A sensitive Faraday rotation setup using triple modulation.

The utilization of polarized targets in scattering experiments has become a common practice in many major accelerator laboratories. Noble gases are especially suitable for such applications, since they can be easily hyper-polarized using spin exchange or metastable pumping techniques. Polarized helium-3 is a very popular target because it often serves as an effective polarized neutron due to its simple nuclear structure. A favorite cell material to generate and store polarized helium-3 is GE-180, a relatively dense aluminosilicate glass. In this paper, we present a Faraday rotation method, using a new triple modulation technique, where the measurement of the Verdet constants of SF57 flint glass, pyrex glass, and air was tested. The sensitivity obtained shows that this technique may be implemented in future cell wall characterization and thickness measurements. We also discuss the first ever extraction of the Verdet constant of GE-180 glass for four wavelength values of 632 nm, 773 nm, 1500 nm, and 1547 nm, whereupon the expected 1/λ(2) dependence was observed.

Arise the systems physician.

Healthcare in Australia faces significant challenges. Variations in care, suboptimal safety and reliability, fragmentation of care and unsustainable cost increases are compounded by substantial overuse and underuse of clinical interventions. These problems arise not from intentional actions of individual clinicians, but from deficiencies in the design, operations and governance of systems of care. Physicians play an important role in optimising systems of care and, in doing so, must rely on enhanced skills in a range of domains. These include: how to evaluate and improve quality and safety of clinical processes; analyse and interpret clinical and administrative data in ways that can be used to enhance care delivery; build and lead cohesive multidisciplinary teams capable of solving operational defects and inefficient workarounds; and implement new and effective innovations in clinical service delivery. While clinical skills are essential in individual patient care, skills that improve systems of care targeting whole patient populations will become increasingly desirable and recognised as core skills.

Why has the safety and quality movement been slow to improve care?

Buist and Middleton lament that the safety and quality 'agenda' has failed to fundamentally alter the safety of healthcare systems, in part because of the disengagement of doctors from their responsibilities for patient safety . While there have been discernable improvements in the efficiency and effectiveness of care in some settings, patients still experience unacceptable harm and often struggle to have their voices heard; processes are not as efficient as they could be; and costs continue to rise at alarming rates while quality issues remain . Perhaps of most concern, recent public reports into health system failures continue to document a widespread lack of attentiveness to patient concerns, a culture of denial and widespread lack of professionalism . Alarmingly, clinician discontentment, cynicism and burn-out are reflected in antagonistic language by clinicians about the healthcare system and their patients. Taken together with the many dissatisfied and now more vocal patient groups, all point to an unprecedented crisis of faith in our healthcare systems which has been getting worse over past decade . This personal perspective aims to address the fundamental tensions that are keeping much of healthcare reform efforts from successfully transforming the culture and outcomes except at the margins.

Modification of the National Inpatient Medication Chart improves venous thromboembolism prophylaxis rates in high-risk medical patients.

BACKGROUND: Venous thromboembolism (VTE) is a significant contributor to morbidity and mortality in Australia. While there is well-established evidence for the use of VTE prophylaxis in hospital inpatients, adherence to such guidelines is poor. AIM: The aim of the present study is to assess the impact of education and system change on improving rates of VTE prophylaxis in hospital inpatients. METHODS: We performed four consecutive audits of inpatient medical records of a regional hospital service over 2 years. The audits aimed to test the impact of serial interventions at increasing the appropriate use of VTE prophylaxis (based on risk assessment). The interventions were (i) staff education and (ii) a process change that mandated a prophylaxis decision by modifying the National Inpatient Medication Chart with 'VTE avoidance' preprinted in the first medication box. RESULTS: Our results from the baseline study showed that of the 236 medical inpatients reviewed, 80% were at high risk of VTE. Of this high-risk cohort, 34.9% (confidence interval (CI) 28-42%) had appropriate prophylaxis decisions. Post the education intervention, 43.2% (CI 37-49%) of the high-risk cohort received appropriate VTE prophylaxis, an improvement of 8.3% (CI -1% to 18%) from baseline. With the subsequent introduction of a process change, 82.1% (CI 66-92%) of the high-risk cohort received appropriate prophylaxis, an improvement of 47.2% and 38.8% (CI 24-54%) when compared with baseline and education respectively. Retention rates at 11 months postsystem change were 73% (CI 55-86%). CONCLUSIONS: This study therefore concluded that while education has an impact on rates of appropriate VTE prophylaxis, it is system change that has the most marked and sustained effect.

Demonstrable professionalism: linking patient-centred care and revalidation.

The move by the Medical Board of Australia to commence a conversation with the medical profession about revalidation reflects that patient-centred care is at the heart of good medical practice. Patients judge their doctors' commitment to them based on whether their individual interactions with doctors meet their needs. We argue that ensuring that doctors are continuing to perform at a level that the community regards as acceptable is a demonstration of an individual doctor's professionalism and thus their commitment to patient-centred care. This impacts on the profession as a whole, which needs to commit to what we call 'demonstrable professionalism'--the ongoing and active demonstration of performance that the community regards as acceptable. This needs to be supported by organisations in which doctors work, reflecting the importance of organisational context to clinical practice. Revalidation processes thus need both to reflect the work of doctors and be meaningful to the community. The move to consider revalidation of doctors by regulatory authorities should not be seen by the profession as a threat, but more as an opportunity to demonstrate the profession's commitment to patient-centred care.

Assessing individual clinical performance: a primer for physicians.

The assessment of individual physician performance has attracted interest from several quarters, including statutory licensing agencies and credentialing bodies of healthcare institutions. Performance measures and assessment methods have been developed, although their validity, reliability and feasibility in regards to physician specialty practice are open to challenge. Despite this, professional colleges and societies will be increasingly obliged to ensure their members are demonstrating high-quality performance on the basis of assessment methods viewed as being transparent, impartial and reproducible. This article provides an overview of the current state of the art which hopefully will serve to inform future debate both within and outside professional circles.

All-optical optomechanics: an optical spring mirror.

The dominant hurdle to the operation of optomechanical systems in the quantum regime is the coupling of the vibrating element to a thermal reservoir via mechanical supports. Here we propose a scheme that uses an optical spring to replace the mechanical support. We show that the resolved-sideband regime of cooling can be reached in a configuration using a high-reflectivity disk mirror held by an optical tweezer as one of the end mirrors of a Fabry-Perot cavity. We find a final phonon occupation number of the trapped mirror n=0.56 for reasonable parameters, the limit being set by our approximations, and not any fundamental physics. This demonstrates the promise of dielectric disks attached to optical springs for the observation of quantum effects in macroscopic objects.

Paracetamol overdose and hepatotoxicity at a regional Australian hospital: a 4-year experience.

BACKGROUND: Paracetamol is a component of a number of drugs taken in overdose (OD). The influence of alcohol use (acute or chronic) on the presentation and clinical course of paracetamol OD is contentious. This study explores the relationship between paracetamol OD, alcohol consumption and clinical outcomes at a regional Australian hospital. AIMS: To determine the frequency, circumstances and outcomes of paracetamol OD presentations to a regional Australian general hospital over a 4-year period. METHODS: Medical records of patients admitted to the Ballarat Health Services (BHS) as a result of paracetamol OD between January 2000 and December 2003 were reviewed. Patient demographics, amount of paracetamol ingested, other drug coingestions, alcohol history, previous medication OD, clinical course and outcomes were recorded. RESULTS: Annual admissions resulting from paracetamol OD almost doubled during the 4 years studied. The risk of a repeat paracetamol OD was highest within 4 weeks of the initial OD. Alcohol, benzodiazepines and antidepressants were commonly coingested. The strongest predictor of severe hepatotoxicity was delayed or no N-acetyl cysteine treatment in patients consuming greater than 10 g of paracetamol or with toxic serum paracetamol levels. A history of alcohol consumption did not appear to worsen outcomes.

Audit of sedated versus unsedated gastroscopy: do patients notice a difference?

Unsedated diagnostic gastroscopy has become widely accepted as a diagnostic procedure which avoids the risk of an anaesthetic. It also provides advantages for patients and hospitals in converting the procedure to an ambulatory care investigation. Patient perception of the procedure can sometimes differ from that of medical and nursing staff. We have decided to report our usual clinical practice by auditing 100 consecutive patients undergoing this procedure in a large rural private hospital. Patient tolerance was analyzed in various categories including degree of comfort, degree of pain, ease of breathing and willingness to repeat the procedure under the same conditions. The perceived comfort rating was compared between the patient, the endoscopist and the endoscopy nurse. A total of 100 consecutive patients were evaluated; 55 chose to be sedated and 45 were unsedated. Of the 100 patients tested, 88% stated they would have the procedure the same way if a repeat procedure was required. There was no significant difference between male/female or sedated/unsedated patients. The most important consideration for patients who chose to have the procedure unsedated was the ability to speak to the endoscopist immediately post-procedure. Patient rating of pain was not significantly different between the sedated and unsedated groups. There was no significant difference in the independent assessment by the endoscopist and the nurse with respect to patient comfort in both the sedated and the unsedated groups. However, their assessment differed significantly from the patients own rating, as endoscopists and gastrointestinal (GI) nurses rated the patient degree of comfort as higher than the patients themselves (P < 0.01 for doctor/patient and nurse/patient score, Student's t-test). No complications were reported in either group of patients during the audit. Unsedated diagnostic gastroscopy is perceived to be an acceptable alternative to a sedated procedure by the majority of patients. Patients rate the procedure as more uncomfortable than their health care professionals, but the majority of patients would still have the repeat procedure the same way.

Quality assessment in private practice: the clinician as service provider.

Assessment of quality in the private practice setting may be difficult. The author has taken the view that service delivery is a key outcome of private clinician practice. A method of assessing service delivery in a private consultant physician practice setting is described.

Alcohol withdrawal in a medical-surgical setting: the 'too little, too late' phenomenon.

Alcohol withdrawal within a medical-surgical setting frequently causes management problems and negative patient outcomes. The authors describe a multidisciplinary withdrawal protocol that addresses risk management and quality of care issues. Fewer "Against Medical Advice" discharges and staff assaults, and decreased length of stay were reported as a result of the protocol's implementation.

Myocardial infarction in a rural hospital.

Little is known of the outcome of myocardial infarction in patients managed in regional hospitals, where investigational and therapeutic modalities may have limited availability. Policies in place in the Intensive Care Unit of Wimmera Base Hospital for the management of myocardial infarction are designed to ensure that current 'best practice' is followed where possible. In order to audit our practices, and to ensure that these practices lead to patient outcomes similar to those published in cardiological literature, we performed a case note audit of patients admitted with myocardial infarction. We were keen to assess the risk factors of our patients, as it has been our impression that most patients with myocardial infarction have risk factors for ischaemic heart disease. Over a three year period (1991 to 1994) 88 persons with diagnosis of myocardial infarction were discharged from the intensive care unit. The in-hospital and 30 day mortality rates were 7.95%.

Awareness of substance abuse in orthopedic patients: a survey of orthopedic surgeons.

We surveyed 178 orthopedic physicians in the Washington, DC, area to ascertain the effect on patient care of previous education in the area of drug and alcohol issues. The return rate was 75%. Of the respondents, 99% were male, average age was 46.7 years (+/- 9.3), and average number of years in practice was 15.2 (+/- 9.6). A majority of respondents indicated that they did not have training in the abuse potential of analgesics (92 [69%]), characteristics of benzodiazepine abuse (77 [58%]), or when to seek the assistance of an addiction medicine specialist for patients with chronic pain (106 [80%]). Only 41 (31%) of the orthopedists indicated that they inquire about alcohol and drug use before prescribing opiates for more than a week. We offer suggestions for self-education for interested physicians.