Trends in the use of hospital beds by older people in Australia: 1993-2002.
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Age Factors↗
Biomedical subjects
Mark Mackay
Publications and source records attributed to Mark Mackay.
Choice of models for the analysis and forecasting of hospital beds.
There is growing concern that current health care services are not sustainable. The compartmental flow model provides the opportunity for improved decision-making about bed occupancy decisions, particularly those of a strategic nature. This modelling can be applied to complement infrastructure and workforce-planning methods. Discussion about appropriateness of the level of model complexity, the degree of fit and the ability to use compartmental flow models for generalization and forecasting has been lacking. The authors investigated model selection and assessment in relation to hospital bed compartment flow models. A compartment model for a range of scenarios was created. The training and test data related to the 1998 and 1999 calendar years, respectively. The majority of scenarios tested were based upon commonly used periods that describe periods of time. The goodness-of-fit achieved by optimisation was measured against the training and test data. Model fit improved with increasing complexity as expected. The analysis of model fit against the test data showed that increasing model complexity did result in over-fitting, and better prediction was achieved with a relatively simple model. In terms of generalisation, the seasonal models performed best. Single day census type models, which have been used by Millard and his colleagues, were also generated. The performance of these models was similar, but inferior to that of the models generated from a full year of training data. The additional data make the models better able to capture the variation across the year in activity.
Bed Occupancy↗
Modelling variability in hospital bed occupancy.
A stochastic version of the Harrison-Millard multistage model of the flow of patients through a hospital division is developed in order to model correctly not only the average but also the variability in occupancy levels, since it is the variability that makes planning difficult and high percent occupancy levels increase the risk of frequent overflows. The model is fit to one year of data from the medical division of an acute care hospital in Adelaide, Australia. Admissions can be modeled as a Poisson process with rates varying by day of the week and by season. Methods are developed to use the entire annual occupancy profile to estimate transition rate parameters when admission rates are not constant and to estimate rate parameters that vary by day of the week and by season, which are necessary for the model variability to be as large as in the data. The final model matches well the mean, standard deviation and autocorrelation function of the occupancy data and also six months of data not used to estimate the parameters. Repeated simulations are used to construct percentiles of the daily occupancy distributions and thus identify ranges of normal fluctuations and those that are substantive deviations from the past, and also to investigate the trade-offs between frequency of overflows and the percent occupancy for both fixed and flexible bed allocations. Larger divisions can achieve more efficient occupancy levels than smaller ones with the same frequency of overflows. Seasonal variations are more significant than day-of-the-week variations and variable discharge rates are more significant than variable admission rates in contributing to overflows.
Australia↗
Fits, faints and funny turns in children.
BACKGROUND: Seizures and epilepsy are a common problem in childhood. There are many other paroxysmal disorders that can mimic seizures and it is important to exclude these conditions before diagnosing epilepsy and making the decision to commence anticonvulsant treatment. OBJECTIVE: This article discusses the features that differentiate seizures from nonepileptic events in children and adolescents. DISCUSSION: Diagnosis of epileptic seizures is largely dependent on the clinical history. Modes of presentation include collapse, loss of consciousness, staring, altered responsiveness, limb movements and nocturnal events. Electroencephalography is helpful in confirming the diagnosis and differentiating between focal and generalised seizures.
Adolescent↗
Cortical dysplastic lesions in children with intractable epilepsy: role of complete resection.
OBJECT: The authors conducted a study to determine seizure-related outcomes in a group of pediatric patients with pathologically proven focal cortical dysplasia (FCD) treated by focal cortical resections and multiple subpial transections (MSTs). METHODS: The authors performed a retrospective review of pediatric patients in whom surgery was conducted to treat medically refractory epilepsy secondary to cortical dysplasia between April 1989 and January 2001. Diagnostic studies included preoperative scalp electroencephalography (EEG), magnetic resonance (MR) imaging, positron emission tomography (PET), and magnetoencephalography (MEG). Intraoperative electrocorticography (ECoG) or extraoperative subdural grid EEG monitoring was performed in all patients. Seizure outcome was classified using the Engel scheme. The authors analyzed nine data points and compared these with seizure outcome, including seizure semiology, MR imaging, PET and MEG data, as well as location of resection, intracranial video-EEG findings, MSTs, postresection ECoG data, and histological findings. The authors analyzed data obtained in 39 children in whom the follow-up interval after epilepsy surgery was at least 18 months. Patients had suffered epilepsy for a mean of 7.7 years prior to surgical intervention and their mean age at treatment was 9.6 years (range 2 months-18 years). A good seizure-related outcome was demonstrated in 28 patients (72%), including 21 (54%) who were free of seizures (Engel Class I) and seven (18%) in whom seizures were rare (Engel Class II). In 11 patients seizure-related outcome was less favorable, including six (15%) with worthwhile improvement involving some seizures (Engel Class III) and five (13%) with no postoperative seizure improvement (Engel Class IV). There was no significant correlation between seizure outcome and data related to seizure characteristics, MR imaging, PET scanning, MEG, location of resection, intracranial video-EEG, postresection ECoG, and histological findings. Eight (50%) of 16 patients who underwent MSTs in addition to incomplete resection of FCD experienced a good outcome (Engel Class I and II). Twenty (87%) of 23 patients in whom resection of FCD was complete and in whom MSTs were not performed experienced a good seizure outcome (p < 0.05). CONCLUSIONS: Complete resection of FCD results in good seizure outcome in a majority of children. When conducted in conjunction with incomplete cortical resection, MSTs do not improve seizure outcome in patients with FCD. Focal cortical dysplasia located outside of eloquent cortex and complete excision of the lesion are the most important predictors of seizure outcome.
Adolescent↗
Prospective preliminary analysis of the development of autism and epilepsy in children with infantile spasms.
The objective of this study was to compare the efficacy of corticotropin (ACTH) versus vigabatrin in treating infantile spasms and to determine which medication has a more favorable long-term outcome in terms of cognitive function, evolution of epilepsy, and incidence of autism. Patients with infantile spasms were included in the study if they were 3 to 16 months old, had hypsarrhythmia, and had no previous treatment with vigabatrin or corticosteroids. Patient evaluation included electroencephalographic and psychometric measures before and after treatment. Patients were stratified based on etiology (idiopathic or symptomatic) and sex and then randomized between the ACTH and vigabatrin treatment groups. Each of the treatment groups received either ACTH or vigabatrin for 2 weeks. At the end of 2 weeks of treatment, patients were considered responders if spasms and hypsarrhythmia resolved. Nonresponders were crossed over and treated with the alternate drug. Nine patients were included in the study. Three patients received ACTH, one of whom was a responder. Six patients received vigabatrin, three of whom were responders. The five nonresponders received both therapies. All patients had some degree of developmental plateau or regression before the initiation of treatment. Four patients with idiopathic infantile spasms showed improved cognitive function following treatment. The remaining five patients remained significantly delayed. Five patients with symptomatic infantile spasms had epilepsy following treatment; three of them were in the autistic spectrum. The small number of infants in this pilot study is insufficient to determine which of the two drugs is more effective. However, the following trends were identified: vigabatrin may be more effective for patients with symptomatic infantile spasms; patients with idiopathic infantile spasms tend to have a better cognitive outcome; and patients with symptomatic infantile spasms tend to develop both epilepsy and autism.
Adrenocorticotropic Hormone↗
Treatment of infantile spasms: an evidence-based approach.
The object of this work was to subject established empirical medical treatment regimens for infantile spasms to evidence-based medicine analysis in order to determine the current best practice for the treatment of infantile spasms in children. Clinical studies of infantile spasms reported during the presteroid era were reviewed critically to define the natural history of the disorder. Treatment trials of infantile spasms conducted since 1958 were rigorously assessed using MEDLINE and hand searches of the English language literature. Inclusion criteria were the documented presence of infantile spasms and hypsarrhythmia. Outcome measures included complete cessation of spasms, resolution of hypsarrhythmia, relapse rate, developmental outcome, the presence or absence of epilepsy, and/or an epileptiform electroencephalogram. Evidence was defined as class I, II, or III, and practice parameter recommendations were made using the framework devised by the American Academy of Neurology. Class I and III evidence support a standard of practice recommendation for the use of vigabatrin in the treatment of infantile spasms in children with tuberous sclerosis. Class I and III evidence support a guidelines recommendation for the use of either ACTH or vigabatrin in infantile spasms in nontuberous sclerosis patients. There is no strong evidence that successful treatment of infantile spasms improves the long-term prognosis for cognitive outcome or decreases the incidence of later epilepsy. A practice option recommendation for the use of oral corticosteroids in the treatment of infantile spasms is supported by limited and inconclusive class I and III data. Based on the evidence, no recommendation can be made for the use of pyridoxine, benzodiazepines, or the newer antiepileptic drugs in the treatment of infantile spasms. ACTH and vigabatrin are the most effective agents in the treatment of infantile spasms, but concerns remain about the risk/benefit profiles of these drugs.
Adrenocorticotropic Hormone↗