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Biomedical subjects

M I Rob

Publications and source records attributed to M I Rob.

13 recordsLinked to original sources
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↗
PubMed1998

The impact of new technology on cholecystectomy rates in New South Wales.

This study examined the impact of the introduction of laparoscopic cholecystectomy (LC) on the rate and pattern of cholecystectomy in New South Wales, Australia. An analysis of the hospital data for the period 1981-94/95 was performed, which encompassed patients of both public and private hospitals. Cholecystectomy rates in the years after the introduction of LC in mid-1990 were 24% higher on average than rates in the prior years and rose from an average 1.68-2.09 per 1000. In the 5-year period of the study after the introduction of LC, the average age of private hospital patients increased from 50.6 to 53.4 years, while that of public hospital patients declined slightly from 53.5 to 52.4 years. Laparoscopic cholecystectomy was introduced more rapidly in private than public hospitals. By June 1995, 96% of private compared with 71% of public hospitals had introduced LC, and cholecystectomy patients in private hospitals were more likely to have laparoscopic surgery than patients in public hospitals (92% compared with 80%). The introduction of LC has been accompanied by a marked and sustained increase in the cholecystectomy rate. While the unit cost for the laparoscopic procedure is lower because of a shorter length of stay, the increase in the number of procedures means that there have been no net savings for the health system from the increased efficiency. While the new procedure offers superior advantages to patients with symptomatic gallbladder disease, the effect of the apparent lower threshold for surgery needs investigation.

Adult↗
PubMed1995

Readmissions to hospital: the contribution of morbidity data to the evaluation of asthma management.

We evaluated hospital readmission as an indicator of the quality of management of asthma patients, between July 1989 and June 1990. Using hospital separation data, we constructed a matched data set to identify early (within two weeks of discharge) readmissions. Of over 14,000 admissions for asthma in the 1-to-44-year age group, 2.8 per cent were classified as early readmissions. Admissions and readmissions were more common in rural than metropolitan areas. Admissions were most common during autumn, but early readmissions occurred most often during spring. Patients staying more than one day were 0.5 times (95 per cent confidence interval (CI) 0.37 to 0.68) as likely to have an early readmission than patients staying less than one day. Using the same data set, we identified patients who had the potential for readmission within a six-month period. Of the 5052 patients, 17.8 per cent were readmitted at least once during the period; 3.7 per cent had at least one early readmission, and 15.8 per cent had at least one late readmission (more than two weeks following discharge). A length of stay of more than one day was associated with 0.41 times (CI 0.24 to 0.70) the risk of early readmission in this cohort. A length of stay of more than one day was associated with a higher risk of late readmission (1.52, CI 1.09 to 2.12), which was less likely to occur in rural than metropolitan areas (0.45, CI 0.37 to 0.55).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
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↗
PubMed1994

Assessing utilisation of health technologies: coronary artery bypass graft surgery in New South Wales.

The New South Wales health system aims to provide the most effective and efficient health care in a context of scarce resources and increasing availability of expensive technologies. The aging of the population and the management of chronic disease place further demands on the health system. Examination of the pattern of provision of services over time and between groups can serve to illustrate trends in clinical management practices which may affect other elements of the health system. In this paper we report an evaluation of the patterns of coronary artery bypass graft surgery (CABG) in New South Wales, within subgroups of the population and over time. The results demonstrate increased utilisation of this procedure in the population over recent years, particularly among the older age groups. We found differences in procedure rates between geographic areas which suggest that there are differences in the management of ischaemic heart disease between population subgroups. These patterns are examined in the context of the available literature on the health outcomes of CABG relative to other management options for ischaemic heart disease.

Adult↗
PubMed1994

Diagnostic testing during pregnancy: a descriptive analysis of utilisation data.

To describe patterns of diagnostic testing during the antenatal period and to assess the potential benefit of using Medicare claims data in monitoring testing practice, we examined the matched claims data (with identifying details removed) on approximately 10,000 women having a confinement for which a Medicare benefit was claimed between 1 July and 30 September 1990. The results showed that almost all the women included in the study sample had an ultrasound and blood group and antibody examination. A smaller proportion had serological tests for syphilis (77 per cent), rubella (51 per cent) and hepatitis B carriage (73 per cent). Two-thirds had urine microscopy and culture, and under half (40 per cent) had serum alpha-fetoprotein estimation. Few (18 per cent) had a claim processed for microscopy and culture of a genital swab and fewer than 8 per cent claimed for any other pathology tests. There were differences in the proportions having tests, depending on whether the clinician managing the confinement was a specialist obstetrician or a general practitioner, and depending on geographic area and age group. While the data do not represent all women having a confinement in New South Wales, the selective use of antenatal diagnostic tests found in this study is of considerable public health importance and analysis of claims data can provide useful information for health professionals.

Adult↗
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

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↗
PubMed1988

The role of family difficulties in adolescent depression, drug-taking and other problem behaviours.

A comprehensive self-report questionnaire that covered many aspects of adolescents' lives was administered to 1270 students in Years 7, 10 and 11 who attended seven State high schools in Sydney. The prevalences of unhealthy and acting-out behaviours increased significantly between the ages of 12 and 15 years (Years 7 and 10) and then levelled out. By the age of 15 years, 15% of adolescents were drinking alcohol at least three times a week; 30% of adolescents smoked cigarettes; 15% of adolescents had used marijuana in the past week; and 18% of adolescents had had previous sexual experience. Nine per cent of all adolescents often felt "so down or low that life has lost its meaning". The quality of the family relationship was found to be associated closely with the presence or absence of adolescent depression and unhealthy or acting-out behaviours. Where the family relationship was not close or loving, the prevalence of depression was three times as high and the prevalences of alcohol, cigarette and marijuana use and early sexual activity were about twice as high as among adolescents who perceived that their families were close and loving. The majority of adolescents with poor family relationships felt that their parents could do more to help them. Help in the form of more understanding, support, trust, time, interest and freedom was wanted much more frequently than was help in the form of material items such as pocket-money. Parental divorce or separation and having a mother who was working full-time were also associated with a perceived lack of family closeness and love. The implications of these findings for the prevention of the establishment of health-threatening behavioural patterns and suicide among adolescents are discussed.

Acting Out↗
PubMed1984

Changes in the caries experience of 12-year-old Sydney schoolchildren between 1963 and 1982.

A study of the caries experience of 12-year-old children attending public high schools in the northern suburbs of Sydney was undertaken in 1982. The data obtained were compared with those from a similar study conducted in the same area in 1963. In the period between the two examinations, Sydney's water supply was fluoridated and fluoride toothpastes became widely available. There was a major improvement in dental health in the 19-year interval between the surveys. The mean number of decayed, missing, and filled teeth (DMFT) per child declined from 8.49 in 1963 to 1.37 in 1982, a reduction of 84%. An analysis of the DMFT index showed that the greatest reductions occurred in the decayed tooth (DT), and missing tooth (MT) components (95% and 94%, respectively). In 1982, in contrast to the situation in 1963, the backlog of unmet restorative dentistry needs was low.

Australia↗