Objective: Design and setting: Prospective modelling with the tools FluSurge 2.0 and FluAid 2.0 (developed by the United States Centers for Disease Control and Prevention) over 12 weeks from when the pandemic “Contain” Phase was declared on 22 May 2009, compared with data obtained from daily hospital reports of pandemic (H1N1) 2009 influenza‐related admissions and transfers to intensive care units (ICUs). Main outcome measures: The effect on hospitals as projected by the FluAid 2.0 model compared with observed hospital admissions and ICU admissions. Results: Prospective use of the FluAid 2.0 model provided valuable health intelligence for assessment and projection of hospitalisation and critical care demand through the first 10 weeks of the pandemic in Victoria. The observed rate of hospital admissions for pandemic (H1N1) 2009 was broadly consistent with a 5% gross clinical attack rate, with 0.3% of infected patients being hospitalised. Transfers to ICUs occurred at a rate of 20% of hospital admissions, and were associated with vulnerable patient groups, and severe respiratory failure in 82% of patients admitted to ICUs. Most patients treated in ICUs (85%) survived after an average ICU length of stay of 9 days (SD, 6.5 days). Mechanical ventilation was required by 72% of patients admitted to ICUs, and extracorporeal membrane oxygenation (ECMO) was used for 7%. Pre‐existing haematological malignancy accounted for half of all the deaths in patients admitted to ICUs with pandemic (H1N1) 2009 influenza. Conclusions: Prospective use of modelling tools informed critical decisions in the planning and management of the pandemic. Early estimation of the clinical attack rate, hospitalisation rates, and demand for ICU beds guided implementation of surge capacity. ECMO emerged as an important treatment modality for pandemic (H1N1) 2009 influenza, and will be an important consideration for future pandemic planning.

Our study highlights the efficacy and utility of simulation in assessing personnel team dynamics and confidence levels and knowledge of emergency airway scenarios. Practitioners in all fields and level of experience benefit in EART training and simulation. We hope that with this information, we will be able to conduct future studies on reduction of patient morbidity and mortality.

Objective To study the suitability of diagnosis‐related groups (DRGs) to quantify blood use in order to fund hospitals directly for fresh blood components. Design (i) Retrospective empirical analysis of hospital inpatient separation data, matching DAG classification with blood usage. (ii) Prediction of blood usage based on actual DRGs and comparison with actual blood products issued from the blood service. Setting Eight large public hospitals, April 1994 ‐ March 1995, the Department of Human Services and the Australian Red Cross Blood Service in Victoria, 1994‐1997. Main outcome measures Requirement for transfusion according to DAG; quantity of blood or blood products transfused; and statistical reliability of measuring blood component usage by DAG. Results A match between patient records and transfusion records for 287117 patient separations showed that the patients had received 51 115 units of red cells, 30 451 units of platelet concentrates, 9043 units of fresh frozen plasma and 1273 units of cryoprecipitate. Ten per cent of DRGs (527) accounted for over 70% of blood product usage. The numbers of DRGs in which blood products were used for at least 30 separations (with a relative SEM [for units of blood used per separations using blood] of up to 20% at a 95% confidence level) were 56 for red cells, 8 for platelets and 4 for fresh frozen plasma. Estimates of red cell usage calculated from actual DRGs for three consecutive years (1994‐1997) showed that DRGs predicted aggregate issues of red cells by the Red Cross Blood Service (ratio of actual red cells issued to red cell usage estimates were 1.036 for 1994‐95, 0.994 for 1995‐96, and 1.021 for 1996‐97, respectively). Conclusion DRGs are moderately good predictors of blood product usage, and could be used to allocate funds for blood products to hospitals instead of to the blood service. However, DAG data are not designed to manage blood issue policies, because DRGs do not represent single diagnoses or procedures and some are surrogate descriptions of procedures.

Background Chronic sinusitis is a common otolaryngologic complaint with a significant impact on patients’ quality of life. There is current debate and differences in quality of evidence regarding the best surgical management approach to pediatric chronic sinusitis. Objective To investigate changes in publishing trends over time in surgical management of pediatric chronic sinusitis. Methods A systematic literature review was conducted in January 2019 using Embase, PubMed, and Web of Science, of all articles that included surgical treatments for pediatric chronic sinusitis. Publications were grouped into 3 time periods: pre-1998, 1999–2008, and 2009–2018. In addition, a subgroup of publications pertaining to endoscopic sinus surgery, balloon sinuplasty, and adenoidectomy were grouped into 2-year periods since 1988 to compare the number of publications on each topic and to examine overall trends. Results A total of 327 abstracts were included in the data collection and analysis. There was an overall significant increase in total number of publications ( P < .0001), total number of authors ( P = .001), and comparison studies ( P = .003) from pre-1989 to 2018. Relative number of prospective studies, systemic review, and case studies/expert opinions have not significantly increased over time when comparing decades ( P > .05). Among the surgery types, functional endoscopic sinus surgery has the most amount of publications regardless of year despite a statistically significant increase in publications pertaining to balloon sinuplasty in the pediatric literature from 1999–2008 to 2009–2018 ( P = .001). Conclusions Studies on pediatric chronic sinusitis have increased significantly during each of the last 2 decades with an increase in the concomitant number of authors and comparison studies. Although most publications are still Level C or D evidence, there has been a nonsignificant increase in Level A evidence in the past decade. Endoscopic sinus surgery still remains the most studied procedure despite the recent increase in publications on balloon sinuplasty.

Consumers regard access to hospital services as one of the key components of quality in health care delivery. A mixed public/private system operates in Victoria, but a morbidity collection from private hospitals was commenced only relatively recently. In 1993-94 the collection covered 82 per cent of private hospital separations, and it was considered timely to examine the utilisation patterns in the private system and compare them with those in the public system. Medical and surgical emergencies and other complex conditions and procedures are serviced largely in the public sector, whereas private hospitals are utilised for elective and less complex surgery and non-urgent conditions. Occupancy rates are around 79 per cent in public hospitals and 67 per cent in private hospitals. Elective surgery waiting list data suggest that while urgent cases are treated within a month, significant proportions wait six months or more for non-urgent surgery. Private health insurance is the main factor in determining access to and the utilisation private hospitals. The current Medicare Agreement and the move to separate the role of purchaser and provider may allow the maximal utilisation of private hospitals and diminish the burden of chronic illness.

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