported they were comfortable approaching patients regarding research biopsies of blood or skin. One fifth of MOs were uncomfortable approaching patients for RPOBs of the breast. One half of MOs were uncomfortable approaching patients for RPOBs of the liver. A significant variation was found in the perceptions by MOs of their patients’ willingness to undergo research biopsies. The factors associated with increased comfort in approaching patients for research biopsies included fewer years in practice, caring for patients who had undergone recent research biopsies, and the predicted willingness of patients to consent to biopsies. The risk of a biopsy and biopsy-related pain were the most common reasons for reluctance to refer patients for research biopsies. Significant variation exists, even at NCI centers, in the comfort level of MOs in approaching MBC patients for research biopsies. MOs’ attitudes toward research biopsies might be a modifiable factor in increasing tissue collection for research. Tissue-based research is critical in advancing our understanding of cancer biology, and obtaining tissue from a research biopsy provides an essential resource. This study demonstrates the variability of oncologists’ attitudes toward research biopsies and elicits factors associated with increased comfort levels with approaching patients for research biopsies. Biopsy risk and biopsy-related pain were commonly cited reasons not to refer patients for research biopsies. If the risk of a research biopsy is deemed sufficiently low enough to be acceptable, oncologists’ attitudes might be a potential target for education and change, which may assist in increasing the availability of tissue for cancer research.
Publisher: Springer Science and Business Media LLC
Date: 05-05-2013
Publisher: SAGE Publications
Date: 06-2007
Abstract: Objective: To assess the evidence for the cost-effectiveness of health behaviour interventions that address the major behavioural risk factors for chronic disease, including smoking, physical inactivity, poor diet, and alcohol misuse. Methods: Medical and economic databases were searched for relevant economic evaluations. Studies were critically appraised using a published 35-point checklist, and the results are described using a narrative approach, noting methodological limitations. The review included 64 studies from 1995—2005, including 17 reports on multiple behaviour interventions. Results: There was considerable variation among the studies by target populations, intervention components, primary outcomes, and economic methods, but the reported incremental cost-effectiveness ratios were consistently low (e.g. ,000 per quality-adjusted life-year gained for smoking-cessation programmes in 2006 Euros) as compared to certain preventive pharmaceutical and invasive interventions. Interventions targeting high-risk-population subgroups were relatively better value for money as compared to those targeting general populations. Discussion: In general, the results of this review demonstrate favourable cost-effectiveness for smoking interventions, physical activity interventions and multiple behaviour interventions in high-risk groups. Although alcohol and dietary interventions appeared to be economically favourable, it is difficult to draw conclusions because of the variety in study outcomes. However, methodological limitations weaken the generalizability of findings, and suggest that the results of any given study should be considered carefully when being used to inform resource allocation.
Publisher: Harborside Press, LLC
Date: 2014
Location: Australia
No related grants have been discovered for Davinia Seah.