Organisational governance structures in allied health services: a decade of change.

A ten year review of developments in the organisation and management of allied health services in Australian acute care public hospitals reveals a steady transformation away from a medically managed universal model towards more complex and contested models of governance. This article revisits early observations about the reorganisation of allied health services and presents more recent research findings to guide managerial decision-making about restructuring the diverse disciplines that constitute allied health. A new organisational model "integrated decentralization" is presented as an approach to managing allied health services which accommodates multiple stakeholder demands in the context of New Public Management (NPM) related reforms. The focus on the institutional level is complemented by examining developments in the profile and activity of allied health at the regional, state and national levels to present a more comprehensive picture of change over the decade of the 1990s.

Cardiac organogenesis in vitro: reestablishment of three-dimensional tissue architecture by dissociated neonatal rat ventricular cells.

The mammalian heart does not regenerate in vivo. The heart is, therefore, an excellent candidate for tissue engineering approaches and for the use of biosynthetic devices in the replacement or augmentation of defective tissue. Unfortunately, little is known about the capacity of isolated heart cells to re-establish tissue architectures in vitro. In this study, we examined the possibility that cardiac cells possess a latent organizational potential that is unrealized within the mechanically active tissue but that can be accessed in quiescent environments in culture. In the series of experiments presented here, total cell populations were isolated from neonatal rat ventricles and recombined in rotating bioreactors containing a serum-free medium and surfaces for cell attachment. The extent to which tissue-like structure and contractile function were established was assessed using a combination of morphological, physiological, and biochemical techniques. We found that mixed populations of ventricular cells formed extensive three-dimensional aggregates that were spontaneously and rhythmically contractile and that large aggregates of structurally-organized cells contracted in unison. The cells were differentially distributed in these aggregates and formed architectures that were indistinguishable from those of intact tissue. These architectures arose in the absence of three-dimensional cues from the matrix, and the formation of organotypic structures was apparently driven by the cells themselves. Our observations suggest that cardiac cells possess an innate capacity to re-establish complex, three-dimensional, cardiac organization in vitro. Understanding the basis of this capacity, and harnessing the organizational potential of heart cells, will be critical in the development of tissue homologues for use in basic research and in the engineering of biosynthetic implants for the treatment of cardiac disease.

Internal market reforms of health care systems and the allied health professions: an international perspective.

Fundamental reshaping of the organization of health services is occurring in publically funded health care systems introducing internal market reforms. Management of clinical activity and the introduction of competition through contract-based processes has concentrated on the impacts on medicine and nursing. This article reports early experiences of the consequences of restructuring on the allied health professions from a five-country fieldwork study. Data suggest that decisions on new organizational structures for allied health professions are likely to effect their potential to participate competitively in the market reforms of health care systems.

Enteral nutrition in hyperemesis gravidarum: a new development.

Hyperemesis gravidarum occurs in up to 2% of pregnancies. Hospitalization is commonly required to treat dehydration and electrolyte and metabolic imbalances. Severe forms of hyperemesis gravidarum involving weight loss greater than 5% of prepregnancy weight have been associated with poor fetal growth and outcome. Hyperemesis gravidarum is a high-risk condition from a nutritional perspective. Traditional approaches to nutrition management focus on the cautious introduction of fluids and low-fat solids following resolution of acute nausea and vomiting. When trials of oral feeding fail to be tolerated, consideration should be given to the enteral route as the means of nutritional rehabilitation. A carefully designed delivery regimen combined with antiemetic therapy can prevent abdominal or sensory episodes that might precipitate further vomiting. Two case studies of the successful use of enteral nutrition in hyperemesis gravidarum are presented. Although clinical experience is limited and further research is needed, early results suggest that enteral nutrition in hyperemesis gravidarum is an effective and safe technique.

The in vivo release of 90Y from cyclic and acyclic ligand-antibody conjugates.

Yttrium binding ligands DOTA, caDTPA and CT-DTPA were each conjugated to monoclonal antibody B72.3, labelled with 90Y and injected into mice in order to assess the in vivo inertness of the antibody-linked 90Y-ligand complexes. Levels of 90Y in femur shafts of the DOTA-B72.3 mice were low, being approximately 7 and 44%, respectively, of levels in the femur shafts of the caDTPA-B72.3 and CT-DTPA-B72.3 treated mice. This finding demonstrates the greater inertness and by implication the greater suitability for immunotherapy of the DOTA-90Y complex.

Hospital restructuring--the implications for allied health professions.

Allied health professionals are not immune to the forces affecting the health care system at the macro-policy and political level. Policy implementation at the organisational level can have serious consequences for health professions which are not effectively scanning the broader health care agenda and developing systematic strategic responses. This paper will explore the changing work environment for allied health professions as a result of current trends in organisational restructuring. Five models of hospital organisation will be presented and examined in terms of their potential impacts on the allied health professions.

Elevated DNA topoisomerase II activity in nitrogen mustard-resistant human cells.

A human Burkitt lymphoma cell line, Raji-HN2, made 10-fold more resistant to nitrogen mustard (HN2) than the parental Raji cell line, exhibited the following characteristics when compared to the parental Raji cells: (i) decreased HN2-induced DNA interstrand crosslinking; (ii) increased (3-fold) DNA topoisomerase II [DNA topoisomerase (ATP-hydrolyzing), EC 5.99.1.3] activity; (iii) increased (4- to 11-fold) sensitivity to topoisomerase II inhibitors; (iv) increased (2-fold) glutathione content; and (v) increased (2-fold) cell doubling time. The resistant phenotype was unstable and was maintained by weekly treatment of the cells with HN2. Growing the resistant cells in the absence of HN2 resulted in a time-dependent decrease in both resistance to HN2 and topoisomerase II activity and an increase in DNA interstrand crosslinking induced by HN2. We hypothesize that HN2 resistance is due to enhanced monoadduct repair with resultant decreased DNA crosslinking and that this process is mediated by topoisomerase II.

Elevated topoisomerase II activity and altered chromatin in nitrogen mustard-resistant human cells.

A human Burkitt's lymphoma cell line (Raji-HN2) made resistant to nitrogen mustard, a bifunctional alkylating agent, was used to study the mechanism of resistance to nitrogen mustard. A comparative study of Raji-HN2 and the parental sensitive Raji cell lines revealed the following: (1) The DNA of Raji-HN2 cells was crosslinked by nitrogen mustard to a lower extent than Raji DNA; (2) once interstrand crosslinks were formed, they were repaired at the same rate in both cell lines; (3) DNA crosslink formation in Raji-HN2, but not in Raji cells, was enhanced by novobiocin, a topoisomerase II inhibitor; (4) Raji-HN2 cells had elevated topoisomerase II activity and were hypersensitive to topoisomerase inhibitors (amsacrine, novobiocin, teniposide); (5) similar amounts of topoisomerase I were found in both cell lines; and (6) the chromatin of Raji-HN2 but not of Raji cells, was hypersensitive to DNase I digestion. The relationship between DNA repair, topoisomerase II activity, chromatin structure and drug resistance is discussed.

Dietetic staffing in Australian general hospitals.

In order to ascertain the existing and required staffing patterns of Australian dietitians, the 190 general hospitals in Australia which claim to provide an on premises dietetic service were surveyed. The questionnaire was directed to the dietitian in charge at each hospital. The 97 responses have been analysed to produce a histogram of hospital versus beds, histograms of hospitals versus required and existing dietitians, a correlation matrix for staffing predictors, regression analysis of staffing versus the predictors, a discussion of variance, and other results.