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This thesis explores the human rights of people with mental disabilities in regional Queensland, Australia, within the context of contemporary human rights frameworks adopted by the United Nations and the World Health Organization. The study was informed by a scoping literature review to synthesise the current knowledge in this field and identify gaps. It is a qualitative study using a ‘stellar approach’ characterised by superimposed triangulation of data sources and data-gathering methods. This involved semi-structured interviews with persons with mental disabilities and carers, a focus group with stakeholders and consultations with legal and psychiatric experts. The data were analysed iteratively, informed by post-modernist and critical realist frameworks. Abductive analysis – a combination of deductive and inductive analyses – was conducted. In the interest of reflexivity, a chapter on the positioning of the candidate as a situated researcher was included. This study found widespread violations of the human rights of people with mental disabilities. Involuntary/coercive psychiatric treatment; inadequate access to healthcare; and stigma and discrimination were found to be the most common violations of rights. While most participants, including service-users, agreed with the need to retain involuntary treatment provisions as the last resort, many participants highlighted the excessively restrictive ways in which involuntary treatment was enforced, violating their dignity. Poor access to healthcare, especially in rural and remote areas, was highlighted. Social exclusion through stigma, ‘the lonely road’, was the most distressing violation of rights. The study concluded that citizenship approaches, coupled with the capabilities approach to social justice may provide a philosophical basis for promotion of human rights of people with mental disabilities, which can then be practically implemented by addressing the social determinants of health and adopting the recovery

Objectives/Hypothesis: The objective of this study was to determine the predictors of sleep quality among head and neck cancer patients 1 year after diagnosis. Study Design: This was a prospective, multisite cohort study of head and neck cancer patients (N = 457). Methods: Patients were surveyed at baseline and 1 year after diagnosis. Chart audits were also conducted. The dependent variable was a self-assessed sleep score 1 year after diagnosis. The independent variables were a 1 year pain score, xerostomia, treatment received (radiation, chemotherapy, and/or surgery), presence of a feeding tube and/or tracheotomy, tumor site and stage, comorbidities, depression, smoking, problem drinking, age, and sex. Results: Both baseline (67.1) and 1-year postdiagnosis (69.3) sleep scores were slightly lower than population means (72). Multivariate analyses showed that pain, xerostomia, depression, presence of a tracheotomy tube, comorbidities, and younger age were statistically significant predictors of poor sleep 1 year after diagnosis of head and neck cancer ( P < .05). Smoking, problem drinking, and female sex were marginally significant ( P < .09). Type of treatment (surgery, radiation and/or chemotherapy), primary tumor site, and cancer stage were not significantly associated with 1-year sleep scores. Conclusions: Many factors adversely affecting sleep in head and neck cancer patients are potentially modifiable and appear to contribute to decreased quality of life. Strategies to reduce pain, xerostomia, depression, smoking, and problem drinking may be warranted, not only for their own inherent value, but also for improvement of sleep and the enhancement of quality of life. Laryngoscope, 2010

Community based Health Services have traditionally used electronic health information management systems (EHIMSs) that are different to, and have not interfaced with, inpatient EHIMSs. For an Australian regional Palliative Care Service that provided care to patients in a variety of facilities and community locations the lack of an EHIMS that traversed the continuum of care represented a barrier to efficient service delivery. Utilising a pre-existing inpatient EHIMS (Cerner Powerchart) a local solution was developed and implemented that addressed a number of key service requirements. These were that clinical documentation would be accessible to staff regardless of location and be accessible 24/7; that patient movements in and out of key facilities could be tracked in real time; that the Palliative Care record would be visible to other health care providers such as the Emergency Department and Primary Care practitioners; and that service reporting functionality would be automated. This networked integrated information system (NIIS) has successfully supported and enhanced the delivery of Palliative Care across the continuum of care.

Over the past 10 years there have been dramatic changes in health care financing in the United States, such as Medicare's Prospective Payment System for hospitalized Medicare beneficiaries, and in health services delivery, such as the growth in health maintenance organizations and other forms of managed care. These changes have occurred largely in response to payors' concerns about the rising cost of health care. A study of such changes in financing and delivery, and how specific groups of patients are affected is necessary so that the effects of these changes on patients' health can be determined. We examined the hospitalization rates for patients with musculoskeletal diseases in Michigan from 1980 through 1987. During this period, the overall ageadjusted hospitalization rates decreased 7.0% per year (p = 0.001). The decrease occurred less for surgical discharges (6.0% per year) than for medical discharges (8.6% per year) (p <0.001). While these overall trends are of interest, they obscure disease-specific trends that vary significantly from both the overall, and the medical and surgical trends. For example, while surgical discharges, in general declined, procedures related to major joint and limb reattachment (DRG # 209) increased at a rate of 6.3% per year. And while medical discharges in general decreased over this period, discharges for osteomyelitis increased 5.4% per year. The patterns of diseasespecific trends offers insight into the possible causes for these changes. Finally, it is important to understand the epidemiology of hospital use to evaluate the effects of new medical care delivery and payment systems on the care of subsets of patients.

Utilization review (UR) has become a prominent approach to cost containment now used by almost 65% of private group insurance plans. Although insurers have increasingly relied on UR to contain health care costs, until recently little was known about the effects of this cost containment approach. This article re views some of the key findings of a UR evaluation, based on analysis of claims data on 223 insured groups for the years 1984 through 1986. The evalu ation found that UR reduced admissions by 12%, in- patient expenditures by 8%, and total expenditures by 6%. It was estimated that UR generated net sav ings of $115 per employee per year. Groups adopting UR with high baseline rates of hospital use had larger expenditure reductions and greater net savings. It appears that UR can play an important role in private cost containment and help improve medical care re source consumption.

The challenges presented by managed care ar rangements and third-party utilization controls have led hospitals to strengthen internal utilization man agement programs. This article reports findings from a set of case studies on how hospitals have adapted their utilization management programs to their en vironments. While knowledge acquired from case studies should not be overgeneralized, the findings of these studies suggest some lessons that merit consid eration by hospitals advancing their own programs in utilization management.

BACKGROUND: Given accumulating evidence supporting postmastectomy radiotherapy (PMRT) in selected patients, it is important to evaluate patterns and correlates of PMRT utilization, including communication and attitudinal factors. METHODS: The authors surveyed 2382 patients diagnosed with breast cancer in 2002 and reported to the Los Angeles and Detroit Surveillance, Epidemiology, and End Results registries (n=1844, 77.4% response rate). Analyses were restricted to patients with nonmetastatic invasive breast cancer treated by mastectomy who had decided whether or not to undergo PMRT (n=396). The authors assessed rates of explanation, recommendation, and receipt of radiation by indication grouping, defined primarily by the 2001 American Society of Clinical Oncology guidelines. They evaluated correlates of PMRT receipt, including tumor and sociodemographic characteristics. They also explored patients' self-reported reasons for nonreceipt of PMRT. RESULTS: The adjusted proportion in each indication group reporting that a provider had explained radiation was high (77% of those in whom PMRT was indicated, 76% of those in whom medical opinion was divided, and 73% of those in whom PMRT was not indicated; P = .10). The adjusted proportions reporting recommendations for radiation (86%, 35%, and 17%, respectively) and receipt (81%, 34%, and 10%, respectively) varied significantly by indication grouping ( P < .001). On multivariate analysis, tumor size ( P < .001), lymph node status ( P < .001), comorbidity ( P = .02), and chemotherapy receipt ( P = .003) were found to be independent significant correlates of PMRT receipt. The most common reasons cited for not pursuing PMRT were lack of physician recommendation and perceived lack of need. CONCLUSIONS: PMRT receipt is strongly correlated with clinical indication. The authors found no sociodemographic disparities in utilization. However, approximately one-fifth of patients with strong indications did not receive treatment. Cancer

This paper provides a framework for evaluating healthcare software from a usability perspective. The framework is based on a review of both the healthcare software literature and the general literature on software usability and evaluation. The need for such a framework arises from the proliferation of software packages in the healthcare field, and from an historical focus on the technical and functional aspects, rather than on the usability, of these packages. Healthcare managers are generally unfamiliar with usability concepts, even though usability differences among software can play a significant role in the acceptance and effectiveness of systems. Six major areas of usability are described, and specific criteria which can be used in the software evaluation process are also presented.

To evaluate the differential charges for treating end-stage renal disease (ESRD) associated with diabetes mellitus, Medicare billing data are analyzed. The charges of 244 patients in the Michigan Kidney Registry identified as having (ESRD) from diabetes are compared with charges of 902 nondiabetic patients. Average annual charges for ESRD treatment for diabetics are $29,671 (+/-27,662) which are $4695 (+/-1344) higher than charges for nondiabetics. The majority of the difference (84.3%) is attributable to higher inpatient hospital charges. Most of the remainder (14.5%) is attributable to higher physician and medical supply charges. Charges for treatment of diabetics are higher on all modalities of treatment, but differences are not significant among modalities.

Use of continuous ambulatory peritoneal dialysis (CAPD) is increasing, and it is being promoted as a less expensive alternative to center hemodialysis (CHD). The debate over the relative charges for CAPD and CHD cannot generally be answered without considering the relationship between modality selection and patient characteristics. When selection and patient characteristics are accounted for, the difference between annual charges for CAPD and CHD patients is insignificant, in part because of the current payment system. The analysis suggests that patients using CHD may have lower charges than if they were using CAPD; similarly, patients using CAPD may have lower charges than if they were using CHD. Charges during CAPD training are lower than CHD or CAPD charges. Charges during the transition between CHD and CAPD tend to be higher than either CHD or CAPD due to additional hospitalizations. Estimated results suggest that encouraging current CHD patients to transfer to CAPD (or vice versa) may not have the desired effect of reducing charges.

Objectives: Risk associated with needlestick injuries (NSI) in health care workers (HCWs) in Taiwan has not been characterized. We conducted this investigation to study 1) the prevalence and yearly incidence of NSI in HCWs in Taiwan, and the risk factors associated with NSIs; 2) reporting behavior when a NSI was sustained; and 3) seroprevalence of blood-borne pathogens among inpatients. Combination of the above information allowed for risk estimation for contracting hepatitis B virus (HBV), hepatitis C virus (HCV) and human immunodeficiency virus (HIV) in HCWs. Methodology: A cross-sectional questionnaire survey for life-time experience and frequency of NSI was conducted in a random sample from four strata of accredited hospitals according to the number of employees, from July 1996 to June 1997 in Taiwan. All full time employees, including physicians, nurses, technicians, and supporting personnel were recruited. Seroprevalence was examined for HBV, HCV and HIV among inpatients six years in age or older in one teaching hospital during July 1997 to June 1998. Results: A total of 10,469 health care workers were recruited from 16 out of 132 accredited hospitals and 82.6% (8,645) completed the survey, including nurses (61.0%), physicians (16.1%), medical technicians (14.9%), supporting personnel (7.9%). The prevalence of NSI were 93.1%, 86.6%, 78.3%, 61.0% in nurses, physicians, technicians, and supporting personnel respectively. The reported incidence of needlestick and other sharps injuries was 1.30 and 1.21 times per person in the past 12 months. Of the most recent episodes of NSIs, ordinary syringe needles accounted for 80.3% (95% CI, 79.4% - 81.2%) of hollow-bore needles associated incidents, and 74.1% (95% CI, 72.8% - 75.4%) of them were contaminated. The most frequently reported circumstance was the "Breakdown of Universal Precautions", recapping-related behaviors (81.6%, 95% CI 80.3% - 82.9%) of HCWs. More than a quarter (27.8%, 2,399) of HCWs were unprotected (e

1,708 members of the Australian Infection Control Association were surveyed to describe the practices of Australian infection control practitioners. The study details the methods infection control practitioners use to co-ordinate and measure nosocomial infections as clinical outcomes of Australian infection surveillance and control programs. Administrators' and clinicians' perceptions of the elements and infrastructure of infection surveillance and control programs and the role of the infection control were measured in 316 hospitals in New South Wales, Australia.A literature review found that the development of Australian infection surveillance and control programs is behind that of U.S.A and the United Kingdom. The survey of the infection control practitioners identified that their role and duties varied between facilities as did the time allocated to infection control tasks. The survey of infection control practitioners demonstrated variation in their levels of skill, education and experience. Infection control practitioners' use and application of evidence and associated skills was examined and found to be limited in relation to clinical decision making and policy development. The survey also examined the methods infection control practitioners use to undertake surveillance of nosocomial infections. The methods reported indicated non-standard approaches to surveillance activity.A survey of administrators and clinicians in NSW hospitals was undertaken to identify variation in administrator and clinician perceptions and to describe their level of support for recommended essential infrastructure and criteria for infection surveillance and control programs and the role of the infection control practitioner in accordance with Scheckler's model. The survey indicated divergent views regarding the role of the infection control practitioner and the essential elements of infection surveillance and control programs.The study identified that education of infection control pr