Inform Future Decisions Research Articles

University of Washington School of Medicine

University of Washington School of Medicine

Chemotherapy-induced Liver Injury in Metastatic Colorectal Cancer: Semiquantitative Histologic Analysis of 334 Resected Liver Specimens Shows That Vascular Injury but not Steatohepatitis Is Associated With Preoperative Chemotherapy

The use of newer chemotherapeutic agents before resection of colorectal cancer liver metastases has been linked with parenchymal liver injury, in particular preoperative irinotecan and oxaliplatin with chemotherapy-associated steatohepatitis (CASH) and vascular parenchymal injury, respectively. We retrospectively assessed 334 cases from 2002 to 2007 and correlated pathologic findings with chemotherapy use and perioperative course. Features of fatty liver disease were graded according to established schemes, and several features of vascular injury, including sinusoidal dilation, nodular regenerative hyperplasia and parenchymal extinction lesions (PELs), were also scored semiquantitatively and a combined vascular injury (CVI) score was determined. Moderate and severe fatty injury was uncommon with steatohepatitis detected in 8 cases (2.4%), 7 of whom did not receive chemotherapy. Multivariate analysis showed steatosis greater than 33% and steatohepatitis were independently associated with Body Mass Index of 30 or more (P<0.001) but not chemotherapy. Vascular injuries were detected in 117 cases, were significantly associated with oxaliplatin, and the combined assessment of vascular features (a CVI score of 3 or more) was more strongly associated with oxaliplatin (P=0.0004) than any one feature in isolation. Perioperative outcome was not associated with parenchymal injury or preoperative chemotherapy. We conclude that although CASH is uncommon in this population vascular injury is frequently seen in resection specimens, but pathologic examination limited to sinusoidal dilation misses the majority of these. Semiquantitative measurement enables reproducible assessment of vascular injuries, allows comparison between studies, and may help inform future treatment decisions in patients with limited hepatic reserve.

Public private partnerships: an exploratory study in health care

PurposePublic private partnerships (PPPs) are a relatively new policy that some governments now use to secure infrastructure assets. The objective of this paper is to document the construction and development of a Victorian state government hospital, Casey Hospital (CH), to identify the essential features of this contract and the relationship between the government and the private sector provider.Design/methodology/approachA case study approach is employed. The boundaries of the CH case study are limited to the identification of the service or program that was/is subjected to PPP, the reasons for adopting the PPP policy in this instance and what the criteria were that led to a successful/unsuccessful outcome for this project. Data collection methods included interviews with key participants and analysis of archival documentation.FindingsThe findings suggest that clear outcomes as specified in the contract specifications, previous experience in the hospital sector and a willingness to be flexible were key factors that resulted in a successful outcome. The government defines success for PPP projects as being built on time and within budget.Research limitations/implicationsGiven that governments in Australia and in many developed countries worldwide have now accepted the procurement model known as public private partnerships, further research is required to ensure that future projects meet defined objectives. This study provides an analysis of one case study and further research needs to be carried out for a thorough assessment of this policy.Originality/valueCasey Hospital was the first hospital in Australia to be constructed and its ancillary facilities operated under the auspices of a PPP policy. This study is significant as public sector managers can use the findings of this report to help inform future decision making with respect to PPP projects.

Choice and preference in the Thames floodplain: the beginnings of a participatory approach?

Research carried out by the Flood Hazard Research Centre suggests that members of the public have particular preferences for the management of river environments. Research in study areas along the River Thames is currently examining people's preferences concerning proposed flood alleviation schemes that are likely to have a significant impact on the environment. This paper looks first at the British institutional setting and secondly proceeds to discuss issues including: the perception of the floodplain environment by floodplain dwellers; response to changes or proposed changes to this environment aimed at alleviation of the flood risk; the existence of a possible trade-off between maintenance of the integrity of a given environment and acceptance of the flood risk; the adoption of “bottom up” approaches to decision making and whether allowing people a greater participatory role in the process will lead to more environmentally sound river corridor management. This research is aimed at the construction of a conceptual framework for gauging the aspirations of residents in relation to the environment in flood-prone areas. Such a framework should allow a more meaningful analysis of past developments and inform future decisions.

Looking Back to the Future

A sense of history is important for managers of modern corporations; par ticularly for those concerned with human resource management because all change has deep roots in the past and much of it is effected through people. The idea af a corporate history is not new, but those man agers who are content with histories that simply celebrate past achievements fail to take advantage of the special skills of historians. Corporate historians can be used in management training to help explain corporate cultures and to extend the experience of managers and employees. They can enhance cor porate planning, help explain current situations, inform future decisions and preparefor change. Historians can also be used in more tangible areas to provide legal support, material for product marketing and advertising and company promotion.