Australian health review : a publication of the Australian Hospital Association
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The objective was to determine the proportion of patients presenting to the Emergency Department (ED) in atrial fibrillation (AF) who are at high risk of thromboembolic stroke as defined by the American Heart Association and who might benefit from anticoagulation therapy. We enrolled all patients identified as having AF between 28th June 1999 and 26th March 2000. ⋯ Of these, 65 patients were at high risk for thromboembolic stroke and had no contraindication to anticoagulation therapy 43 (66%) were on Warfarin at presentation but 14 (22%) were on Aspirin and 8 (12%) were on neither. 34% of patients with chronic atrial fibrillation presenting to the ED, at high risk of thromboembolic stroke and without contra-indication to anticoagulation, were not anticoagulated on presentation. ED attendance provides an opportunity for intervention for the prevention of stroke in this group.
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The Asthma Management Plan (AMP) was developed by the Thoracic Society of Australia and New Zealand in 1989 to provide a more uniform approach to asthma care, aimed at reducing mortality, morbidity and emergency presentations. The AMP is often supplemented with Asthma Clinical Pathways (CPs) within the emergency department and hospital setting. ⋯ The AMP and CP were both found to have had positive influences on asthma management. However, the study illustrates that there continue to be problems with asthma management, which would be improved by a more consistent use of these instruments.
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The allocation of resources to providers and the way in which the resources are then prioritised to specific service areas and patients remain the critical ethical decisions which determine the type of health system a community receives. Health care providers will never be given enough resources to satisfy all the demands placed upon them by a community that is becoming increasingly informed and demanding. ⋯ It translates the theoretical constructs of distribution into a practical situation that arose at The Geelong Hospital. It is important to emphasise that the aim of giving the example is not necessarily to provide the right answer but rather to assist in determining what ought to be the questions.
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Ongoing structural change has been a feature of the New Zealand health system throughout the 1990s. As we enter the new millennium a new government is now embarking upon yet another round of reform. I look back on the past few years and consider what lessons might be learned about the process of health policy-making in New Zealand. They include the need for a clear vision about the goals of health policy, the importance of consulting with key stakeholders at an early stage, the problems of implementing change too speedily, and the need to allow sufficient time for systems to mature before replacing them with new structures.
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Aboriginal Community Controlled Health Services face particular management issues as they adjust to the dominant Western paradigm of managerialism and the market model of health service provision. Their cultural orientation leads to distinctive organisational features which both advantage and disadvantages them in this environment. ⋯ However, effective community control is difficult to achieve. Services may benefit from partnerships with collaborators such as hospitals, regional health services and university departments of rural health if the partnerships are based on mutual respect and ensure that community control is retained.