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R L Rushworth

Publications and source records attributed to R L Rushworth.

At least 19 recordsLinked to original sources
PubMed2001

Where the data are deficient: a field evaluation of the effectiveness of pneumococcal vaccination in remote Australia.

The aims of the study were to: (i) determine whether a field evaluation of a pneumococcal vaccination program conducted in 1991-1993 could show whether the program was effective; and (ii) to describe the epidemiology of invasive pneumococcal disease using laboratory surveillance data. As part of quality assurance, we undertook a retrospective cohort study to compare the hospitalisation and mortality rates of a pneumococcal-vaccine-vaccinated and an unvaccinated group and a correlational study to compare the before- and after-vaccination hospitalisation rates for the vaccinated and unvaccinated groups. We used laboratory data to describe the epidemiology of invasive pneumococcal disease. The cohort study consisted of 815 subjects (306 vaccinated, 509 comparison). No significant differences were observed in the admission rates for pneumonia and lower respiratory tract infection between the two groups. By using a correlational study, we examined before- and after-vaccination hospitalisation rates and this also failed to reveal any differences, except for persons aged 50 years and older. Laboratory surveillance of invasive disease demonstrated that children younger than 6 years and adults younger than 50 years with alcohol-related problems accounted for most of the cases. Despite the study's limitations, it supports the use of pneumococcal vaccine in persons aged older than 50 years, while at the same time highlighting the ongoing need for better vaccines, especially for children and those aged younger than 50 years with medical conditions predisposing to pneumococcal disease.

Adolescent↗
PubMed2001

Foot orthosis prescription habits of Australian and New Zealand podiatric physicians.

This research project investigated the orthotic prescription habits of podiatric physicians in Australia and New Zealand. A 23-item questionnaire was distributed to all members of the Australian Podiatry Association and the New Zealand Society of Podiatrists. When asked what type of foot orthoses they prescribe most often, 72% of respondents reported functional foot orthoses; the next most common response was prefabricated orthoses (12%). A typical prescription for functional foot orthoses consisted of a modified Root style orthosis, balanced to the neutral calcaneal stance position, with the shell made from polypropylene and an ethyl vinyl acetate (EVA) rearfoot post applied. The majority of podiatric physicians surveyed used a commercial orthotic laboratory to fabricate their orthoses. However, New Zealand respondents were three times more likely to prescribe prefabricated foot orthoses, and males were twice as likely as females to manufacture the orthoses themselves rather than use a commercial orthotic laboratory.

Australia↗
PubMed1998

"Death by proxy": ethics and classification in epidemiology.

Epidemiology is reductionist in that it usually relies on creating categories of people or risk factors. Classification must be undertaken as part of any study, however by the act of choosing groups, individuals are (potentially) consigned to either a higher or lower risk group. We discuss this from an ethical perspective and consider: (a) whether the groupings commonly chosen genuinely represent the risk factor of interest, (b) the implications for individuals when consigned to groups and (c) the implications for epidemiology.

Community Health Planning↗
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↗
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↗
PubMed1998

Hysterectomy fractions in New South Wales, 1971-2006.

Hysterectomy fractions by age group for particular periods are of interest for: estimating proper population denominators for calculation of disease and procedure rates affecting the cervix and uterus; estimating the target population for Pap test programs, and response rates; and as a way of displaying the cumulative consequences of hysterectomies in a population. Hysterectomy fractions for populations can be determined by direct inquiry via a representative sample survey, or, as in this study, from prior hysterectomy rates of the cohorts of women which compose each age bracket. Hysterectomy data 1979-93 were obtained from the hospital In-patients Statistics Collection (ISC) which covers both public and private hospitals in NSW. Annual population denominators of women were obtained from Census data. Data were modelled by Poisson regression, using five-year age group (15- > or = 85 years), annual period, and five-year birth cohort (APC model). Forward- and back-projection of the period effects were undertaken. The resultant NSW hysterectomy fractions by age and period are consistent with fractions obtained from modelled hysterectomy rates for Western Australia (1980-84), and fractions from national representative sample surveys (1989/90 and 1995) for younger women, but not for women aged > or = 70 years in 1995, which revealed higher hysterectomy fractions than modelled hysterectomy data would suggest. Hysterectomy fractions for NSW women by five-year age group for quinquennia centred on 1971 to 2006 are provided.

Adolescent↗
PubMed1997

Health outcomes and infectious disease control.

With the development of improved health systems, antibiotics and vaccines throughout the 20th century, the prospects of control of infectious diseases improved. During the same time-frame, an approach to disease control was developed which used the health outcomes resulting from various interventions to choose, guide and modify those interventions. Despite these major advances in the control of diseases, infectious diseases have (with occasional exceptions) not only continued to occur but in many instances the situation had deteriorated with the emergence and re-emergence in recent years of a range of infectious diseases. In this paper we consider why infectious disease control has not benefited from the move towards a health outcomes approach, why infectious disease control might benefit from such a move, and the differences between infectious and non-infectious diseases when considering health outcomes. We follow-up with some practical approaches to the use of health outcomes. We argue that appropriate use of health outcomes when planning and evaluating infectious disease control programs will improve human health.

Acquired Immunodeficiency Syndrome↗
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↗