Patients prefer chemotherapy on the same day as their medical oncology outpatient appointment.

PURPOSE: Numerous oncology units have separated outpatient appointments and chemotherapy delivery to another day (TOD) to improve efficiency. This survey assessed patient preferences for scheduling medical oncology outpatient appointments and chemotherapy delivery for either treatment delivered on the same day as the outpatient appointment (TSD) or TOD. PATIENTS AND METHODS: Patients (N = 198) from two major metropolitan tertiary centers in Perth-Sir Charles Gairdner Hospital (n = 110) and Royal Perth Hospital (n = 88)-completed surveys from April 15 to May 24, 2013. Eligibility criteria included any adult patient with cancer receiving an intravenous chemotherapy or targeted agent who had completed ≥ two cycles of treatment or attended ≥ two chemotherapy appointments on a concurrent chemoradiotherapy program. RESULTS: The majority of patients preferred TSD (85%) versus TOD. Convenience (50%) and distance or difficulty in transportation to hospital (25%) were the most common reasons for TSD preference. Current treatment schedule (odds ratio [OR], 59.2; 95% CI, 18.7 to 265.2) was significantly associated with treatment schedule preference. Younger age (58.3 v 65.2 years; P = .01) and presence of household dependents (OR, 4.2; 95% CI, 1.2 to 27.1) were also associated with TSD preference. Scheduling preference was not influenced by time prepared to wait for chemotherapy (χ(2) (2) = 3.86; P = .14), with 44% and 39% of patients willing to wait up to 60 and 120 minutes, respectively. Almost all patients preferred chemotherapy delivery before 2 pm (99%). CONCLUSION: Patients preferred to receive chemotherapy on the same day as their medical oncology outpatient appointment. Morning delivery of chemotherapy was preferred. Meeting patients' expectations will present significant challenges to efficient service provision as caseloads increase.

The serum hepcidin:ferritin ratio is a potential biomarker for cirrhosis.

BACKGROUND: Serum hepcidin concentration is potentially affected by inflammation and iron stores in chronic liver disease (CLD), but little is known about the relationship between hepcidin and the degree of hepatic fibrosis. We investigated the potential role of serum hepcidin as a biomarker of advanced liver disease. METHODS: Serum hepcidin was measured in 332 adults with CLD of varying aetiologies, 45 healthy and 50 non-liver disease patient controls. Liver biopsy data were available for 228 CLD subjects. RESULTS: Hepcidin was decreased in CLD patients compared with non-liver disease patient controls (P < 0.0001) but not healthy controls, and was lowest in those with cirrhosis (P < 0.0001). Serum hepcidin correlated with hepatic hepcidin mRNA expression in 91 biopsy samples available for genetic analysis (r = 0.68, P < 0.0001). Hepcidin also correlated positively with serum ferritin concentration, transferrin saturation, ALT, serum albumin and haemoglobin, but negatively with serum bilirubin. The hepcidin:ferritin ratio was significantly lower in CLD subjects compared with healthy and disease controls, and decreased with each increase in the stage of fibrosis and siderosis. The hepcidin:ferritin ratio was associated with progressive fibrosis on linear regression, and a value of less than 0.1 was independently associated with cirrhosis on logistic regression analyses (OR 5.54, P < 0.001). Receiver operating characteristic analysis showed the hepcidin:ferritin ratio was able to distinguish between F0 and F4 stages of fibrosis (area under receiver operating characteristic curve = 0.86). CONCLUSIONS: The hepcidin:ferritin ratio is reduced in relation to increasing fibrosis in CLD and the use of this ratio may have potential future diagnostic implications as a marker of cirrhosis.

Impact of hospital-wide process redesign on clinical outcomes: a comparative study of internally versus externally led intervention.

INTRODUCTION In response to increasing demand for hospital beds, institution-wide clinical process redesign has been advocated for improving efficiency. METHODS This retrospective, before-after study involved five tertiary hospitals in Queensland, Australia and assessed effects of externally led redesign over 6 months within two hospitals, comprising ward-based innovations led by consultancy-led standardised processes, and internally led redesign over 25 months in one hospital which implemented medical assessment and planning unit, 23 h elective surgical ward and new bed management processes. The primary outcome measures were control chart changes in emergency department (ED) access block and overdue category 1 elective surgery waits over 3.5 years involving intervention hospitals and two control hospitals. RESULTS At one externally led redesign hospital, control charts indicated a decrease in ED access block outside control limits which coincided with the intervention, but this was not subsequently sustained. There were no special-cause variations seen in the other hospital. In contrast, at the internally led redesign hospital, there were two decreases in access block outside control limits during the intervention period, resulting in a decrease from a baseline average of 55% to a postintervention average of 22%. All hospitals showed declines in elective surgery waits with oscillations in data indicating the existence of special-cause factors other than redesign. CONCLUSION Internally led compared with externally led redesign led to superior and sustained improvements in ED access block as a result of major structural reforms that were driven by committed clinicians and managers and cut across departmental boundaries.

Comparison of self-reported week-day and weekend-day sitting time and weekly time-use: results from the Australian Longitudinal Study on Women's Health.

BACKGROUND: The study of sedentary behavior is a relatively new area in population health research, and little is known about patterns of sitting time on week-days and weekend-days. PURPOSE: To compare self-reported week-day and weekend-day sitting time with reported weekly time spent in other activities. METHOD: Data were from 8,717 women born between 1973 and 1978 ('younger'), and 10,490 women born between 1946 and 1951 ('mid-age') who completed surveys for the Australian Longitudinal Study on Women's Health in 2003 and 2001, respectively. They were asked about time spent sitting on week-days and weekend-days. The women were also asked to report time spent in employment, active leisure, passive leisure, home duties, and studying. Mean week-day and weekend-day sitting times were compared with time-use using analysis of variance. RESULTS: Younger women sat more than mid-aged women, and sitting time was higher on week-days than on weekend-days in both cohorts. There were marked positive associations between week-day and weekend-day sitting times and time spent in passive leisure in both cohorts, and with time spent studying on week-days for the younger women. Week-day sitting time was markedly higher in women who reported >35 h in employment, compared with those who worked <35 h. In contrast, there were inverse associations between sitting time and time spent in home duties. Associations between sitting and active leisure were less consistent. CONCLUSION: Although week-day sitting time was higher than weekend-day sitting time, the patterns of the relationships between week-day and weekend-day sitting and time-use were largely similar, except for time spent in employment.

Sitting time is associated with weight, but not with weight gain in mid-aged Australian women.

The aim of this study was to examine the associations between sitting time, weight, and weight gain in Australian women born in 1946-1951. Data were from 8,233 women who completed surveys for the Australian Longitudinal Study on Women's Health (ALSWH) in 2001, 2004, and 2007. Associations between sitting time and weight, and between sitting time and weight change in each 3-year period were examined using repeated measures modeling. The associations between weight and change in sitting time were also examined. Analyses were stratified for BMI categories: normal weight (18.5 or= 30). In cross-sectional models, each additional hour of sitting time was associated with 110 g (95% confidence interval (CI): 40-180) and 260 g (95% CI: 140-380) additional weight in overweight and obese women, respectively (fully adjusted model). In prospective analyses, sitting time was not consistently associated with weight change, after adjustment for other variables, and weight was not associated with change in sitting time over successive 3-year periods. In conclusion, although the cross-sectional associations between sitting time and weight were evident in overweight and obese women, there was no consistent association between sitting time and weight gain. A potential explanation is that prospective associations may only be apparent over longer periods of time. These results do not support a role for reducing sitting time as a short-term means of weight control in mid-aged women.