ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138304.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138305.x

出版商:Wiley    

年代:1994

数据来源: WILEY

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138306.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

Medical miracles wrought by high technology and the public's insistent demand for better health care have created a headache for governments throughout the world. No national health care system appears to have solved the problem of health care financing. Many are in a state of constant reform. Better care at lower cost is the universal goal: what government initiatives promise to deliver?

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138307.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

“Managed competition” is at the heart of recent changes to the British National Health Service (NHS), and now attracts some interest in Australia. What does it mean, and what can we learn from the British experience?

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138308.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

How should hospital administrators respond to budget cuts? Which responses are both economically sensible and ethical? The principles guiding resource allocation decisions within hospitals were the subject of a forum held in May 1993 at the Alfred Hospital in Melbourne, organised jointly by the Alfred Hospital Ethics Committee and the Eleanor Shaw Centre for the Study of Medicine, Society and Law at the Baker Institute.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138309.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

The clamorous call for us to do better with scarce health care resources may obscure the fact that we do well with what we have. And the realities of our complex health care system are that we have only a marginal power to effect change. So what can we do for a healthier health care system? In a paper based on his address to the recent symposium on resource allocation (see also page 468), Stephen Leeder presents ideas which he developed in cooperation with health economist Alan Shiell.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138310.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectivesTo determine the value of infection and vaccination histories as predictors of immunity to measles, rubella and mumps, and to compare the costs of various screening strategies with the cost of universal vaccination of health care workers.SettingStaff employed by a Sydney children's hospital.MethodsHistories of measles, rubella and mumps infection or vaccination were compared with the results of serological testing to determine which historical statements had high positive predictive values (PPV) for immunity. Using this, we devised three prevaccination screening strategies and compared their costs with the cost of universal staff vaccination.ResultsOf 235 participants, 98.3% were serologically immune to measles, 96.6% to rubella and 83.0% to mumps. Historical statements indicating immunity with a PPV of more than 95% were histories of measles or of rubella vaccination, and personal recollection of mumps infection. Strategies using historical screening were cheaper than universal vaccination, which in turn was cheaper than using serological screening alone.ConclusionsAmong health care workers at occupational risk of measles, rubella and mumps, the need for vaccination can be reduced by combining historical and serological screening. Where screening is felt to impose an administrative burden, a universal vaccination strategy costs 30%‐50% more than strategies which use historical screening. (Med J Aust 1994; 160: 478‐482)

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138311.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectivesTo estimate the incidence and sequelae ofHaemophilus Influenzaetype b disease (Hib) in the Australian population, and to evaluate the costs and outcomes of a vaccination program using the vaccine PRP‐OMP at two, four and 12 months.DesignThe evaluation was based on a decision analytic model developed by Merck Sharp and Dohme (Australia) Pty Ltd, to predict the number of children who would contract Hib, and suffer mild or severe sequelae or die as a result. The state of health of a cohort of children was modelled each month over a five‐year period. A survey of medical records and interviews with parents of children who contracted meningitis in Western Australia from 1984‐1990 was undertaken to provide data on the extent and costs of sequelae.ResultsThe incidence of Hib among non‐Aboriginal Australians under five years of age was estimated as 53 per 100000, and 460 per 100000 among Aborigines. In a single year at least 630 children may contract Hib, up to 19 may die, and a further 46 may have neurological damage, this being severe in up to 18 children. The number of deaths could be reduced by 17 per year and a further 25 cases of severe and 16 cases of mild disability could be averted. At a price of $20 per dose, and a 5% discount rate, the expected cost per year of life extended by a vaccination program is $3148. When adjusted for the increased number of years without neurological impairment, the incremental cost per quality adjusted life year (QALY) is $1965. Compared with a single vaccine at 18 months, the incremental cost per additional QALY gained is $5047. A separate analysis of the Aboriginal population showed that the proposed vaccination program would be of significant benefit, leading to a saving of resources.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138312.x

出版商:Wiley    

年代:1994

数据来源: WILEY

摘要:

ObjectiveTo review the epidemiology, risk factors for acquisition, clinical features and outcomes ofListeria monocytogenesinfection in Sydney.DesignA retrospective study over the period 1983‐1992 at four university teaching hospitals in Sydney. Cases were identified from microbiology laboratory records of the isolation ofL. monocytogenesfrom sterile sites.ResultsEighty‐four cases were reviewed, with 72 patients (86%) having a predisposing underlying condition, including 13 perinatal patients (15%). Septicaemia (56%) and central nervous system disease (41 %) were the major clinical presentations. Nineteen patients (23%) had hospital‐associated infection. A mortality of 21% (18 patients) was directly attributable toL. monocytogenesinfection, with another 10% (nine patients) dying of their underlying disease during admission. The 84 cases represented 80% of allL. monocytogenescases occurring in Sydney during the study period.ConclusionsListeriosis is predominantly a disease of the elderly or of immunosuppressed individuals, pregnant women and neonates. The presentation and outcome in these groups are similar to those reported in other Western countries. A significant feature of this study was the number of cases occurring in already hospitalised patients, suggesting thatL. monocytogenesmay be an important hospital‐associated pathogen in immunocompromised patients.

ISSN:0025-729X    

DOI:10.5694/j.1326-5377.1994.tb138313.x

出版商:Wiley    

年代:1994

数据来源: WILEY