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At least 199 records · Page 11Linked to original sources
PubMed1993

Influenza vaccination in Victoria, 1992.

OBJECTIVES: To determine the rates and patterns of vaccination against influenza in the Victorian population. Further, to determine rates of vaccination against influenza in residents of Victorian nursing homes and hostels. DESIGN: Between May and June of 1992 we conducted a telephone survey of 537 systematically selected Victorian residents. We obtained information on age, sex, vaccination status, and level of risk for the complications of influenza. We conducted a separate postal survey of 143 randomly selected Victorian nursing homes and hostels to establish rates of vaccination within these institutions. PARTICIPANTS: Residents of Victoria listed in the White Pages telephone directories in both metropolitan and rural areas. We made calls during working hours to both residential and business numbers, and spoke to the first person who answered the telephone. Participants in the nursing home survey were the matrons or directors of nursing of randomly chosen facilities in the State, who filled out questionnaires relating to their residents. RESULTS: The vaccination rate against influenza in the whole population was 13.3%. This and all other figures quoted are adjusted for age, unless otherwise specified. There was a significant difference in vaccination rates between rural (9%) and metropolitan (16%) areas (P < 0.05). Using the National Health and Medical Research Council (NHMRC) guidelines, 29% of the population had at least one indication for vaccination. Of people at low risk for complications of influenza, 7.8% were vaccinated. Of people with one or more specific indications for vaccination, 29.4% were vaccinated. Vaccination rates increased with increasing number of indications and with increasing age, approaching 45% in people over 65 years and 50% in people with three or more indications for vaccination. The postal survey of nursing homes and hostels revealed that a mean of 52% of residents per facility were vaccinated against influenza. This figure varied between 45% in rural facilities and 53% in metropolitan facilities. CONCLUSIONS: We estimate that 550,000 doses of influenza vaccine were used in Victoria in 1992. Approximately 50% of these were given to people at low risk for complications of influenza. These findings highlight the need to target high risk groups for vaccination, reassure the general public, and educate health care professionals.

Adolescent↗
PubMed1994

Changes in the investigation and management of primary operable breast cancer in Victoria.

OBJECTIVES: To investigate the surgical practice and adjuvant therapies used in the treatment of primary operable breast cancer in Victoria in 1990 and compare them with results of a similar study in 1986. DESIGN: All 856 cases of primary operable breast cancer registered by the Victorian Cancer Registry between 1 April and 30 September 1990 were identified. Each patient's surgeon was sent a standard questionnaire covering diagnosis, investigations, operative procedures, adjuvant therapies and reasons for certain management choices. Data were collected on 89% of the patients from 176 participating surgeons. RESULTS: Most patients (82%) were referred to surgeons by general practitioners. Mammographic screening detected 14% of the cancers. The proportion of women receiving breast-conserving operations rose from 22% in 1986 to 42% in 1990. Surgeons operating on more than 20 breast cancers per annum were most likely to perform breast-conserving operations. The most common reasons given for non-conservative operations were the size of the tumour (37%), its central location (25%) and/or patient concern about the risk of recurrence if the breast was to be conserved (22%). Among these patients, reconstruction was done at the time of primary treatment in 13%, subsequently in 2%, and was planned by another 5%. Of all patients, 33% were referred to a radiation oncologist and 24% actually received radiotherapy (similar to 1986). Medical oncologists saw 33% of the patients and 20% of all patients received chemotherapy (similar to 1986), which was given by a medical oncologist in 83% of the cases. Use of endocrine therapy increased from 20% in 1986 to 40% in 1990. CONCLUSIONS: There has been a strong trend towards more conservative breast surgery in Victoria, with surgeons who are most active in breast cancer surgery most likely to perform breast-conserving operations. Apart from a significant increase in the use of endocrine therapy, use of adjuvant therapies was unchanged from 1986.

Adult↗
PubMed1997

Undergraduate procedural skills training in Victoria: is it adequate?

OBJECTIVES: To assess the experience in basic and advanced clinical procedures of recently graduated medical students and to identify deficiencies in procedural skills training. DESIGN: An anonymous, voluntary, questionnaire-based survey. SETTING: The 13 hospitals in the State of Victoria that employ their own interns. SUBJECTS: New interns, immediately before starting their intern year in 1996. RESULTS: One hundred and seventy-four interns participated. They reported that they had had few opportunities to practise some procedures during their medical courses. By their own report, 3% had never sutured a patient, 10% had never drawn blood gases, 16% had never applied a limb plaster, 18% had never inserted a catheter and 37% had never intubated a patient. Twenty-nine per cent perceived their proficiency in basic procedural skills to be inadequate and 43% perceived their training in basic skills to have been inadequate. Except for intravenous cannulation, there was a significant association (P < 0.01) between the number of procedures performed and perceived proficiency in that procedure. The new interns reported that they had been taught mainly by residents and registrars in the emergency department. "Doctors performing most procedures" and "limited access to patients" were considered the main obstacles to procedural training. Fewer than 50% of interns had spent extra time improving their procedural skills. CONCLUSION: Undergraduate training in procedural skills in Victoria is inadequate. Comprehensive training programs appear to be lacking and clinical schools have few techniques for quality assurance. RECOMMENDATION: Victorian clinical schools need to review their procedural skills training programs.

Clinical Competence↗
PubMed2000

Prevention of perinatal group B streptococcal disease: screening practice in public hospitals in Victoria.

OBJECTIVES: To survey clinical protocols for prevention of early-onset group B streptococcal disease (EOGBSD) of the newborn in public maternity hospitals. DESIGN: Postal questionnaire with telephone follow-up when required. SETTING: All hospitals that undertook deliveries in public patients in the State of Victoria, November 1997 to January 1998. RESULTS: The survey was sent to 84 hospitals: 71 responded and 64 met the criteria and provided usable data (76% response rate). These 64 represented 42,784 births (68% of births in Victoria in 1996). Most hospitals (62; 97%) undertook actions that would identify and treat pregnant women at risk of EOGBSD. 48 (75%) performed bacteriological screening for maternal GBS carriage, but only 20 of these had a unified protocol. Screening was mostly by low vaginal swab (15 hospitals) and before 30 weeks' gestation (12 hospitals). Low vaginal swab plus anal swab was used in only one hospital. Bacteriological screening was significantly more common in metropolitan hospitals than in rural hospitals (100% versus 67%; P = 0.007, Fisher's exact test). Targeting of prophylaxis by recognised risk factors was reported by 59 (92%) hospitals, 45 of which also undertook screening. There was considerable variation in the specific risk factors used. CONCLUSIONS: While there was clearly widespread awareness of EOGBSD in Victorian public hospitals, prevention programs varied considerably. The development of consensus practice guidelines might improve EOGBSD prevention, reducing morbidity, mortality and costs.

Antibiotic Prophylaxis↗
PubMed2000

Invasive pneumococcal disease in the population of Victoria.

OBJECTIVES: To estimate morbidity and mortality rates for invasive Streptococcus pneumoniae (pneumococcal) disease in the non-Indigenous population of Victoria. DESIGN AND SETTING: Survey using data from a statewide voluntary laboratory surveillance scheme (1989-1998), statewide hospital discharge database (1995-1998), medical records of notified patients (1994-1995) and serotyping of notified isolates (1994-1998). MAIN OUTCOME MEASURES: Incidence of pneumococcal bacteraemia and pneumonia; predisposing factors; serotypes of isolates. RESULTS: Minimum estimates of annual incidence of invasive disease, based on laboratory surveillance data for 1995-1998, were 59 per 100,000 for children aged < 2 years, 25 per 100,000 for people aged > or = 65 years, and 8 per 100,000 overall. Annual incidence of pneumococcal pneumonia, calculated from hospital discharge data, was 99 per 100,000 for those aged > or = 65 years. Manifestations of invasive pneumococcal disease varied with age, with meningitis more common in infants, and pneumonia most common in older patients. A predisposing factor for pneumococcal infection was present in 48% of patients. Most isolates from infants (83%) belonged to serotypes in the proposed seven-valent infant vaccine, and 91% of isolates from people aged > or = 2 years belonged to serotypes in the current 23-valent adult vaccine. CONCLUSIONS: S. pneumoniae continues to be a major cause of morbidity and mortality in young children and the elderly in Victoria. More widespread use of the currently available pneumococcal vaccine in adults and introduction of an effective vaccine for infants should greatly reduce incidence of the disease.

Adolescent↗
PubMed2000

Improving pneumococcal vaccination coverage among older people in Victoria.

Although pneumococcal vaccine is recommended by the National Health and Medical Research Council and is cost-effective in preventing invasive pneumococcal disease, it is the only vaccine on the standard schedule that is not nationally funded through public health grants to the States. In Victoria, the Department of Human Services has provided free pneumococcal vaccine to people aged 65 years and over since 1998. Pneumococcal vaccination was given in conjunction with the annual influenza vaccination program; 28.5% of the eligible cohort (95% CI, 24.8%-32.1%) received pneumococcal vaccine in 1998, giving an estimated cumulative coverage of 42% (13.4% had received it in 1997). We expect coverage will continue to increase over time, but revaccination every five years will present a substantial financial burden; access to vaccine is critical to improving coverage. Our experience in Victoria suggests that a nationally funded program, administered similarly to the influenza vaccination program, would dramatically increase pneumococcal vaccination coverage at a national level.

Adolescent↗
PubMed2001

The management of testicular cancer in Victoria, 1988-1993. Urology Study Committee of the Victorian Co-operative Oncology Group.

OBJECTIVES: To evaluate the patterns of care and management of testicular cancer in Victoria. DESIGN AND SETTING: Retrospective analysis of all cases of testicular cancer in Victoria from 1988 to 1993 identified through the Victorian Cancer Registry. MAIN OUTCOME MEASURES: Description of patient characteristics, staging investigations, initial management, and outcome. RESULTS: 667 eligible cases of testicular cancer were identified and questionnaires were returned for 633 of these patients (94.9% response rate). There were 357 (56.4%) patients with pure seminoma; 271 (42.8%) with non-seminomatous germ cell tumours, 3 (0.5%) with stromal tumours, and 2 (0.3%) with other tumours. The median age was 32 years (range, 0-80 years). Preoperative marker levels were not available for 8% of patients, and initial staging was considered inadequate in 6%. Surveillance programs used for patients with Stage I disease were considered inadequate in most. Relative survival at five years was 99% for patients with seminoma and 91% for non-seminoma. CONCLUSIONS: There was considerable variation in the investigation, treatment, and follow-up of these patients, which is likely to have resulted in unnecessary morbidity. Clinical practice guidelines should be developed and implemented to promote optimal management.

Adolescent↗
PubMed2002

Reported management of early-pregnancy bleeding and miscarriage by general practitioners in Victoria.

OBJECTIVES: To describe the management of early-pregnancy bleeding and miscarriage reported by general practitioners in Victoria. DESIGN, SETTING, AND PARTICIPANTS: Self-administered, mailed survey of a stratified random sample of GPs in Victoria. Responses weighted by strata to reflect GP population. MAIN OUTCOME MEASURES: Reported management in referral; investigation (especially ultrasound); expectant versus interventional management; and prevention of rhesus iso-immunisation RESULTS: 382 of 621 eligible GPs responded (response rate, 62%). GPs' reported referral was more likely if the patient had painful bleeding (55%) or if the pregnancy was not viable (77%). Ultrasound strongly influenced the assessment of bleeding. Two-thirds of doctors (262/369; 66%) would routinely order ultrasound for painless bleeding, and 328/369 (84%) for painful bleeding. Expectant management was recommended by 15/353 (4%) for incomplete miscarriage with light bleeding and by 6/351 (2%) when bleeding was heavy. Some GPs are uncertain of the indications for anti-D prophylaxis, including instrumentation of the uterus, for which 261/337 (77%) said they would routinely offer anti-D. There was less agreement about anti-D after threatened miscarriage, for which 213/353 (57%) said they offered the injection. CONCLUSIONS: GPs need a working knowledge of the management of early-pregnancy bleeding, and can probably encourage more rational management. There are significant areas where GPs are uncertain, often reflecting uncertainty elsewhere, and some areas where a minority of GPs are not aware of essential requirements.

Abortion, Spontaneous↗
PubMed2002

Gestational diabetes in Victoria in 1996: incidence, risk factors and outcomes.

OBJECTIVES: To describe the epidemiology of gestational diabetes mellitus (GDM) in Victoria. STUDY DESIGN: Population study of all women having singleton births in Victoria in 1996. METHODS: Probabilistic record linkage of routinely collected data and capture-recapture techniques to provide an estimate of the incidence of GDM. MAIN OUTCOME MEASURES: Risk factors for and the adverse outcomes associated with GDM compared with the non-diabetic population by univariate and multivariate analysis. RESULTS: The estimated incidence of GDM was 3.6% (95% confidence interval [CI], 3.60%-3.64%). GDM is associated with women who are older, Aboriginal, non-Australian born, or who give birth in a larger hospital. The adverse outcomes associated with GDM pregnancies were hypertension/pre-eclampsia (adjusted odds ratio [OR], 1.6; 95% CI, 1.4-1.9), hyaline membrane disease (1.6; 1.2-2.2), neonatal jaundice (1.4; 1.2-1.7) and macrosomia (2.0; 1.8-2.3). Interventions during childbirth were also associated with GDM - for example, induction of labour (3.0; 2.7-3.4) and caesarean section (1.7; 1.6-1.9). CONCLUSION: Women with GDM had increased rates of hypertension, pre-eclampsia, induced labour, and interventional delivery. Their offspring had a higher risk of macrosomia, neonatal jaundice and hyaline membrane disease.

Adult↗
PubMed2007

Workforce trends in specialist and GP obstetric practice in Victoria.

OBJECTIVE: To provide a contemporary picture of the general practitioner and specialist obstetric workforce in Victoria. DESIGN, PARTICIPANTS AND SETTING: Postal census by questionnaire of all 317 Fellows and 961 Diplomates on the Victorian database of the Royal Australian and New Zealand College of Obstetricians and Gynaecologists in September 2003. MAIN OUTCOME MEASURES: Sex, age and geographical distributions and patterns of retirement from and recruitment to the GP and specialist obstetric workforce in Victoria. RESULTS: 244 Fellows (77.0%) and 652 Diplomates (67.8%) participated. The average age of Diplomates was 42 years; only 20% were involved in procedural obstetrics. Of GPs practising procedural obstetrics, 56% intended to cease within 7 years. Two-thirds of specialist obstetricians continued to practise obstetrics. Among those ceasing obstetrics, almost half had done so since 2000. Among Fellows ceasing obstetric practice, there is a peak in the 50-60-years age group, but cessation of obstetric practice occurred across all age groups. CONCLUSION: The proportion of GPs involved in procedural obstetrics has fallen markedly over the past decade, with half of those ceasing practice in the 40-50-years age group. New GPs entering the workforce with the Diploma and overseas doctors are unlikely to meet the procedural workforce shortfall. Attracting the large cohort of doctors aged 40-50 years back to obstetric practice must be a priority. Given the pattern of retirements from obstetrics, there will be insufficient numbers of specialists to maintain current levels of service. The reasons include non-participation in obstetrics by new graduates and international medical graduates, the inadequate number of new graduates, and the predominance of women among specialists aged under 40 years, whose work output tends to be affected by family commitments.

Adult↗
PubMed1993

Hospitalisation of children under 15 years in Victoria.

OBJECTIVE: To determine whether the separation rate from the hospital for children aged 0-15 years in Victoria was higher for those resident in the country area of the State in comparison with the metropolitan area and, if it was, to investigate possible explanations. DESIGN: Discharge data from all public hospitals in Victoria for children aged 0-15 years for the financial years 1988-89, 1989-90 and 1990-91 were analysed with detailed analysis being done on the 1990-91 data set. Discharge rates were determined according to the local authority area of residence. Patients were grouped according to Diagnosis Related Groups (DRGs) version 5. RESULTS: Children living in the country area showed a separation rate of 50 per cent greater than that for the metropolitan area. Separation rates for local authority areas were remarkably constant over the three years. Country local authority areas with the highest separation rates had separation rates for asthma and bronchitis (DRG 98), almost four times that of metropolitan residents, and for otitis media and upper respiratory infection (URI), a rate almost ten times that of metropolitan residents. CONCLUSION: It is suggested that variation in medical practice was the most likely explanation for the observed differences.

Adolescent↗
PubMed1999

A survey of radiation doses to adults from diagnostic radiology in Victoria.

This study examines doses to adult patients from diagnostic radiology. Measurements were made at 37 hospitals and private radiology centres in the state of Victoria. Skin entrance doses in air were measured for the exposure factors used by the radiographer for an average size patient for the following procedures: abdomen AP; pelvis AP; lumbar spine AP, lat, LSJ; and skull AP, lat. There was a large range of doses observed for each particular procedure. Factors contributing to the range of doses were identified. Guidance levels for adult radiography based on the third quartile values of the skin entrance dose have been adopted for use in Victoria.

Adult↗
PubMedDate not supplied

Déjà vu and the regulation of nursing in Victoria.

The issue of the regulation of nursing is a perennial one. In the current climate of review of regulatory practices in the State of Victoria, Australia it is perhaps surprising to note the consistency of issues and positions in this debate over the past seventy-five years. This paper examines the emergence of the first Nurses' Board of Victoria and the political struggles that its implementation entailed. It is argued that the mobilisation of civic discourse by nurses was the means used to extend nursing autonomy and control over regulatory practices. However, this civic discourse did not realise nursing's own interests but widened the role of nurses in the governance of the profession and health services more generally. The current debate over the role of non-nurses in nursing roles and issues of regulation is also discussed.

Employment↗
PubMed1999

A survey of patient dose and image quality factors for CT scanners in Victoria.

Image quality and dose parameters have been measured on most makes and models of CT scanners in Victoria. Image quality was assessed using a dose efficiency and imaging performance parameter (Q-value). Factors relating to patient dose were measured. Patient doses using CTDIw in mGy were determined for average size patients for the abdomen procedure. Guidance levels have been recommended for CT procedures in Victoria.

Data Collection↗
PubMed2000

Guidance levels for diagnostic radiology in Victoria. Radiation Safety Unit, Department of Human Services, Melbourne, Australia.

Guidance levels for radiation doses in diagnostic radiology for average size patients have been developed for use in the state of Victoria. The guidance levels were determined from the results of surveys of patients in hospitals and private radiology centres in Victoria. Guidance levels have been developed for the following procedures: neonate chest AP; several plain film paediatric procedures; several plain film adult procedures; fluoroscopy equipment; and CT procedures. The guidance levels are compared with those recommended in other countries.

Adolescent↗
PubMed2002

Using the two-source capture-recapture method to estimate the incidence of acute flaccid paralysis in Victoria, Australia.

OBJECTIVE: To estimate the incidence and the completeness of ascertainment of acute flaccid paralysis (AFP) in Victoria, Australia, in 1998-2000 and to determine its common causes among children aged under 15 years. METHODS: : The two-source capture-recapture method was used to estimate the incidence of cases of AFP and to evaluate case ascertainment in the routine surveillance system. The primary and secondary data sources were notifications from this system and inpatient hospital records, respectively. FINDINGS: The routine surveillance system indicated that there were 14 cases and the hospital record review identified 19 additional cases. According to the two-source capture-recapture method, there would have been 40 cases during this period (95% confidence interval (CI) = 29-51), representing an average annual incidence of 1.4 per 100000 children aged under 15 years (95% CI = 1.1- 1.7). Thus case ascertainment based on routine surveillance was estimated to be 35% complete. Guillain-Barré syndrome was the commonest single cause of AFP. CONCLUSIONS: Routine surveillance for AFP in Victoria was insensitive. A literature review indicated that the capture-recapture estimates obtained in this study were plausible. The present results help to define a target notification rate for surveillance in settings where poliomyelitis is not endemic.

Acute Disease↗
PubMed2003

Trends and geographic variations in hospital admissions for asthma in Victoria. Opportunities for targeted interventions.

OBJECTIVE: To describe variations in rates of hospital admissions for asthma in Victoria as health indicators of quality of primary care services and access. DESIGN: Routine analyses of age and sex standardised admission rates of asthma in rural and metropolitan Victoria from 1993-1994 to 1999-2000. RESULTS: There were 10,079 admissions for asthma, with an average of 2.71 bed days in 1999-2000. The admission rate for asthma decreased from 3.1/1000 (95% CI: 3.1-3.2) in 1993-1994 to 2.2/1000 (2.1-2.2) in 1999-2000, with a 37% reduction in rural regions and 26% in metropolitan regions. Sixteen primary care partnerships (small areas), 13 of them rural, had significantly higher admission rates than the Victorian average. CONCLUSION: Although asthma hospital admission rates are falling faster in rural than metropolitan areas, rural areas still have higher admission rates with significant variation between small areas.

Age Distribution↗
PubMed2006

People under 60 living in aged care facilities in Victoria.

OBJECTIVE: To describe the characteristics of people under 60 years of age living in residential aged care in Victoria and to examine the occupational participation of younger residents in aged care facilities by measuring their social contact, participation in recreation and community access. METHODS: A survey was sent to the Directors of Nursing at all 803 Commonwealth Department of Health and Aged Care registered aged care facilities in Victoria. RESULTS: The survey had a 78% response rate and information was provided about the characteristics of 330 people under 60 years with high clinical needs residing in aged care facilities. This sample was extremely isolated from peers, with 44% receiving a visit from a friend less often than once per year. Sixteen per cent of residents participated in a recreation activity less than once per month and 21% went outside less than once per month. Of the sample, 34% almost never participated in any community-based activities such as shopping, leisure or visiting friends and family. CONCLUSION: Over one third of younger people in aged care are effectively excluded from life in our community. Most younger residents are socially isolated and have limited opportunities for recreation. Placement of younger people in aged care facilities is inappropriate, and alternative care models and settings are required.

Adolescent↗