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Biomedical subjects

G R Close

Publications and source records attributed to G R Close.

2 recordsLinked to original sources
PubMed1995

Paediatric appendicectomy in NSW: changes in practice over time and between groups.

The present study examined patterns of appendicectomy among 0- to 14-year-old children in New South Wales between 1986 and 1989/90. The study, which used routinely collected hospital separation data, showed that the overall rate of appendicectomy in this age group in 1989/90 was 2.5 per 1000 which was a significant (P < 0.01) reduction on the 1986 rate. The rate of appendicectomy with histologically confirmed appendicitis was 1.8 per 1000 in 1989/90 which was significantly (P < 0.01) lower than the corresponding rate for 1986. The proportions of appendicectomies with perforation (10% in 1989/90) and without acute appendicitis ('negative' appendicectomy; 28% in 1989/90) were comparable to previous Australian and overseas reports and changed little during the study period. Differences in the rates of appendicectomy and of perforated appendices were found between geographic areas. However, the area-specific rates of perforation were not systematically associated with the corresponding rates of negative appendicectomy. The proportion of negative appendicectomies was higher among female than male children (35% of females compared with 25% of males in 1989/90). The youngest age group (0-4 years) had the highest proportion of perforations: 27% compared with 13% in the 5-9 year and 8% in the 10-14 year age groups. We conclude that appendicectomy is now performed less frequently in NSW than in previous years. Surgical practice in relation to appendicectomy in NSW provides outcomes that compare favourably with previous Australian and overseas experience. Although the proportion of perforations is relatively low, the comparatively high proportion of perforations in the youngest age group is of concern.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1993

Variation in selected childhood surgical procedures: the case of tonsillectomy and management of middle ear disease.

We examined rates of the most common ear, nose and throat (ENT) surgical procedures among NSW residents under 15 years of age, against a background of concern for the relevance of differences in clinical practice to cost and quality of health care. We found significant (P < 0.01) increases in the rate of procedures involving myringotomy (from 5.8/1000 to 7.6/1000) or adenoidectomy (from 5.6/1000 to 6.3/1000) between 1986 and 1989/90. Over this period the proportion of ENT procedures which involved myringotomy also increased significantly (P < 0.01) from 53 to 60%. We found significant (P < 0.01) differences in procedural rates between health areas when aggregated into inner and outer metropolitan and rural groups with the mean rate of procedures involving myringotomy highest in the outer metropolitan group in both years. The difference was not due to variation in patient insurance status, per capita hospital bed or staff numbers. We found no evidence that the National Health and Medical Research Council Tonsillectomy and Adenoidectomy Guidelines (first published in 1982) have been effective in influencing clinical practice. The rate of tonsillectomy had been declining in NSW since the late 1970s but has remained stable in recent years. Surgical intervention for middle ear disease is increasing.

Adenoidectomy↗