Bilder, G, Wentz, T, Leadley, R, Amin, D, Byan, L, O’Conner, B, Needle, S, Galczenski, H, Bostwick, J, Kasiewski, C, Myers, M, Spada, A, Merkel, L, Ly, C, Persons, P, Page, K, Perrone, M & Dunwiddie, C 1999, 'Restenosis Following Angioplasty in the Swine Coronary Artery Is Inhibited By an Orally Active PDGF-Receptor Tyrosine Kinase Inhibitor, RPR101511A', Circulation, vol. 99, no. 25, pp. 3292-3299.
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Background—Platelet-derived growth factor (PDGF), a purported mediator of arterial response to injury, stimulates proliferation, chemotaxis, and matrix production by activation of its membrane receptor tyrosine kinase. Because these activities underlie restenosis, inhibition of the PDGF-receptor tyrosine kinase (PDGFr-TK) is postulated to decrease restenosis.Methods and Results—RPR101511A is a novel compound which selectively and potently inhibits the cell-free and in situ PDGFr-TK and PDGFr-dependent proliferation and chemotaxis in vascular smooth muscle cells (VSMC). To evaluate the effect of RPR101511A (30 mg · kg−1· d−1BID for 28 days following PTCA) on coronary restenosis, PTCA was performed in hypercholesterolemic minipigs whose left anterior descending (LAD) coronary artery had been injured by overdilation and denudation, yielding a previously existing lesion. Angiographically determined prePTCA minimal lumen diameters (MLD) were similar in vehicle and RPR101511A-treated pigs (1.98±0.09 versus 2.01±0.08 mm) and increased to the same extent in the 2 groups following successful PTCA (2.30±0.06 versus 2.52±0.13). At termination, there was an average 50% loss of gain in the vehicle-treated group but no loss of gain with RPR101511A (2.16±0.05 versus 2.59±0.11,P<0.001). Morphometric analysis of the LAD showed that RPR101511A caused a significant decrease in total intimal/medial ratio (0.96±0.58 versus 0.67±0.09,P<0.05).Conclusions—RPR101511A, which acts by inhibition of the PDGFr-TK, completely prevented angiographic loss of gain following PTCA and significantly reduced histological intimal hyperplasia.
BURGESS, L & STREET, DJ 1999, 'An Interchange Algorithm For Four Factor Orthogonal Main Effect Plans', Statistics and Computing, vol. 9, no. 3, pp. 171-177.
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In this paper we give a construction for four factor orthogonal main effect plans (OMEPs) and an interchange algorithm to give four factor OMEPs with various different numbers of repeated runs.
Burgess, L, Kreher, DL & Street, DJ 1999, 'Small orthogonal main effect plans with four factors', Communications in Statistics - Theory and Methods, vol. 28, no. 10, pp. 2441-2464.
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In this paper we study orthogonal main effect plans with four factors. A table of such designs, where each factor has at most 10 levels, and there are at most 40 runs, is generated. We determine the spectrum of the degrees of freedom of pure error for th
De Abreu Lourenco, R 1999, 'Health Care Reform - An International Perspective', CHERE Health Economics Review, no. 11.
De Abreu Lourenco, R 1999, 'How much does it cost to remember? Costing a scalds prevention campaign', Health Promotion Journal of Australia, vol. 9, no. 1.
De Abreu Lourenco, R 1999, 'The Australian Health Care System', CHERE Discussion Paper Series, Number 38.
De Abreu Lourenco, R 1999, 'The Wills Review: An Opportunity for Health Services Research', CHERE Health Economics Review, no. 12.
De Abreu Lourenco, R 1999, 'Using Cost Information', CHERE Health Economics Review, no. 13.
Haas, M 1999, 'A Critique of Patient Satisfaction', Health Information Management, vol. 29, no. 1, pp. 9-13.
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Measures of patient satisfaction have been developed primarily so that patients could furnish health care providers and services with feedback on the quality of health care provided to them. However, the theoretical underpinnings of the concept of patient satisfaction are under-developed and the framework within which patient satisfaction has evolved is considered by some to be in need of review and overhaul. In this article, the concept and measurement of patient satisfaction is critically reviewed. Potentially better ways of asking patients (and their families and carers) to describe and/or assess their care are suggested.
Haas, M 1999, 'Commentary on McKenzie therapy and manipulation have similar effects and costs and provide only marginally better outcomes than an educational booklet', Australian Journal of Physiotherapy, vol. 45, no. 1, p. 46.
Haas, M 1999, 'The relationship between expectations and satisfaction: a qualitative study of patients' experiences of surgery for gynaecological cancer', Health Expectations, vol. 2, no. 1, pp. 51-60.
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It is important that a patient perspective is introduced to the identification and measurement of the outcomes of health care. The aim of this study was to use qualitative methods to examine the presence or absence of expectations prior to the experience of health care and the relationship between expectations, satisfaction and dissatisfaction in a group of women undergoing surgery in a large teaching hospital. Nineteen women with a diagnosis of gynaecological cancer were interviewed on two occasions, before and after surgery. A thematic analysis was undertaken. The results suggest that there is not a clear relationship between expectations and satisfaction. Women had different levels of expectations about different types of care and different aspects of care. Unfulfilled expectations did not lead to less satisfaction. The women were able to express satisfaction either with the care overall or with specific aspects of care, as well as being able to distinguish aspects of care with which they were dissatisfied.
Haas, MR 1999, 'Mckenzie Therapy And Manipulation Have Similar Effects And Costs And Provide Only Marginally Better Outcomes Than An Educational Booklet - Commentary', Australian Journal Of Physiotherapy, vol. 45, no. 1, pp. 48-48.
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Objective To examine relative costs and effectiveness of chiropractic manipulation, McKenzie therapy and an educational booklet as treatments for low back pain. Design Randomised controlled trial. Setting: Two primary care clinics in the United States of
Hall, J 1999, 'Incremental Change In the Australian Health Care System', Health Affairs, vol. 18, no. 3, pp. 95-110.
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Hall, J, Lourenco, RD & Viney, R 1999, 'Carrots and sticks - The fall and fall of private health insurance in Australia', HEALTH ECONOMICS, vol. 8, no. 8, pp. 653-660.
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NA
Kenny, P, Quine, S, Shiell, A & Cameron, S 1999, 'Participation in treatment decision‐making by women with early stage breast cancer', Health Expectations, vol. 2, no. 3, pp. 159-168.
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Objective This study aimed to assess the way women treated for early stage breast cancer perceived the treatment selection process. The purpose was to understand more fully patients’ experiences of the decision process and their preferences for participation in treatment decisions. Setting and participants The study informants were 40 women, treated at a teaching hospital in Sydney Australia, who were interviewed face to face 1 year after their first treatment for stage I or stage II breast cancer. Methods This study used a qualitative approach, based on the analysis of interview transcripts. The main areas covered were how the informants’ treatment decisions were made and their preferences for participation in treatment decisions. Content and thematic analyses were conducted with findings presented using verbatim quotations for illustration. Results and conclusions Many of the informants who preferred not to participate in decisions also failed to recognize the need for value judgements (as well as medical expertise) in the decision‐making process. Some informants believed they ought to be responsible for the consequences whilst others did not. Difficulties were identified in patient utilization of medical information for treatment decision‐making, and also in establishing preferences for the risks and benefits of treatments where few patients had prior experience of the potential outcomes. The findings indicate that patient participation in treatment decision‐making is a more complex issue than simply giving patients information and choices. Ways of enhancing patients’ involvement in the treatment selection process are discussed.
Loftus, I, Goodall, S, Crowther, M, Jones, L, Bell, PF, Naylor, A & Thompson, MM 1999, 'Increased MMP-9 activity in acute carotid plaques: Therapeutic avenues to prevent stroke', Annalsof the New York Academy of Sciences, vol. 0, pp. 878-878.
LOFTUS, IM, GOODALL, S, CROWTHER, M, JONES, L, BELL, PRF, NAYLOR, AR & THOMPSON, MM 1999, 'Increased MMP‐9 Activity in Acute Carotid Plaques: Therapeutic Avenues to Prevent Stroke', Annals of the New York Academy of Sciences, vol. 878, no. 1, pp. 551-554.
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Simpson, Hemingway, Crowther, Goodall & Thompson 1999, 'The gelatinases, their activators and inhibitors in the progression of colorectal cancer', Colorectal Disease, vol. 1, no. 5, pp. 248-255.
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BackgroudThe matrix metalloproteinases (MMPs) are a family of proteolytic enzymes which are reported to play an important role in the invasion and metastasis of a number of human cancers. The gelatinase subfamily has substrate specificity for type IV collagen, the principal component of human epithelial basement membrane. They are over‐expressed in colorectal tumour tissues. The relatively recent discovery of a family of membrane‐associated MMPs, some of which function as activators of MMP‐2, represents an important development relevant to this field.MethodsA literature review was performed on the PubMed and Medline databases for English language publications relating to the gelatinases and their activators and inhibitors in colorectal cancer.ResultsThere is evidence to support the up‐regulation and involvement of the gelatinases in the progression of colorectal cancer. The active MMP‐2 species appears particularly closely related to the malignant phenotype. There has been little published on the role of the recently discovered membrane‐associated MMPs in colorectal cancer. Studies in other cancers suggest these may play an important role in the activation of MMP‐2 in vivo.ConclusionGelatinases play an important role in the progression of colorectal cancer. More work is required to understand the mechanisms underlying the up‐regulation of gelatinolytic activity in these tumours. Such work could lead to the development of novel new therapies for the improved treatment of this disease in future years.
Street, D & Street, AP 1999, 'But Where Are Designs Used?', Ars Combinatoria, vol. 53, pp. 3-26.
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Thompson, MM, Boyle, J, Crowther, M, Goodall, S, Wills, A, Loftus, I & Bell, PF 1999, 'Therapeutic options in small abdominal aneurysms: The role of in vitro studies', Annalsof the New York Academy of Sciences, vol. 0, pp. 878-878.
THOMPSON, MM, BOYLE, JR, CROWTHER, M, GOODALL, S, WILLS, A, LOFTUS, IM & BELL, PRF 1999, 'Therapeutic Options in Small Abdominal Aneurysms: The Role of in Vitro Studies', Annals of the New York Academy of Sciences, vol. 878, no. 1, pp. 724-727.
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Treharne, GD, Boyle, JR, Goodall, S, Loftus, IM, Bell, PRF & Thompson, MM 1999, 'Marimastat inhibits elastin degradation and matrix metalloproteinase 2 activity in a model of aneurysm disease', Journal of British Surgery, vol. 86, no. 8, pp. 1053-1058.
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Abstract Background Abdominal aortic aneurysms are characterized by degradation of the extracellular matrix, with a reduction in the elastin concentration of the arterial media. These changes have been linked to increased levels of endogenous metalloproteinases (MMPs) within the aorta, particularly MMP-2 and MMP-9. This provides a potential therapeutic target for pharmacological agents aimed at reducing the growth rate of small aneurysms. In this study, the ability of marimastat (an MMP inhibitor) to reduce matrix degradation was assessed in a previously described model of aneurysm disease. Methods Porcine aortic segments (n = 12) were preincubated in exogenous pancreatic elastase for 24 h before culture in standard conditions for 13 days with marimastat 10−5, 10−6 and 10−7 mol/l. Control segments were cultured both without marimastat and without elastase. At the termination of culture, MMPs were extracted from the tissue and quantified by substrate gel enzymography. The volume fractions of elastin and collagen were determined by stereological analysis of sections stained with Miller's elastin and van Gieson's stain. Results Stereological analysis demonstrated preservation of elastin in aorta treated with marimastat at 10–6 and 10–5 mol/l; this was significant at the latter concentration (P = 0·007). This was accompanied by a significant reduction in active MMP-2 activity in the samples treated with marimastat 10–5 mol/l (P < 0·01). Conclusion
Warner, NJ, King, M, Langlands, AO, Kenny, P & Boyages, J 1999, 'Symptoms 2 weeks, 3 months and 12 months after treatment of early breast cancer: the patients’ perspectives', The Breast, vol. 8, no. 5, pp. 273-277.
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Bridges, J, Haas, M & Mazevska, D CHERE 1999, A qualitative insight into rural casemix education, CHERE Project Report No 10, Sydney.
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NSW, while often regarded as the non- Casemix state, has been using Casemix information to assist planning and funding of hospitals. However, the use of this tool and the necessary education and knowledge about Casemix has not been evenly spread throughout the state, with health service staff in metropolitan areas relatively more familiar with its use then their colleagues in rural NSW. In 1998, both NSW Health and the NSW Casemix Clinical Committee (NCCC) proposed that an effort be made to increase the knowledge and participation of rural clinical and health service staff in Casemix activities. This research was proposed as a means of establishing the current situation regarding Casemix, knowledge in rural areas, providing advice regarding the best methods of implementing Casemix education for rural staff and, if possible, evaluating the success of the education. Casemix is a broad term referring to the tools and information system used to assist in such activities as planning, benchmarking, managing and funding health care services. Casemix is underpinned by classification systems that allow meaningful comparisons of workload or throughput between facilities. In this study, qualitative research methods were used to examine the issues faced by rural health service staff in gaining knowledge of and using Casemix. This information was supplemented by a survey, which assessed the level of knowledge and understanding of Casemix in two rural areas.
Haas, M, Shanahan, M, Viney, R & Cameron, I Commonwealth Department of Health and Ageing 1999, Consultancy to progress hospital in the home care provision: Final report, CHERE Project Report No 13, Canberra.
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In July 1998, the Commonwealth Department of Health and Family Services commissioned the Centre for Health Economics Research and Evaluation (CHERE) to identify and document Hospital in the Home (HITH) care models nationally and internationally. The purpose of this consultancy was to examine the appropriateness of this form of care for acutely ill patients and to make recommendations about how to increase the utilisation and cost effectiveness of services. Hospital in the Home is emerging internationally and within Australia as a viable alternative form of provision of acute care. The benefits of HITH have generally been seen in terms of its capacity to provide a cost-effective and acceptable alternative to hospital inpatient care, which reduces pressure on hospital beds. However, so far there has only been limited evaluation to lend support to these claims. Over the past decade a wide range of hospital in the home programs have been introduced across the Australian health care system. These programs have often emerged in response to local factors and have a range of different purposes, funding and organisational arrangements, and varying levels of success. In some states hospital in the home has been formalised into a program, whereas in other parts of Australia the introduction of HITH has been left to local decision makers. Thus, the experience of HITH has been extremely variable. It is appropriate at this stage to draw together information about what services are available, how acceptable these services are and what they have achieved. This information is important for determining the future directions of HITH in Australia, as well as providing a valuable resource for service providers and policy makers.
Haas, MR, Chapman, S, Viney, RC, Hall, JP & Ferguson, AC CHERE 1999, The news on health economics: a study of resource allocation in health in the Australian print media for 1996, CHERE Discussion Paper No 40, Sydney.
Hall, J, Caleo, S & Stevenson, J CHERE 1999, Economic analysis of psychotherapy for borderline personality disorder patients, CHERE Project Report No 9, Sydney.
Lourenco, RDA, Foulds, K, Smoker, I & Hall, J CHERE 1999, The Australian Health Care System, CHERE Discussion Paper No 38, Sydney.
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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.
