Coordinating health, extended care, and community support services: reforming aged care in Australia.

Under pressure to maximize the cost-effectiveness of programs, efforts to improve coordination have become increasingly central to the development of the broader health and welfare service delivery system in Australia in the past few years. This article reviews recent experience in two related fields: (1) the coordination of different community care services for older people and people with disabilities, funded by the Home and Community Care program; and (2) the attempt to enhance links between community and residential care services, hospitals, and other health care providers. Why coordination has emerged as such an important issue in the field of community care and, increasingly, across the entire system of what the Australian government now terms health and family services is discussed. A number of measures that have been introduced or are proposed to improve a coordination of services are briefly reviewed. These range from individualistic approaches based on information and referral, through schemes involving gatekeeping, case management and brokerage of services, to models involving the reconfiguration of organizational structures, linkages, and finances. These measures are not mutually exclusive and are increasingly likely to be applied in more complex mixed models of service coordination. It is argued that coordination at the level of direct-service provision is difficult if government policies that direct services lack coordination.

Unusual complication of nasal CPAP: subcutaneous emphysema following facial trauma.

Subcutaneous emphysema is an unusual complication of nasal continuous positive airway pressure (CPAP). We report a case of a 58-year-old man who fell and sustained mild facial trauma to the left side of his head. After using CPAP the following night, he developed diffuse subcutaneous emphysema of his face and left neck. He discontinued CPAP, and his symptoms improved. The potential mechanisms of this patient's subcutaneous emphysema and the prior reports of this complication following facial trauma or dental procedure without use of CPAP are reviewed. Although there are case reports of bacterial meningitis and pneumocephalus following use of nasal CPAP, we are not aware of any prior reports of subcutaneous emphysema following use of CPAP. In light of our experience and the above related case reports, we would suggest nasal CPAP be withheld temporarily in the setting of acute facial trauma.

A mutant for spontaneous seizures in C57BL/10Bg mice.

The symptomatology, electroencephalographic and other correlates, development, and genetics of a new mutant in mice for spontaneous seizures are described. This recessive mutant is designated "spontaneous seizures" and is assigned the gene symbol sps. Just at or after puberty, 25% of the sps/sps homozygotes show behavioral arrest and spontaneous generalized convulsions. The behavioral arrest is associated with 1-2/s high-voltage spikes in the neocortex and the generalized convulsions are associated with paroxysmal activity in the neocortex. The effects of this mutant are compared with those of others for reflex or spontaneous seizures in mice.