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At least 1,099 records · Page 61Linked to original sources
PubMed2000

Differences in cardiac procedures among patients in metropolitan and non-metropolitan hospitals in New South Wales after acute myocardial infarction and angina.

An observational cohort study examined the difference in use of cardiac procedures during and after hospital admission for acute chest pain in 47 metropolitan or non-metropolitan hospitals across New South Wales (NSW). There were 3836 patients, represented by 4151 admissions to hospital after acute myocardial infarction (AMI), unstable angina or other angina. Follow up at 22 months was completed on 1695 patients. Patients admitted to metropolitan hospitals had higher rates of most cardiac procedures while in-patients than did patients in non-metropolitan hospitals. Odds ratios (95% confidence intervals) for the use of exercise stress tests, echocardiograms, nuclear studies and coronary angiography were 3.30 (1.38, 7.90), 9.34 (4.07, 21.44), 4.87 (2.08, 11.39) and 68.64 (17.29, 272.49), respectively, for patients with AMI and 1.93 (0.91, 4.12), 5.60 (1.60, 19.57), 3.51 (1.48, 8.33) and 38.57 (9.36, 158.94), respectively, for patients with unstable angina. Rates were similar between hospital types during the 22 months after discharge. The appropriateness of this large variation in resource use between metropolitan and non-metropolitan hospitals requires examination.

Adult↗
PubMed2001

Medical specialists servicing the New England Health Area of New South Wales.

There is increasing emphasis on research, policy and program activity to recruit and retain rural general practitioners in Australia. In contrast, until recently, there has been less attention paid to specific policies and programs relating to rural medical specialists. The New England Area Health Service experiences a shortage of general practitioners and specialists. This study surveyed this region's specialist workforce in 1998 and aimed to identify recruitment and retention issues affecting specialist rural workforce planning in north-west New South Wales. All 91 medical specialists practising in this rural area were surveyed. Seventy-one completed survey forms were received, representing a response rate of 78%. Positive features of rural specialist practice included the rural lifestyle, professional autonomy and available medical infrastructure. Negative features included professional isolation, long working hours, lack of locum relief and inadequate remuneration. Almost all surveyed specialists believe that there is a shortage of specialists servicing the New England Health Area. The major deficits in specialty areas identified relate to: dermatology; ear, nose and throat; obstetrics and gynaecology; orthopaedics; paediatrics; and urology. Recruiting and retaining medical specialists would be facilitated by improvements in the following areas: specialist resources and facilities, specialist locum scheme, remuneration and professional support. Effective strategies need to take account of local circumstances and be based on discussions involving all local key stakeholders.

Female↗
PubMed2002

Identifying and overcoming the barriers to Aboriginal access to general practitioner services in Rural New South Wales.

The Wiradjuri General Practitioners and Aboriginal Health Workers Project aimed to help improve Aboriginal health in central western New South Wales (NSW) by identifying and overcoming the barriers to the Aboriginal population's access to general practitioner services. The central strategy of the project was to convene three rounds of consultative meetings in five towns: Bathurst, Orange, Cowra, Forbes and Condobolin. These meetings brought together Aboriginal community members, general practitioners and Aboriginal health workers to express and define local issues and problems, and to propose solutions. The solutions included general practitioner outreach clinics, a focus on prewinter immunisation, bulk-billing of Aboriginal patients, Aboriginal cultural awareness training for all general practice personnel, employing Aboriginal staff in general practice, and closer professional interaction between general practitioners and Aboriginal health workers. Most participants evaluated the meetings as positive and constructive. The project substantiates the perceived need for alternative models for the funding and delivery of general practitioner services to Aboriginal communities.

Community-Institutional Relations↗
PubMed2003

Starting out in rural New South Wales: the experiences of new graduate occupational therapists.

The current shortage of health personnel in rural Australia is compounded by the difficulty in recruiting and retaining new graduate health professionals in rural practice. This qualitative study aimed to explore the experiences of five new graduate occupational therapists who began their careers in rural New South Wales (NSW). Data were collected via semi-structured, individual interviews. Results indicated that new graduates were attracted to their rural positions by multiple factors, especially their previous rural experience. Participants experienced low self-confidence during their transition from student to therapist. Rewarding and challenging aspects of rural practice were identified. New graduates valued challenging aspects of rural practice as opportunities for skill development. Results suggest that increasing the number of occupational therapy graduates with rural experience may attract more graduates to rural practice. Furthermore, enhancing the support available to new graduates in rural positions may help retain graduates in rural practice.

Adaptation, Psychological↗
PubMed2003

Continuum of care and the antenatal record in rural New South Wales.

OBJECTIVE: The aim of the study was to determine the effect of the woman held antenatal record card (PNC2) on the continuity of maternity care received when presenting to the acute rural setting for clinical assessment. DESIGN: Qualitative, open-ended questionnaires. SETTING: Rural New South Wales public hospital. SUBJECTS: Maternity consumers, 50 women who were inpatients receiving antenatal or postnatal care between August and October 1998. A stratified sample of healthcare professionals employed by the service, 12 midwives and 13 general practitioners. MAIN OUTCOME MEASURE: The self reported use of the antenatal card and the viewed effects of the card on the continuity of healthcare received. RESULTS: The study identified a significant difference between the responding professionals (93%) positive perception of the effect of the PNC2 on the women's pregnancy continuum of care and the maternity consumer (36%), who felt it bore little impact on their care. The study findings suggested a lack of compliance and standardisation in usage of the antenatal card negated any flow on effects for the women. CONCLUSIONS: The intended purposes of the PNC2 were compromised in this rural setting. The study recommends that stakeholders in rural maternity care be accountable for examining the benefits and barriers of their antenatal practices, that the rural community's expectations of 'continuity of maternity care' are sought and that there should be a review of the available models of rural antenatal care.

Continuity of Patient Care↗
PubMed2003

Health career promotion in the New England area of New South Wales: a program to support high school career advisers.

OBJECTIVE: To facilitate the area's high school careers advisers' ability to effectively promote health careers to students. DESIGN: Three cross sectional evaluation surveys at the end of each one-day workshop. SETTING: Conference rooms in three regional centres (Armidale, Moree and Tamworth, New South Wales). SUBJECTS: Twenty-two high school careers advisers. INTERVENTION: One-day workshop. MAIN OUTCOME MEASURES: High school careers advisers' self-rated assessment in terms of the effective delivery of appropriate information and opportunities to network. RESULTS: Participants agreed that the workshop conveyed relevant information (3.8), were of high standard (3.5) and enabled them to identify students wanting to pursue health careers (2.9). Networking between health professionals and career advisers was rated as the most beneficial aspect by a majority of participants (60%). The scenario was rated as a useful tool to educate advisers about health careers (3.8). CONCLUSION: Collaborative workshops between advisers and health professionals are useful in facilitating networks to promote health careers in high schools in rural areas. The use of a farm injury scenario as a learning tool was effective in educating advisers about health careers. WHAT IS ALREADY KNOWN: Previous research carried out in the USA6 and Australia demonstrated that high school careers advisers needed to target high school students earlier in their studies before senior subjects were decided and that about a quarter of careers advisers indicated poor knowledge about health careers.10 WHAT THIS STUDY ADDS: Provision of practical support to high school careers advisers, such as distributing a mentorship directory and up-to-date health career kits as well as facilitating networking with health professionals constitute effective means to promote health careers to high school students.

Career Choice↗
PubMed1999

Variations in breast tangent radiotherapy: a survey of practice in New South Wales and the Australian Capital Territory.

The breast is a complex anatomical structure where achieving a homogeneous dose distribution with radiation treatment is difficult. Despite obvious similarities in the approach to such treatment (using tangents) there is variation in the process of simulation, planning and treatment between radiation oncologists. Previous Australasian studies in the treatment of lung cancer, prostate cancer and Hodgkin's disease highlighted considerable variation in many areas of treatment. As part of a multicentre breast phantom study involving 10 radiation oncology departments throughout New South Wales (NSW) and the Australian Capital Territory (ACT), a 22-question survey was distributed. The aim of the survey was to assess the extent of variation in the approach to the simulation, planning and treatment of early breast cancer using tangents. Responses from 10 different radiation oncology departments revealed variation in most areas of the survey. There is no reason to assume similar variations do not occur Australasia wide. Studies involving overseas radiation oncologists also reveal a wide variation in treating early breast cancer. The consequences of such variations remain unclear.

Australian Capital Territory↗
PubMed2000

Radiotherapy utilization in New South Wales from 1996 to 1998.

The purpose of the present study was to examine utilization rates of radiotherapy by newly diagnosed cancer patients in New South Wales (NSW) from 1996 to 1998. The 1989 report of the Australian Health Ministers' Advisory Council (AHMAC) recommended that 50% of all newly diagnosed cancer patients should receive radiotherapy. Previous reports showed that the true rate was between 30 and 36%. In 1991 and 1995 the NSW Department of Health developed strategic plans that were intended to implement the AHMAC recommendation. An analysis was carried out of activity reports of radiation oncology departments in NSW and its component Area Health Services (AHS). All NSW patients newly diagnosed with cancer between 1996 and 1998 and treated by radiotherapy were included in the study. A total of 37% of newly diagnosed cancer patients received radiotherapy in NSW in 1998. This has increased from 30% since 1990-91. Rural AHS in 1998 had an identical average rate of 37% (range: 23-54%) when compared to urban AHS (average: 37%; range: 26-49%). Rural AHS have increased utilization from 19% in 1990-91. Area health services with a radiation oncology department had a slightly higher rate of utilization than those AHS without a radiation oncology department (39 and 36%, respectively). The rates of utilization of radiotherapy in NSW in 1998 continued to be well below the benchmark set by AHMAC and varied widely between AHS. Attention to and expansion of services should be focused on both rural and urban areas of need.

Health Services Research↗
PubMed1998

Retinopathy of prematurity in infants <29 weeks' gestation at birth in New South Wales from 1986-92.

OBJECTIVE: To study the effect of increased survival of infants <29 weeks' gestation on the incidence and severity of retinopathy of prematurity (ROP). METHODOLOGY: Review of prospective records from 1986 to 1992 kept in the New South Wales (NSW) NICUS database on infants admitted to the neonatal intensive care units (NICU) in NSW. The survival rate and the incidence and severity of ROP on all infants <29 weeks' gestation admitted to the NICUs in NSW from 1 July 1986 to 31 December 1987 were compared to a similar group of infants admitted from 1 January 1992 to 31 December 1992. RESULTS: There was a significant difference in the survival rate of infants admitted between the two periods (235 of 376, 62.5% survival vs 255 of 336, 75.9% survival, respectively, P<0.0001). The odds ratio for survival adjusted for gestational age in the second period was 1.76 [1.24, 2.48 (95% confidence interval), P<0.002]. There was a slight increase in ROP in the second period (79 of 172 examined, 45.9% ROP vs 133 of 238 examined, 55.8% ROP, respectively). There was a rise in the number of infants with Stage 3 ROP in the second time period (14 of 172 examined, 8.1% ROP vs 41 of 238 examined, 17.2% ROP, respectively). However, fewer infants had detached retinas or > or = Stage 4 ROP in the second group [7 of 172, (4.1 %) vs 3 of 238, (1.3%), respectively]. This may be a reflection of the increase in the use of cryo- or laser therapy for Stage 3 ROP with 'plus' disease [2 of 172 examined, (1.2%) vs 18 of 238 examined, (7.6%), respectively]. CONCLUSIONS: With the increase in survival of the very preterm infant in recent years, there has been an increase in severe ROP (> or = Stage 3) in NSW. Despite the increased survival of the highest at-risk group (24- to 26-week gestation infants), there have been fewer cases of retinal detachment. There was also a rise in the number of infants receiving cryo- or laser therapy intervention.

Gestational Age↗
PubMed1998

A population-based survey of immunization coverage in children aged 2 years and younger in New South Wales.

OBJECTIVE: To provide a population-based baseline of immunization rates in children aged 2 years and younger in New South Wales (NSW) in 1992, permitting more accurate evaluation of the efficacy of current programmes. METHODS: A cross-sectional population-based survey of 622 households from areas resident to over 73% of all children aged 4 years and younger in NSW. RESULTS: Of the 322 households with children aged 3-24 months, 212 (66%; confidence interval (CI): 57-75%) were up-to-date with the recommended immunization schedule, 68 (21%; CI: 15-27%) had not commenced any immunization, and 42 (13%; CI: 9-17%) were partially immunised. Ability to read English (odds ratio (OR): 5.43; CI: 2.37-12.44) and receipt of hepatitis B immunization (OR; 2.54; CI: 1.27-5.07%) were highly associated with up-to-date immunization; whilst a history of any illnesses, frequent doctor visits in the past 12 months (OR: 0.47; CI: 0.27-0.85%) and older age (16-24 months) (OR: 0.26; CI: 0.12-0.50%) were less likely to be associated with up-to-date immunization. CONCLUSIONS: In 1992 NSW had low levels of up-to-date immunization. Significantly, one-fifth of NSW families with children aged 3-24 months did not have a record of any immunizations. This could not be explained by delay in commencing immunization. Poor competency in reading English was strongly associated with failure to immunise, suggesting that there had been inadequate targeting of immunization campaigns in non-English-speaking communities.

Child Health Services↗
PubMed1999

A child and adolescent psychiatric outreach service for rural New South Wales: a telemedicine pilot study.

OBJECTIVE: To examine the feasibility of a tertiary outreach service in child and adolescent psychiatry to two rural health centres in New South Wales, Australia. METHODS: Following a site visit to Dubbo Hospital and Bourke Hospital, telemedical videoconferencing was provided for 2 h/week for 32 weeks. Details of referrers, patients' diagnosis and outcome, and satisfaction with the service were obtained. RESULTS: Cases were triaged by a nominated rural adolescent mental health worker. The service provided detailed assessment and management of servere, complex, mental and neuropsychiatric disorders. Fifty-four young people were assessed and 72 joint consultative videoconferencing interviews were undertaken, including 26 initial consultations. Twenty-three initial consultations were undertaken on the visit to the rural centres. Clinical descriptions illustrate the flexibility and sensitivity of the service. CONCLUSION: Telepsychiatry provides access to a flexible, effective tertiary service for those with special, complex needs, including the disadvantaged or isolated. It makes a valuable economic contribution to supporting and educating rural health professionals, thereby enriching rural mental health services.

Adolescent↗
PubMed1999

Children at play: the death and injury pattern in New South Wales, Australia, July 1990-June 1994.

OBJECTIVES: To describe and to understand the pattern of play-related deaths and injury (excluding organized sports) among children in New South Wales (NSW), Australia. METHODOLOGY: This study utilized a state-wide prospective surveillance data collection of paediatric traumatic deaths and injuries at the Royal Alexandra Hospital for Children. Deaths and injury cases were selected from the NSW Trauma Death Registry and Childsafe NSW database. Information including basic demographics, the surrounding circumstances of death and injury incidents, and the required treatment was collected. RESULTS: There were 30 play-related deaths and 92 drownings over the 4-year period. The male to female ratio was about 2:1. Excluding drowning, which has been reported elsewhere, and sports, the leading causes of play-related deaths were burns (eight) and asphyxiation (eight). An average of 6444 presentations to the emergency departments per year were recorded with sex ratio and age distribution pattern similar to the deaths. The home was the most common place (55.5%) of play-related injury, specifically the living and sleeping area. Falls, both under and above 1 metre, were the most common causes of injury (50.9%). The leading mechanism was cuts and lacerations (21.2%). Nearly one-third (32.7%) of all injuries were to the head, with face, cheek, forehead and scalp as the most common injured body part. Significant associations between place of injury, injured body parts and age were observed. CONCLUSIONS: Play-related injury is common among children, and in some cases causes severe injury and death. To tackle the problem of play-related deaths and injuries, a holistic approach is suggested. This includes the provision of a safe environment, supervision by parents, education of children and detailed data collection.

Accident Prevention↗
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↗
PubMed2003

Spinal and spinal cord injuries in horse riding: the New South Wales experience 1976-1996.

OBJECTIVES: The objective of the present study was to determine the incidence of acute spinal cord injuries (ASCI) in all forms of horse riding in New South Wales (NSW) for the period 1976-1996. Other aims of the present study were to compare and contrast ASCI with vertebral column injuries (VCI) without neurological damage and to define appropriate safety measures in relation to spinal injury in horse-riding. DESIGN: A retrospective review was done of all ASCI cases (n = 32) admitted to the two acute spinal cord injury units in NSW for the cited period. A comparable review of VCI cases (n = 30) admitted to these centres for the period 1987-1995 was also undertaken. RESULTS: A fall in flight was the commonest mode of injury in both groups. Occupational and leisure riding accounted for 88% of ASCI and VCI. The incidence of ASCI is very low in those riding under the aegis of the Equestrian Federation of Australia - two cases in 21 years; and there were no cases in the Pony Club Riders or in Riding for the Disabled. The difference in the spinal damage caused by ASCI and VCI is in degree rather than kind. Associated appendicular/visceral injuries were common. CONCLUSIONS: No measures were defined to improve spinal safety in any form of horse riding. The possible role of body protectors warrants formal evaluation. Continued safety education for all horse riders is strongly recommended.

Acute Disease↗
PubMed2003

Preoperative cardiac assessment for patients with infrarenal abdominal aortic aneurysms: a survey of current practice by vascular surgeons in New South Wales and Australian Capital Territory.

BACKGROUND: The reported mortality rate following open elective repair of abdominal aortic aneurysm (AAA) varies between 0 and 12%. Much of the mortality and major morbidity is caused by cardiac events. The evidence regarding best practice for cardiac assessment and optimization of this patient group is unclear. The aim of the present study was to evaluate current practice of cardiac risk factor assessment by vascular surgeons in New South Wales (NSW) and Australian Capital Territory (ACT) for patients undergoing open elective repair of infrarenal AAA. METHODS: A postal questionnaire was sent to 46 surgeons in NSW and ACT identified as expressing a principal or major interest in vascular surgery. If no response was received within 3 weeks, a second questionnaire was sent and if no response was received after the second mailing, a telephone survey of non-responders was conducted. Data were collated regarding the importance of risk factors elicited by clinical history, preoperative investigation, referral for cardiological opinion, use of perioperative beta-blockade and the timing of aortic surgery in relation to coronary artery revascularization and acute myocardial infarction. RESULTS: The overall response rate was 87% (40/46) and the median (range) response time was 14 (4-109) days. Only 22 of 40 and 23 of 40 surgeons consider diabetes mellitus or renal impairment, respectively, to be important when assessing cardiac risk and 34 of 40 surgeons do not employ a validated risk index in preoperative assessment. Sixteen of 40 surgeons refer all patients needing AAA repair to a cardiologist, while 24 of 40 would initiate cardiac investigations themselves (either stress electrocardiography, scintigraphy or echocardiography). Seventeen surgeons always or usually commenced perioperative beta-blockade with wide variations in the commencement (1 to > 28 days preoperatively) and duration (< 1 week to > 28 days postoperatively) of treatment. The timing of AAA repair following coronary revascularization ranged from < 1 week to 6 months and delay in surgical repair of AAA following myocardial infarction ranged from < 1 week to > 6 months. CONCLUSION: Preoperative assessment of cardiac risk in patients for repair of AAA lacks consensus among vascular surgeons in NSW and ACT. The diversity of clinical practice may rest with the paucity of prospective trials published in the medical literature or the influence of local institutional facilities.

Aortic Aneurysm, Abdominal↗
PubMed2001

An investigation of erectile dysfunction in Gwent, Wales.

OBJECTIVE: To quantify incidence of erectile dysfunction (ED) and the associated risk factors in men attending community clinics in a large population in Wales, UK. SUBJECTS AND METHODS: Of 4060 men who were invited to attend 11 community clinics, primarily to check for prostate disease, 2025 (aged 55-70 years) attended. Of these, 2002 men answered a questionnaire about personal details, medical, family and sexual history, and detailed alcohol and smoking habits. All had their serum prostate-specific antigen (PSA) analysed and those referred for investigation of prostatic disease underwent serum testosterone analysis. RESULTS: Complete ED was reported by 265 men (13.2%), and was closely related to age (r = 0.19, P < 0.001) and medication (r = 0.2, P < 0.001). ED occurred in 6.9% of men aged 55-60 years, 12.5% aged 61-65 and 22.2% of those aged 66-70. Patients taking diabetic medication had the highest relative risk for ED and 11.3% of men with ED were taking nitrates. The numbers of years of smoking had the third closest correlation with impotence (r = 0.16, P < 0.001). A low serum testosterone level was a poor predictor of ED and increasing serum PSA levels did not influence the distribution of ED. CONCLUSION: About 13% of these men aged 55-70 years had complete ED; if this value is extrapolated to the whole of the UK, this equates to almost half a million men being unable to achieve any erections. The estimate would be much greater if those with milder forms of ED are included.

Aged↗
PubMed2003

Current practice in the management of vasectomy reversal and unobstructive azoospermia in Merseyside & North Wales: a questionnaire-based survey.

OBJECTIVE: To investigate the current incidence of vasectomy reversal procedures, the techniques used and which practitioners use them. PATIENTS AND METHODS: Using a questionnaire, 130 general surgeons and urologists practising in Merseyside and North Wales were surveyed. RESULTS: The response rate was 74%, with 24 urological surgeons and 14 general surgeons undertaking vasectomy reversal. Annually, urological surgeons carried out significantly more procedures than did general surgeons, at 8.5 and 5.3 (P = 0.029), respectively. They were also more likely to use double-layer closure and microsurgical techniques, whilst significantly less likely to use stents. Urologists reported significantly greater patency rates, at 76% and 52% (P = 0.017), respectively, with no significant differences in subsequent pregnancy rates (30% vs 25%). Only one practitioner checked tubal patency in the female partner before vasectomy reversal. CONCLUSIONS: The use of vasectomy reversal is a cost-effective treatment for men wanting paternity after vasectomy. The technique used by the clinician and proper audit of the results require close attention; it would also appear to be obvious that all the partners of men seeking a vasectomy reversal should have their fertility status established before reversal, something that is clearly not done at present.

Attitude of Health Personnel↗
PubMed2000

A client-centered model: discharge planning in Juvenile Justice Centres in New South Wales, Australia.

Health care delivered in Juvenile Justice Centres in New South Wales, Australia, leads to improvement in the health status of detainees while in custody but this declines on discharge and is contributed to by a breakdown in continuity of care. In an effort to halt this decline in health status, a model of interdisciplinary discharge planning is proposed to address the interface between Juvenile Justice Centres and adult correctional facilities and the community. Key features of the process are: collaboration through the development of links by establishment of a community liaison co-ordinator position; open and continuous communication between service providers; continuous involvement of detainees and their significant others; and ongoing support to detainees once discharged. Evaluation of the discharge-planning process ensures that the process is appropriate to meet the needs of this specific and diverse population of young people and supplies feedback to all service providers. The trusting relationship that is developed between detainees and registered nurses within centres leaves nurses ideally placed to co-ordinate the discharge-planning process.

Adolescent↗