Sending parents outpatient letters about their children: parents' and general practitioners' views.
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Parents' cooperation is essential to ensuring implementation of effective healthcare management of children, and complete openness should exist between paediatricians and parents. One method of achieving this is to send parents a copy of the outpatient letter to the general practitioner (GP) after the child's outpatient consultation. To determine the views of parents and GPs a pilot survey was conducted in two general children's outpatient clinics in hospitals in Newcastle upon Tyne. In March and April 1991 a postal questionnaire was sent to 57 parents of children attending the clinics, and a similar questionnaire to their GPs to elicit, respectively, parents' understanding of the letter and perception of its helpfulness, and GPs' views on the value of sending the letters to parents. Completed questionnaires were received from 34(60%) parents and 47(82%) GPs; 26(45%) respondents were matched pairs. 27(79%) parents said they understood all of the letter, 19(56%) that it helped their understanding, 32(94%) felt it was a good idea, and 31(91%) made positive comments. In all, 29(61%) GPs favoured the idea and six (13%) did not. Eleven (23%) said they would be concerned if this became routine practice, and 20(74%) of the 27 providing comments were doubtful or negative; several considered that they should communicate information to parents. The views in the matched pairs were dissimilar: parents were universally in favour whereas many GPs had reservations. The authors concluded that sending the letters improved parents' satisfaction with communication, and they recommend that paediatricians consider adopting this practice. (+info)
Management of primary antibody deficiency by consultant immunologists in the United Kingdom: a paradigm for other rare diseases.
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Variation in clinical practice and its effect on outcome is little known for rare diseases such as primary antibody deficiency. As part of a national audit a survey of all 30 consultant immunologists in the United Kingdom dealing with primary antibody deficiency syndromes in adults and children was carried out in 1993 to ascertain their practices in diagnosis and management. Consensus guidelines were published after the survey was completed. Comparison of the survey results of clinical practice at the time the guidelines were published with the standards identified highlighted that the practice of a minority of specialists was at variance with their peers and with the consensus document, particularly in the use of intramuscular immunoglobulin, the dose and frequency of intravenous immunoglobulin, and target trough immunoglobulin G concentration, which has implications for the quality of patient care. However, much closer agreement existed in the key areas of management, such as diagnosis and selection of intravenous immunoglobulin. The approach and the problems identified are relevant to the management of other rare diseases, in which diagnosis and management is complex and there are few specialists with the necessary knowledge to undertake such care. This survey, the first attempted audit of practice, shows that within a motivated group of specialists highly significant differences in practice may exist and the authors emphasise the importance of setting clear guidelines against which care can be assessed. (+info)
Cardioversion for atrial fibrillation: the views of consultant physicians, geriatricians and cardiologists.
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BACKGROUND AND AIMS: Atrial fibrillation (AF) increases the risk of stroke and also has adverse haemodynamic consequences. Cardioversion of AF to sinus rhythm may obviate the need for long-term anticoagulation and improve cardiovascular haemodynamics, but is probably underused. We therefore investigated the views of hospital consultants about cardioversion for AF. METHODS: 336 Postal questionnaires were sent to all 186 consultant physicians, 54 cardiologists and 96 geriatricians in Scotland, followed by one reminder letter to non-responders. RESULTS: 71% Of questionnaires were returned. Cardiologists referred 18% of AF patients for cardioversion, while physicians referred 11% and geriatricians 5%. Cardiologists had better access to cardioversion facilities and were less likely to consider an enlarged left atrium and organic heart disease to be contra-indications to cardioversion. Anticoagulation was given for less than 3 weeks before cardioversion by 9% of cardiologists, 39% of physicians and 65% of geriatricians (P<0.001), and for less than 3 weeks after cardioversion by 17% of cardiologists, 45% of physicians and 47% of geriatricians (P = 0.7). SUMMARY: The wide variation in practice both between and within the different specialties suggests that consensus guidelines based on the best available evidence should be developed. (+info)
Role of the surgical trainee in upper gastrointestinal resectional surgery.
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The 'New Deal' set out by the Department of Health in 1991, together with the introduction of specialist 6-year training grades by Calman in 1993, has resulted in a decrease in available training time for surgeons in the UK. There is also an emerging belief that surgical procedures performed by trainees might compromise patient outcome. This study examines the level of trainee experience in a specialist gastrointestinal unit and whether operation by a trainee surgeon adversely affects patient outcome. All patients in the University Department of Surgery, Royal Infirmary, Edinburgh, undergoing oesophagogastric, hepatic or pancreatic resection between January 1994 and December 1996 were entered into the study. The early clinical outcome (in-hospital mortality and morbidity, considered in three groups: anastomotic leak, other technique-related complications and non-technique-related complications) was evaluated with regard to the grade of surgeon (consultant or trainee) performing the operation. Of the 222 patients undergoing major upper gastrointestinal resection during the study period, 100 (45%) were operated on by trainees. Trainees were assisted and closely supervised by consultants in all but six resections. There was no major difference in mortality rate (consultant, 4.1% vs trainee, 5%), incidence of non-technique-related complications (consultant, 6.7% vs trainee, 7.1%), anastomotic leaks (consultant, 10.7% vs trainee, 5%) or technique-related complications (consultant, 18.9% vs trainee, 15%) between the two grades of surgeon. In a specialist unit, the early clinical outcome of patients undergoing major upper gastrointestinal resection by supervised trainees is no worse than in those operated on by consultants. Participation of trainees in such complex procedures enhances surgical training and does not jeopardise patient care. (+info)
Influence of hospital and clinician workload on survival from colorectal cancer: cohort study.
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OBJECTIVE: To determine whether clinician or hospital caseload affects mortality from colorectal cancer. DESIGN: Cohort study of cases ascertained between 1990 and 1994 by a region-wide colorectal cancer register. OUTCOME MEASURES: Mortality within a median follow up period of 54 months after diagnosis. RESULTS: Of the 3217 new patients registered over the period, 1512 (48%) died before 31 December 1996. Strong predictors of survival both in a logistic regression (fixed follow up) and in a Cox's proportional hazards model (variable follow up) were Duke's stage, the degree of tumour differentiation, whether the liver was deemed clear of cancer by the surgeon at operation, and the type of intervention (elective or emergency and curative or palliative intent). In a multilevel model, surgeon's caseload had no significant effect on mortality at 2 years. Hospital workload, however, had a significant impact on survival. The odds ratio for death within 2 years for cases managed in a hospital with a caseload of between 33 and 46 cases per year, 47 and 54 cases per year, and >/=55 cases per year (compared to one with +info)
Content-based image retrieval in picture archiving and communications systems.
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We propose the concept of content-based image retrieval (CBIR) and demonstrate its potential use in picture archival and communication system (PACS). We address the importance of image retrieval in PACS and highlight the drawbacks existing in traditional textual-based retrieval. We use a digital mammogram database as our testing data to illustrate the idea of CBIR, where retrieval is carried out based on object shape, size, and brightness histogram. With a user-supplied query image, the system can find images with similar characteristics from the archive, and return them along with the corresponding ancillary data, which may provide a valuable reference for radiologists in a new case study. Furthermore, CBIR can perform like a consultant in emergencies when radiologists are not available. We also show that content-based retrieval is a more natural approach to man-machine communication. (+info)
Doctors as patients: postal survey examining consultants and general practitioners adherence to guidelines.
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OBJECTIVES: To examine the adherence by senior NHS medical staff to the BMA guidelines on the ethical responsibilities of doctors towards themselves and their families. DESIGN: Postal semistructured questionnaire. SETTING: Four randomly selected NHS trusts and three local medical committees in South Thames region. SUBJECTS: Consultants and principals in general practice. MAIN OUTCOME MEASURES: Personal use of health services. RESULTS: The response rate was 64% (724) for general practitioners and 72% (427) for consultants after three mailings. Most (1106, 96%) respondents were registered with a general practitioner, although little use was made of their services. 159 (26%) general practitioners were registered with a general practitioner in their own practice and 80 (11%) admitted to looking after members of their family. 73 (24%) consultants would never see their general practitioner before obtaining consultant advice. Most consultants and general practitioners admitted to prescribing for themselves and their family. Responses to vignettes for different health problems indicated a general reluctance to take time off, but there were differences between consultants and general practitioners and by sex. Views on improvements needed included the possibility of a "doctor's doctor," access to out of area secondary care, an occupational health service for general practitioners, and regular health check ups. CONCLUSION: The guidelines are largely not being followed, perhaps because of the difficulties of obtaining access to general practitioners outside working hours. The occupational health service should be expanded and a general practitioner service for NHS staff piloted. (+info)
Major incidents: training for on site medical personnel.
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OBJECTIVE: To assess the present levels of training for the medical incident officer (MIO) and the mobile medical team leader (MMTL) throughout the UK. METHOD: Postal questionnaire to consultants in charge of accident and emergency (A&E) departments seeing more than 30,000 patients a year. Information regarding MIO staffing and training and MMTL training and provision requested. RESULTS: A&E provides the majority of both MIOs and MMTLs in the event of a major incident. Virtually all MIOs are consultants or general practitioners. However, 63% of MMTLs are from hospital training grade staff. One third of hospitals required their designated MIO to have undertaken a Major Incident Medical Management and Support course and a quarter had no training requirement at all. Two thirds of MMTLs were expected to have completed an Advanced Trauma Life Support course, but in 21% there was no minimum training requirement. Training exercises are infrequent, and hence the exposure of any one individual to exercises will be minimal. CONCLUSION: There has been some improvement in major incident training and planning since 1992, but much remains to be done to improve the national situation to an acceptable standard. (+info)