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Biomedical subjects

K P Dawson

Publications and source records attributed to K P Dawson.

At least 19 recordsLinked to original sources
PubMed1992

Observations on the management of childhood acute asthma in a large hospital.

OBJECTIVE: To study the documentation of assessment, the treatment and the follow-up arrangements for children admitted to hospital with acute asthma. DESIGN: A retrospective audit of case notes. SETTING: Tertiary level teaching hospital. MAIN OUTCOME MEASURES: A comparison with the asthma management plan issued by the Thoracic Society of Australia and New Zealand. RESULTS: We found poor documentation of assessment of asthma severity, low referral rates for asthma education, and inappropriate use of chest radiography. Bronchodilator therapy did not follow published guidelines. Good follow-up arrangements were achieved. CONCLUSIONS: The proportion of children with documentation of the assessment of acute asthma was unacceptably low.

Acute Disease↗
PubMed1992

The discharge letter and data collection--a method for avoiding duplication.

It frequently happens that following a patient consultation similar data are recorded in a number of ways in a number of places. This paper describes a method which has been used in one busy clinic to capture this data only once, effecting a saving in consultant's time, avoiding delay in data capture and ensuring consistency of databases. The implementation, using a mixture of custom programs and commercial database software, is discussed. Examples of the sort of data input and user interfaces and some future directions for extension are given. Limitations of commercial packages encountered are mentioned.

Data Collection↗
PubMed1992

Attitude and assessment in nurse education.

This paper considers the difficulties and dangers inherent in attempts to assess attitude as an aspect of learning. It considers the definition of the concept, some implications for educational programmes, and the means and validity, in this context, of different assessment techniques. Finally, a form of learner profile is proposed as a possible means of assessing this aspect of learning--but it is emphasized that this will only have the status of a formative assessment. The importance of appropriate attitudes in the professional nurse is acknowledged, but the danger of simplistic behavioural tools is highlighted.

Attitude↗
PubMed1992

The prehospital management of children with acute asthma.

Parents of 100 children admitted sequentially to hospital with acute asthma were interviewed in order to determine the frequency of the use of asthma action plans and the intensity of prehospital treatment. The results revealed that 51% of the parents possessed some form of action plan and 84% of this group used their plan prior to the child's admission to hospital. However 79% of those children with more than two prior hospital admissions for asthma had an action plan. Bronchodilator therapy was widely used, with widespread possession of nebulizer units, but tended to be given infrequently prior to hospital admission. Steroid use in the acute attack was inadequate. Despite a concurrent national asthma campaign prehospital management was considered to be suboptimal.

Acute Disease↗
PubMed1992

The paediatric hospital medical record: a quality assessment.

The objective of this study was to assess the quality of the medical contribution to patient records in a children's department. It was carried out in a tertiary level teaching hospital. A structured audit of 100 randomly selected case records, with independent observers using a grading system for 3 of the measures, was performed. The outcome provides a comparison with the hospital's guidelines for case histories and notes. The results of this study show inadequate documentation of basic information. Communication was hindered by poor hand writing and the use of abbreviations. Overall comprehension of the course of the patients' illnesses was regarded as only fair to average. Recording of diagnosis and initial plans of management were present in over 70% of records. While discharge information was well recorded, the recommendation for the duration of drug therapy was inadequate. Mediocre handwriting and poor documentation are still prevalent in medical records. Strict supervision of this important area of medical practice is mandatory.

Child↗
PubMed1992

Towards a quantitative description of asthmatic cough sounds.

This study describes a method of quantitatively characterizing cough sounds using digital signal processing techniques. Differences between asthmatic and non-asthmatic cough sounds are presented. Coughs from 12 asthmatic and 5 non-asthmatic subjects were analysed. Cough sounds and flows were digitized, at a sampling rate of 5 kHz, before and after a free-running exercise test. Individual coughs were divided into two or three phases, corresponding to the initial glottal opening burst, the quieter middle phase, and (sometimes) the final closing burst. Standard signal processing techniques were then invoked to characterize the spectral and temporal shapes of the first two phases. Factor analysis indicated that the spectral shapes of the two phases are independent, with each being largely described by the degree of "peakedness" in the spectrum, and by the balance of energy between low and high frequencies. Both the duration of the initial burst and zero-crossing rates of the cough waveform (which indicates the "spectral balance") during each of the first two phases were smaller for asthmatic than for non-asthmatic coughs. Fewer asthmatic coughs contained a final burst. Discriminant analysis between the two groups gave classification error rates of 20-30%. The peak flow recorded during the cough was significantly smaller for asthmatics, and correlated very well with the peak flow recorded during forced expiration. Thus, significant differences exist between asthmatic and non-asthmatic cough sounds. An effective representation of the temporal structure of the cough sound is required to successfully characterize the cough.

Asthma, Exercise-Induced↗
PubMed1991

Molecular screening of cystic fibrosis patients.

A method for the direct direction of the delta F508 mutation in the cystic fibrosis gene has been developed and applied to the analysis of over 280 individuals including 104 individuals with cystic fibrosis. This technique allows the rapid analysis of DNA from whole blood, Guthrie card blood spots, and the antenatal diagnosis of cystic fibrosis from chorionic villus biopsy samples. Based on these analyses, the delta F508 mutation is found in 77.88% of cystic fibrosis chromosomes in New Zealand cystic fibrosis patients. Thus this test can be used to establish a direct DNA diagnosis in over 60% of cystic fibrosis patients. Approximately a further 30% are heterozygous for this mutation.

Alleles↗
PubMed1991

A paediatric day ward: parental expectations, perceptions, and satisfaction.

OBJECT: to evaluate an acute paediatric day ward service from the parental perspective. METHODS: parental interview using structured questionnaire. RESULTS: overall satisfaction with the day ward concept and practice was high. Specific delays in the admission and management process were highlighted, as were concerns over practical issues such as parking facilities, pharmacy support, and perceived staff workload. CONCLUSIONS: the broad aims of the unit are being met. Areas for potential improvement are defined and discussed.

Consumer Behavior↗
PubMed1991

Severe acute laryngotracheitis in Christchurch 1980-90.

A review of children admitted to Christchurch Hospital with acute laryngotracheitis over a 10 year and nine month period revealed that 894 admissions occurred for this condition. Forty-four (4.9%) were admitted to the intensive care unit of the hospital, of whom 12 (1.3% of all laryngotracheitis admissions) required endotracheal intubation. The mean time of intubation was 170 hours (range 24-432). There were no deaths, although seven children who were intubated had serious complications, of which perforation of a gastric ulcer was the most important. In our group of patients intubation is a rare event, and the need for aggressive treatment with dexamethasone at the time of admission to the general ward is questioned.

Airway Obstruction↗
PubMed1991

Admission patterns for childhood acute asthma: Christchurch 1974-89.

OBJECT: to examine trends in hospital admission for acute childhood asthma in Christchurch over the period 1974-89. METHODS: trends in the estimated annual rates of admission and readmission for asthma were compared between boys and girls in each of three age groups: 0-4 years, 5-9 years, 10-13 years. RESULTS: for both sexes there was a 4.5-5 fold increase in overall rates of admission during the survey period. Boys on average had higher admission rates than girls with this effect being most marked in the preschool age group. Since the mid 1980s there has been a changing pattern of admissions with a downward trend in admission rates for school aged children and a continuing upward trend in the preschool age group. An alarming new trend is a rise in the numbers of preschool girls admitted with acute asthma: admission rates for this group have shown a three-fold increase since 1983. CONCLUSIONS: possible reasons for the changing pattern of admissions are discussed, with emphasis on the possible role of the increased use of cromoglycate and inhaled steroid in older children. Further research is needed to determine whether the trends in these data are reflected throughout the country.

Acute Disease↗
PubMed1991

A paediatric day unit: the first year's experience.

In June 1989 a day unit was introduced into the paediatric department of Christchurch Hospital. Over the subsequent year, 1308 admissions occurred to the unit. Five hundred and thirty (40.6%) of the children were discharged home on the day of referral, only 22 (4%), were readmitted to the inpatient facility within a week of their first assessment. The common conditions dealt with were asthma and acute respiratory tract infection and the pattern generally reflected that normally seen in the inpatient wards. The average stay in the day unit was four hours thirty minutes. The day unit has proved to be effective in reducing overnight inpatient admissions but it requires a higher staff ratio than allocated to ensure rapid and efficient turnover. Utilisation on the weekends and wider use by other specialities dealing with children would increase the units effectiveness further.

Adolescent↗
PubMed1991

The assessment of dehydration in congenital pyloric stenosis.

In a retrospective review of the records of 88 infants who underwent a Ramstedt pyloromyotomy for pyloric stenosis, biochemical and clinical measures were used to determine the most useful guide to the degree of dehydration on admission. The only measure which correlated to the dehydration was the clinical assessment (r = 0.62). Apart from indicating the presence of alkalosis and hypochloraemia, serum chloride and serum bicarbonate levels were not useful measures. While clinical measures show only a degree of linear correlation with dehydration, they do present the most useful baseline to judge fluid requirements. Biochemistry is needed to measure the electrolyte and acid base imbalance found in the condition.

Body Weight↗
PubMed1991

Parental perceptions of paediatric inpatient care.

The parents of 206 children admitted to a paediatric department completed a structured questionnaire, 4-6 days after their child's discharge from hospital. The aim of the study was to assess the parents perceptions of the quality of care given over a range of measures. Overall satisfaction was in the order of 86%. Areas of discontent were in the admission process, information about available hospital facilities and information on the future management of the child's illness.

Child↗
PubMed1991

A microcomputer-based interactive cough sound analysis system.

The occurrence and nature of cough sounds, especially those occurring in asthma in young children, is of considerable interest to workers in paediatrics and general practice. To facilitate our research into the characteristics of such sounds, we have developed a microcomputer-based analysis system, which we call COFF. In this paper we discuss the design and implementation of the system, emphasising its user-friendly, interactive features, and the manner in which it efficiently manages the large amounts of data that research into sounds incurs. We illustrate the operation of the system with examples of spectrograms computed from cough sounds recorded simultaneously at the mouth and through the chest wall.

Asthma↗