PubMed Health⌕ Search

Biomedical subjects

J I Westbrook

Publications and source records attributed to J I Westbrook.

At least 19 recordsLinked to original sources
PubMed2006

Computerised pathology test order entry reduces laboratory turnaround times and influences tests ordered by hospital clinicians: a controlled before and after study.

OBJECTIVE: To assess the impact of a computerised pathology order entry system on laboratory turnaround times and test ordering within a teaching hospital. METHODS: A controlled before and after study compared test assays ordered from 11 wards two months before (n = 97 851) and after (n = 113 762) the implementation of a computerised pathology order entry system (Cerner Millennium Powerchart). Comparisons were made of laboratory turnaround times, frequency of tests ordered and specimens taken, proportions of patients having tests, average number per patient, and percentage of gentamicin and vancomycin specimens labelled as random. RESULTS: Intervention wards experienced an average decrease in turnaround of 15.5 minutes/test assay (range 73.8 to 58.3 minutes; p<0.001). Reductions were significant for prioritised and non-prioritised tests, and for those done within and outside business hours. There was no significant change in the average number of tests (p = 0.228), or specimens per patient (p = 0.324), and no change in turnaround time for the control ward (p = 0.218). Use of structured order screens enhanced data provided to laboratories. Removing three test assays from the liver function order set resulted in significantly fewer of these tests being done. CONCLUSIONS: Computerised order entry systems are an important element in achieving faster test results. These systems can influence test ordering patterns through structured order screens, manipulation of order sets, and analysis of real time data to assess the impact of such changes, not possible with paper based systems. The extent to which improvements translate into improved patient outcomes remains to be determined. A potentially limiting factor is clinicians' capacity to respond to, and make use of, faster test results.

Chi-Square Distribution↗
PubMed2005

Use of point-of-care online clinical evidence by junior and senior doctors in New South Wales public hospitals.

BACKGROUND: The Clinical Information Access Program (CIAP), an online evidence retrieval system, provides NSW health professionals in public hospitals with 24 h access to information supporting evidence-based practice. AIM: To assess the frequency and type of CIAP usage by senior and junior medical staff and doctors' attitudes to CIAP. METHODS: A convenience sample of 25% of doctors from 65 randomly selected public hospitals completed a survey. Junior (n = 392) and senior (n = 684) doctors' responses were compared using chi2 analyses and t-tests. RESULTS: Most doctors had heard of CIAP (71.8%) and 60.6% had used it. More junior (72.4%) than senior (53.8%) doctors had used CIAP and junior doctors found it easier to use. Of the users 93.5% believed CIAP had the potential to improve patient care; 55.2% had directly experienced this. Most usage (61.5%) occurred at point-of-care; 74% of users found all/most of the information they sought and 71.6% found the search time to be 'good/excellent'. Users had increased their usage in the past year and predicted increased future usage. The most popular databases were Medline and MIMS. Age, access to other evidence, and lack of training, time and computer skills were associated with non-usage. Junior and senior users differed in 4 of 15 reasons for using CIAP. CONCLUSIONS: CIAP is used and valued by the majority of doctors. Patterns of usage, online experiences and the attitudes toward CIAP of senior doctors who use CIAP are relatively similar to those of junior doctors.

Adult↗
PubMed2004

Increased rates of ENT surgery among young children: have clinical guidelines made a difference?

OBJECTIVES: To examine the association between introduction of paediatric ear, nose and throat (ENT) surgery guidelines and population procedure rates. To determine changes in children's risk of undergoing ENT surgery. METHODS: Trend analysis of incidence of myringotomy, tonsillectomy and adenoidectomy among New South Wales (NSW) children aged 0-14 between 1981 and mid 1999. Poisson regression models were used to estimate annual rates of change pre and postguidelines introduction and age/gender specific rates, and lifetable methods to determine risk of undergoing an ENT procedure by age 15. RESULTS: ENT surgery rates increased by 21% over the study period. Children's risk of surgery increased from 17.9% in 1981 to 20.2% in 1998/99. Guideline introduction was associated with moderate short-term decreases in rates. For tonsillectomy, rates decreased between 1981 and 1983, but then rose continually until the introduction of myringotomy guidelines in 1993, when they fell, only to recommence rising until the end of the study period. For myringotomy, rates rose annually from 1981 to 1992/93 and fell in the 3 years following guideline introduction, after which they rose again. Increases were almost exclusively restricted to children aged 0-4 and correspond with increased use of formal childcare. The prevalence of myringotomy by the age of 5 years rose from 5.6% of children born in 1988/89 to 6.4% of those born in 1994/95, and the prevalence of tonsillectomy from 2.4% to 2.7%. CONCLUSIONS: The risk of young Australian children undergoing ENT surgery increased significantly over the last two decades despite the introduction of guidelines and no evidence of an increase in otitis media, one condition prompting surgery. Surgery increased most among the very young. We hypothesize this is related to increasing use of childcare.

Adenoidectomy↗
PubMed2003

Diagnostic investigation rates and use of prescription and non-prescription medications amongst dyspeptics: a population-based study of 2300 Australians.

BACKGROUND: : There is limited knowledge of the diagnostic investigation rates and use of prescription and non-prescription drugs amongst dyspeptics. AIM: : To assess the investigation rates and use of prescription and non-prescription anti-ulcer medications amongst dyspeptics in the population. METHODS: : A cross-sectional survey was performed of 2300 Australians. RESULTS: : Of 748 dyspeptics, 422 (56%) had consulted a doctor regarding dyspepsia at some time in their life. Of the consulters, 64% had undergone investigations at some time: 37% an endoscopy, 54% a barium meal and 27% both. A diagnosis of peptic ulcer was reported by 31% of those investigated. The symptom profile of gastroscopy patients differed significantly from that of uninvestigated dyspeptics. Of the consulters, 36% had taken anti-ulcer prescription drugs in the last 3 months: Histamine-2 receptor antagonists (73% of prescriptions), proton pump inhibitors (17%), cytoprotectants (5%) and prokinetic drugs (5%). Antacids were taken by 30% of non-consulting dyspeptics, 44% of consulters not on prescription drugs and 58% of dyspeptics taking prescription drugs. Advancing age, but not gender, was associated with diagnostic investigation and prescription and non-prescription drug usage. CONCLUSIONS: : There are high rates of diagnostic investigation amongst dyspeptics who consult doctors. Many individuals with dyspepsia decide to self-medicate with antacids regardless of consulting or prescriptions, suggesting that current management is suboptimal.

Adolescent↗
PubMed2002

Empiric clustering of dyspepsia into symptom subgroups: a population-based study.

BACKGROUND: Different definitions of dyspepsia are applied by researchers yet measurement of the influence of these on prevalence estimates is uncertain. Despite continued debate regarding dyspepsia subgroups, few studies have used a data-drive approach to assess the existence and relevance of symptom clusters. We aimed to address both these issues. METHODS: A random population sample (n = 2300) identified in New South Wales. Prevalence estimates of dyspepsia were calculated by applying four standardized dyspepsia definitions. Principal components analyses, using firstly the presence/absence of symptoms and then secondly severity of symptoms, were undertaken to determine if symptom factors existed. RESULTS: Prevalence estimates ranged from 11% to 36%. Similar prevalence rates for men and women were observed for all definitions except Rome II. Over one-third of respondents nominated heartburn or epigastric pain as their most bothersome symptom. However, 22% of respondents were unable to answer this question. The principal components analysis produced four symptom factors: a nausea factor, dysmotility-like dyspepsia (early satiety and fullness), ulcer-like (epigastric pain and bloating) and reflux-like (heartburn and acid regurgitation). However, the factors accounted for less than 50% of the variance. Similar factors were identified in men and women for dysmotility-like and reflux-like dyspepsia. Use of presence/absence or severity of symptoms made little difference to the symptom factors produced or the amount of variance explained. CONCLUSIONS: The prevalence of dyspepsia depends on the definition applied. While there is some empirical evidence of symptom subgroups, they appear to be of little clinical utility.

Dyspepsia↗
PubMed2001

Accuracy of provisional diagnoses of dyspepsia in patients undergoing first endoscopy.

BACKGROUND: This study assessed agreement between provisional and endoscopic diagnoses for patients with dyspepsia undergoing initial endoscopy, and examined variation between clinicians at 2 hospitals. METHODS: This was a retrospective review of 423 consecutive patients. RESULTS: Crude percentage agreement ranged from 55% to 97%. Kappa scores revealed poor agreement: peptic ulcers (0.11: 95% CI [0.05, 0.17]); gastroesophageal reflux disease (0.29: 95% CI [0.20, 0.38]); benign esophageal stricture (0.33: 95% CI [0.08, 0.58]); and cancer (0.12: 95% CI [-0.12, 0.36]). Positive and negative predictive values for cancer and benign esophageal stricture showed that agreement for a negative diagnosis was almost perfect, whereas agreement for a positive diagnosis was low. Only 17% of patients with cancer were given an accurate provisional diagnosis. Accuracy of diagnosis did not vary substantially between hospitals. CONCLUSIONS: Crude percentage agreement is misleading. Emphasis should be placed on better prediction of cancer, benign esophageal stricture, and peptic ulcer disease. Accuracy of provisional diagnosis in everyday practice is no worse than that found in prospective studies in which clinicians knew a priori that diagnoses would be scrutinized. The difficulty of predicting diagnoses supports increased reliance on endoscopy.

Confidence Intervals↗
PubMed2000

Factors associated with consulting medical or non-medical practitioners for dyspepsia: an australian population-based study.

BACKGROUND: Little is known about how many dyspeptics in the population consult medical and non-medical practitioners, or the factors associated with various consulting patterns. METHODS: A cross-sectional survey of 748 Australians with dyspepsia investigated their age, sex, dyspepsia symptoms, medical and non-medical consultations, and health status on the SF-12. RESULTS: Overall, 56% had ever consulted a medical practitioner for dyspepsia. Of these, 54% consulted within 6 months of first symptoms. Non-medical practitioners were consulted by 29%. Compared to dyspeptics in all, or most, other consulting groups, subjects who did not consult (37%, group NO) were characterized by fewer symptoms, better physical health, and younger age. Those who only consulted doctors (34%, group M) were older and had better mental, but poorer physical health. Those who only consulted non-medical practitioners (7%, group N) were younger and had better physical, but poorer mental health. Dyspeptics consulting both medical and non-medical practitioners (22%, group M + N), were older, more dissatisfied with medical care, had more symptoms and poorer physical and mental health. Timing of medical consultations was similar in groups M and M + N. Group M + N dyspeptics consulted similar types, but more non-medical practitioners than group N. No sex differences were found in consulting behaviour. CONCLUSIONS: Many dyspeptics do not consult; they have fewer symptoms than consulters. Consultation with non-medical practitioners is common and is associated with poor mental health. Dyspeptics seeking advice from both medical and non-medical practitioners are less satisfied with their medical management than those who only consult doctors for their dyspepsia.

Adult↗
PubMed1998

Agreement between medical record data and patients' accounts of their medical history and treatment for dyspepsia.

We examined agreement between data abstracted from medical records and interview data for patients with dyspepsia admitted to hospital for endoscopy, to determine the extent to which health records could be used to validate self-reports of dyspepsia and the management of this condition. Results from the sample of 220 patients showed that there was poor agreement between data sources for information about duration of dyspepsia (k=0.34) and previous barium meal examination (k=0.34). Patients reported significantly longer dyspepsia histories (Wilcoxon sign test Z=4.13, p<0.0001) and significantly more barium meals (sign test Z=8.43, p<0.0001) than were documented in their records. There was also disagreement between data sources regarding the number of drugs taken before and after endoscopy (k=0.28 and k=0.31, respectively). Where there was disagreement for number of drugs there was no significant difference in the direction of the disagreement. There was moderate agreement regarding the name of pre-endoscopy medication (k=0.55) and substantial agreement for the name of medication used post-endoscopy (k=0.62). There was very poor agreement regarding diagnosis. The medical record was the gold standard for this information. Choice of data source, medical records or self-reports, will in many instances provide significantly different results and it is likely that this may also be true for other variables of interest to researchers. Thus in the case where no gold standards are available researchers need to consider carefully the implication of choice of data source on their results.

Dyspepsia↗
PubMed1997

A glimpse into the future: a survey of the expectations and ambitions of Australian health information management students.

The future of the health information management profession is largely dependent on the ability of educational programs to attract high-caliber students who have a clear understanding of their future career when entering their course and who aspire to become active members of the profession after graduation. A sample of Australian health information management students was surveyed to obtain information about satisfaction with their career choice, employment options, and intended involvement in professional and postgraduate education activities. The survey looked for differences between the responses of students at different stages of their courses and changes in student responses over time. The majority of students believed that they had made the correct career choice. There was a general preference for nontraditional health information management employment positions on graduation and a strong commitment to professional involvement and postgraduate education. Significant differences in some questionnaire responses were found among the student groups. Students' responses to questionnaire items about their future careers were less likely to change compared with other questionnaire items. Implications of the results for the health information management profession and educational institutions are discussed.

Australia↗
PubMed1994

Evaluating health care: what can hospital separation data tell us about the complications of hospital care?

The New South Wales (NSW) Health Department is attempting to refocus the health system towards examination of the outcomes of health interventions. Increased use of existing State-wide databases to measure outcomes of services is an important part of the reorientation of the health system. Complications of hospital care is one indicator of the quality and outcomes of health services. This study analyses surgical complications occurring in NSW residents admitted to hospital during 1989/90. Over 20,000 complications were recorded during this time (corresponding to a rate of 30/1000 surgical procedures). The most common complication recorded was postoperative infection. 71% of complications occurred during a surgical admission, while 29% of complications were associated with a readmission to hospital. While the incidence of complications could be estimated, there were substantial problems with the interpretation of the data which severely limited their potential usefulness. The implications of these results for the ongoing evaluation of the quality and outcomes of hospital care are discussed.

Disease↗
PubMed1993

Diagnostic procedures and health outcomes. Upper gastrointestinal tract investigations in the elderly.

OBJECTIVES: To examine the use of upper gastrointestinal endoscopy in people 65 years of age and over in New South Wales, and compare its use between geographic areas, sex and age groups. Also, to investigate the relationship between endoscopy use and peptic ulcer mortality. DESIGN: A retrospective review of upper gastrointestinal tract (GIT) endoscopy hospital separation data for NSW from 1986 to 1989-1990 and peptic ulcer mortality data from 1979 to 1989. MAIN OUTCOME MEASURES: Rates per 1000 population aged 65 years and over were calculated for upper GIT endoscopy for each of the four-year age groups and by sex. Peptic ulcer and other digestive system disease rates for endoscopy patients were determined. Correlations between hospital standardised separation rates for endoscopy and standardised mortality rates for gastric cancer and peptic ulcers were calculated. Age and sex standardised death rates were calculated for each year between 1979 and 1989, and changes in death rates over time were determined by regression analysis. RESULTS: The rate of endoscopies increased significantly (P < 0.001) over the period 1986 to 1989-1990, with the highest rate and greatest increase occurring in patients aged 70 years and over. Men had significantly higher endoscopy rates than women (P < 0.001). Geographic variations in the use of endoscopy were found and were not explained by geographic differences in the proportion of peptic ulcers diagnosed, deaths from peptic ulcers or malignant neoplasms. Despite the increase in endoscopies performed, there was no corresponding significant increase in the rate of peptic ulcers detected. Between 1979 and 1989 peptic ulcer mortality rates for women over 74 years of age increased significantly (P < 0.05); the rate for men did not change. CONCLUSION: Many endoscopies are performed in people aged 65 years and over in NSW and there has been a substantial increase in endoscopy rates in recent years. While the increase in upper GIT endoscopy may have resulted in a number of health benefits, it does not appear to have resulted in a reduction in peptic ulcer related mortality.

Aged↗
PubMed1993

The epidemiology of peptic ulcer mortality 1953-1989: a birth cohort analysis.

Peptic ulcer (PU) disease is the cause of substantial morbidity and mortality in a number of countries including Australia. Despite diagnostic and treatment advances, sustained mortality from PU disease has been reported. To understand this problem a birth cohort analysis using the Median Polish Technique (MPT) was performed on 36 years of mortality data from New South Wales, Australia. The MPT allows cohort effects to be quantified, yet has rarely been applied to mortality data. Birth cohort effects detected using graphical presentation of mortality data for duodenal (DU) and gastric ulcer (GU) mortality data for both males and females, were supported by the results obtained using the MPT. The DU mortality rates for females increased significantly over the 36-year period. This increase can be explained by the presence of a birth cohort effect, with women born between 1898 and 1913 having a greater risk of dying from DU than preceding or subsequent generations. Cohort effects in GU and DU mortality data for males and in GU mortality for females were also present, although these were masked by the overall decline in PU mortality rates. The results support the findings of other studies of birth cohort effects in PU mortality data from England, Europe and Japan, and provide support for the existence of environmental factors which resulted in increased PU mortality among specific birth cohorts. Demonstration of these birth cohort effects should influence the theories of PU disease aetiology and prevention and should be considered in developing approaches for further research.

Aged↗
PubMed1993

Patient satisfaction: methodological issues and research findings.

Patient satisfaction plays a significant role in the health care process. It influences the health care seeking behaviour of patients, compliance with treatment and the health outcomes of patients. The use of ill-conceived and limited patient satisfaction questionnaires, in conjunction with inadequate methods of administration, have contributed to the poor reputation of patient satisfaction as an indicator of the quality of health care services. This paper addresses some of the methodological issues related to the measurement of patient satisfaction and describes validated and reliable tools which are available for use by hospitals in Australia. Research findings discussed demonstrate that patients are able to evaluate validly and reliably the quality of both clinical and non-clinical aspects of health care services. Australian health care organisations should implement patient satisfaction as a quality indicator and thereby actively seek to improve the health outcomes of their patients.

Australia↗
PubMed1993

An analysis of patient accidents in hospital.

An analysis of patient accidents occurring at St Vincent's Hospital, Sydney in 1990 was undertaken using data obtained from the hospital's computerized accident database. Ward, age and sex specific fall rates were calculated from a total of 800 patient-related accidents and incidents reported. Ninety per cent of all accidents were falls, the majority occurring in patients over the age of 60 years. Female patients experienced a significantly greater rate of accidents than male patients (P < 0.05). No significant difference in the overall fall rates for males and females was found. However males 50 years of age and under were almost twice as likely to fall as females in this age group. More than 50% of patients who fell sustained an injury; 4% of these were serious injuries. The geriatric, neurosciences and HIV wards had the highest rates of patient falls. Nearly 40% of falls involved only 77 patients who fell on multiple occasions. Preventative strategies are discussed. Patient accident data from other Australian hospitals is required for adequate assessment of the incidence of patient accidents.

Accidental Falls↗