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Biomedical subjects

R M Hanson

Publications and source records attributed to R M Hanson.

17 recordsLinked to original sources
PubMed2001

The importance of age and other variables in predicting paediatric patient flows in New South Wales.

This research focuses upon the relationship between a child's age and the likelihood that the child was treated at a Specialist Children's Hospital rather than at a local hospital. While it is generally regarded that younger patients are more resource intensive, a study was required to determine whether the Specialist Children's Hospitals attracted younger patients. The analysis is based on 42,363 children treated in Greater Metropolitan Sydney in 1996/97, and on separations classified (role delineated) as non-tertiary DRGs (defined as Level 4 activity). However, this activity is of varying degrees of severity. A number of variables were used to explain why a child was treated at either a local hospital or at a specialist children's hospital. This study clearly demonstrates that Specialist Children's Hospitals do attract younger and more severe patients.

Adolescent↗
PubMed2000

Casemix funding for a specialist paediatrics hospital: a hedonic regression approach.

This paper inquires into the effects that Diagnosis Related Groups (DRGs) have had on the ability to explain patient-level costs in a specialist paediatrics hospital. Two hedonic models are estimated using 1996/97 New Children's Hospital (NCH) patient level cost data, one with and one without a casemix index (CMI). The results show that the inclusion of a casemix index as an explanatory variable leads to a better accounting of cost. The full hedonic model is then used to simulate a funding model for the 1997/98 NCH cost data. These costs are highly correlated with the actual costs reported for that year. In addition, univariate regression indicates that there has been inflation in costs in the order of 4.8% between the two years. In conclusion, hedonic analysis can provide valuable evidence for the design of funding models that account for casemix.

Accounting↗
PubMed1998

The true cost of treating children.

Paediatric patients (compared with adults) require additional time, effort and skill from hospital staff caring for them. Many suggestions for making successive versions of AN-DRGs more child friendly have not been implemented. Rather than relying on age, the AN-DRG classification should allow a better definition of complexity within DRGs. The two groups of children who place a disproportionate burden on paediatric teaching centres are children under 3 years and those with congenital abnormalities and chronic illness. Cost weights are not specific for paediatric patients. The extra costs of caring for children are reflected in nursing costs, highlighting the importance of including nurse dependency data in any costing study.

Australia↗
PubMed1998

A comparison between digital images viewed on a picture archiving and communication system diagnostic workstation and on a PC-based remote viewing system by emergency physicians.

Picture Archiving and Communication Systems (PACS) make possible the viewing of radiographic images on computer workstations located where clinical care is delivered. By the nature of their work this feature is particularly useful for emergency physicians who view radiographic studies for information and use them to explain results to patients and their families. However, the high cost of PACS diagnostic workstations with fuller functionality places limits on the number of and therefore the accessibility to workstations in the emergency department. This study was undertaken to establish how well less expensive personal computer-based workstations would work to support these needs of emergency physicians. The study compared the outcome of observations by 5 emergency physicians on a series of radiographic studies containing subtle abnormalities displayed on both a PACS diagnostic workstation and on a PC-based workstation. The 73 digitized radiographic studies were randomly arranged on both types of workstation over four separate viewing sessions for each emergency physician. There was no statistical difference between a PACS diagnostic workstation and a PC-based workstation in this trial. The mean correct ratings were 59% on the PACS diagnostic workstations and 61% on the PC-based workstations. These findings also emphasize the need for prompt reporting by a radiologist.

Emergency Service, Hospital↗
PubMed1998

Clonidine overdose in childhood: implications of increased prescribing.

OBJECTIVE: To highlight the increase in the number of cases of clonidine overdose admitted to a specialist paediatric hospital, with particular reference to the clinical features, clinical course and circumstances surrounding the incident. METHODS: Cases of clonidine overdose were identified by review of the emergency department attendance register, the intensive care unit database and inpatient statistics collection. Case notes were reviewed to determine the clinical features, history and clinical course in each case. RESULTS: Fifteen patients experienced 16 overdoses during the period 1990-97 inclusive. Only one case occurred before 1994. Depressed level of consciousness and bradycardia were the most common clinical manifestations, and were observed in 75 and 88% of cases respectively. There were no fatalities. Five patients received naloxone. Other treatment modalities included gastrointestinal decontamination, atropine, ventilation and inotropic support. Fourteen cases occurred in association with medication prescribed for attention-deficit hyperactivity disorder (ADHD). CONCLUSION: Clonidine overdose is a potentially serious condition, often requiring intensive care management. Our experience suggests that it is a growing problem, related in part to its increased use in the treatment of ADHD. Preventive strategies, including raising the level of awareness of risks, changes to packaging and appropriate selection of patients for treatment, need consideration if further overdoses are to be prevented.

Adrenergic alpha-Agonists↗
PubMed1997

Rotavirus gastroenteritis: impact on young children, their families and the health care system.

OBJECTIVE: To assess the impact of rotavirus gastroenteritis on young children attending a paediatric hospital, their families and the health care system. DESIGN: Cross-sectional descriptive survey. SETTING: New Children's Hospital (Royal Alexandra Hospital for Children), Sydney, New South Wales, 15 July to 4 October 1996. PARTICIPANTS: Children aged under three years attending the Emergency Department with acute diarrhoea as the presenting symptom. OUTCOME MEASURES: Cases of rotavirus infection confirmed by enzyme-linked immunosorbent assay by age; rotavirus serotype; gastroenteritis severity score; estimated costs to parents (lost pay or leave, travel, medication and other expenses) and to the health care system (visits to Emergency Department and other health care workers, hospital admissions). RESULTS: 280 children were recruited (73% of 384 children who met the inclusion criteria and 27% of the 1037 aged under three years with acute gastroenteritis). Rotavirus was detected in 188 of the 280 (67%); most isolates were serotype G1 (86% of the 174 serotyped). Of the 188 children with confirmed rotavirus infection 78% were aged 7-24 months and 82% visited at least one other health care worker, usually a general practitioner. Seventy (37% of the 188) were admitted to hospital; 33 of these (47%) were aged 13-24 months. Estimated mean total cost per episode of rotavirus gastroenteritis was $1744 for children admitted to hospital and $441 for children not admitted. The mean cost to families was $493 for children admitted to hospital and $228 for children not admitted. CONCLUSIONS: Rotavirus gastroenteritis has a significant impact on young children, their families and the health care system. Prevention of severe disease through routine infant vaccination would be potentially cost-effective.

Adult↗
PubMed1993

Sexually transmitted diseases and the sexually abused child.

Sexually transmitted diseases pose a significant problem for children who have been sexually abused. The pattern of sexually transmitted diseases in this group reflects their changing pattern in the community at large. The prevalence of sexually transmitted diseases in sexual abuse victims is significant although it depends on a number of factors, including sexually transmitted disease prevalence in the community, the organism, and the type of abuse. The transmission route of most common sexually transmitted diseases beyond the neonatal period is accepted as sexual abuse, although the possibility of nonsexual transmission of some organisms, particularly those that can be transmitted at birth and have a long incubation and latency periods, is recognized. Mounting evidence for nonsexual transmission of human papillomavirus is generating continuing controversy. The significance of other organisms as indicators of abuse remains unclear. It is recommended that children suspected of being abused be screened for sexually transmitted diseases. There has been considerable discussion about the extent of screening. Screening should adhere to clear guidelines that address local epidemiologic issues. Screening for human immunodeficiency virus should be based on the extent of the virus in the community in which the child lives and on the nature of the abuse. Child sexual abuse must be recognized as an exposure category for human immunodeficiency virus. Test selection for evaluating sexually transmitted diseases in sexual abuse victims is a critical issue. Rapid screening methodologies should not be relied on, and if positive results are obtained, they should be confirmed using another method or even another laboratory.(ABSTRACT TRUNCATED AT 250 WORDS)

Child↗
PubMed1991

Infants and atropine: a dangerous mixture.

Colic in infants is a common but short-lived problem. Many different theories and treatment for this distressing ailment have been tried over the years, yet the definitive cure remains elusive. Although the risks associated with the use of atropine and its derivatives are well known, they are still prescribed by some in the management of colic. We report a case of serious side effects from the treatment of colic with an atropine containing mixture, in which an error in preparation was identified. In view of the potential for serious toxicity resulting from either inappropriate prescription, preparation or administration, alternative methods of treatment should be employed.

Atropine↗
PubMed1990

Seizures associated with 1% cyclopentolate eyedrops.

A 4.5 year old boy with cerebral palsy presented with seizures associated with facial flushing and tachycardia following the instillation of 1% cyclopentolate, a commonly used mydriatic in paediatric practice. He had no prior history of convulsions. This case demonstrates the uncommon, though serious, atropine-like side effect of cyclopentolate eyedrops (Cyclogyl, Alcon) in usual dosage in a brain damaged child without an epileptic focus.

Cerebral Palsy↗
PubMed1989

Anogenital warts in childhood.

Fifteen children with anogenital warts are presented. Twelve cases were referred for assessment of sexual abuse which was established in six cases, strongly suspected in one, and excluded in three. In two, the source was unclear. Papillomavirus typing was carried out by HPV DNA dot and Southern blot hybridization using mixed HPV 6/11, 16/18, and 2/3 DNA probes on 15 specimens from 12 of the children. Seven biopsy specimens were positive for HPV 6 or 11 and one hybridized with both HPV 6/11 and 16/18 mixed sets of probes. Two specimens were positive for HPV 2, and a further two hybridized with both HPV 18 and 2. Three wart specimens could not be typed with the available genital or skin probes. The viruses causing genital tract papillomata are the same for children and adults. The identification of HPV 16/18 raises the concern of potential oncogenicity and stresses the need for long-term assessment. The diagnosis of sexual abuse was made on history rather than examination, as only two cases showed additional physical signs of sexual abuse. It is advocated that the presence of anogenital warts alone be sufficient grounds to pursue the possibility of sexual abuse. Nonsexual transmission, although possible, is far less likely.

Adolescent↗
PubMed1985

Paediatric accident & emergency services. Are we meeting the need?

Paediatric Casualty has evolved into a blend of true Accident and Emergency and Primary Care Services. With the impending redevelopment of the Accident and Emergency Department at the Camperdown Children's Hospital a survey of families utilising the service was conducted to assess their perceptions of the services provided. It emerged that although many families travelled long distances to the Hospital and had to contend with long waits, they perceived the trip as worthwhile with most finding the quality of care satisfactory (95%) and friendly (90%), coming away with a good understanding of their child's problem (94%), the investigations performed and management prescribed (97%), and arrangements made for follow up (89%). A large percentage (51%) came to the hospital seeking a second opinion for which they had already consulted another agency. Nineteen percent were directly referred, with the remainder seeking a second opinion on their own initiative. This high referral rate necessitates a staffing formula that provides appropriate expertise and supervision. As the demand on hospitals to provide primary care facilities is likely to remain, recommendations are made for improvement in the services provided as well as making more use in forward planning of available expertise and supervision.

Australia↗
PubMed1977

Membranous effects on adenosine triphosphatase activities of mitochondria from rat liver and Morris hepatoma 3924A.

Adenosine triphosphatase (ATPase) activities of sonically prepared submitochondrial particles of rat liver and Morris Hepatoma 3924A were compared as a function of changes in temperature. On Arrhenius plots, a discontinuity at 18 degrees was observed for the rat liver mitochondrial ATPase, while the hepatoma mitochondrial ATPase revealed a discontinuity at 20.4 degrees. Values for energy of activation of the rat liver and hepatoma mitochondrial ATPases were comparable below the break (34.5 and 35.5 kcal/mole, respectively) and above the break (11.6 and 9.2 kcal/mole, respectively). Solubilization of the mitochondrial membrances with Triton X-100 resulted in constant and similar values of energy of activation for the ATPases Km values of hepatoma and rat liver mitochondrial ATPases for adenosine triphosphate were similar in both the membrane-bound and solubilized states. The lack of uncoupler-stimulated ATPase activity in hepatoma mitochondria is apparently not due to membranous effects on the affinity of the ATPase for adenosine triphosphate.

Adenosine Triphosphatases↗
PubMedDate not supplied

Outcomes of a nutrition audit in a tertiary paediatric hospital: implications for service improvement.

OBJECTIVE: To examine the process of anthropometric assessment of nutritional status in a tertiary paediatric hospital, to identify the barriers and to make recommendations for service improvement. METHODS: The accuracy of height and weight scales in wards was checked. Dietitians measured height and weight of a representative sample of 245 inpatients and checked whether these measurements had been recorded on bed charts. Patients were classified as overweight, obese or under-nourished. Diagnoses and procedures were obtained for each patient. Funding implications were modelled for inappropriate coding of nutritional status. RESULTS: The barriers to nutritional assessment and management of nutritional comorbidities were: (i) inaccurate height scales in seven out of 12 wards; (ii) under-recording of height and weight on patient bed charts (73% height missing, 12% both height and weight missing); (iii) under-reporting of obesity and under-nutrition in medical notes (one of eight obese patients, and none of 28 undernourished patients, reported); and (iv) low referral rate of obese or under-nourished children to dietetic services (two of 42 overweight/obese patients referred, five of 28 undernourished patients referred). Funding simulation showed that if under-nourished patients were correctly diagnosed then the potential facility reimbursement would have increased by $A52 326. CONCLUSIONS: Barriers to nutritional assessment can lead to failure to diagnose and treat both over- and under-nutrition, thereby affecting quality of patient care, and may have financial implications for hospitals. Suggestions for service improvement include provision of accurate equipment, adequate training of staff undertaking nutritional assessments and clear definitions of staff responsibilities in all aspects of the process.

Body Height↗