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Biomedical subjects

A Hopkins

Publications and source records attributed to A Hopkins.

At least 55 records · Page 3Linked to original sources
PubMed1994

Comparative hospital databases: value for management and quality.

OBJECTIVES: To establish an accurate and reliable comparative database of discharge abstracts and to appraise its value for assessments of quality of care. DESIGN: Retrospective review of case notes by trained research abstractors and comparison with matched information as routinely collected by the hospitals' own information systems. SETTING: Three district general hospitals and two major London teaching hospitals. PATIENTS: The database included 3905 medical and surgical cases and 2082 obstetric cases from 1990 and 1991. MAIN MEASURES: Accessibility of case notes; measures of reliability between reviewers and of validity of case note content; application of high level quality indicators. RESULTS: The existing hospital systems extracted insufficient detail from case notes to conduct clinical comparative analyses for medical and surgical cases. The research abstractors at least doubled the diagnostic codes extracted. Interabstractor agreement of about 70% was obtained for primary diagnosis and assignment to diagnosis related group. These data were sufficient to create a comparative database and apply high level quality indicators designed to flag topics for further study. For obstetric-specific indicators the rates were comparable for abstractors and the hospital information systems, which in each case was a departmentally based system (SMMIS) producing more detailed and accessible data. CONCLUSIONS: Current methods of extracting and coding diagnostic and procedural data from case notes in this sample of hospitals is unsatisfactory: notes were difficult to access and recording is unacceptably incomplete. IMPLICATIONS: Improvements as piloted in this project, are readily available should the NHS, hospital managers, and clinicians see the value of these data in their clinical and managerial activities.

Data Collection↗
PubMed1993

Precision in reporting the dose given in a course of radiotherapy.

A knowledge of the precise dose given in a course of radiotherapy is vital to the interpretation of the result. Despite this, an acceptable level of reporting was found in only 72 (36%) of 200 papers published in the two leading journals of radiation oncology. Analysis of the treatment data of the cases with head and neck tumours in the pilot study of CHART showed that the mean of the minimum tumour doses given was 5.1% lower than the mean of those at the intersection points. Had the same total dose been prescribed to the intersection point instead of the minimum there would have been a similar lowering of dose. There is evidence from published clinical data and a suggestion from an analysis of the CHART pilot study data that a dose difference as small as 5% may lead to real impairment or enhancement of tumour response, as well as altering the risk of morbidity. Inadequate reporting may lead to a false interpretation of a study and to its wrongful application. It is strongly recommended that it should be editorial policy to publish only those papers where the radiation dose is fully described.

Absorption↗
PubMed1992

Transoesophageal echocardiography in heart disease--old technologies, new tricks.

Cardiac ultrasound and upper gastrointestinal endoscopy are relatively old technologies. With the introduction of new ultrasound probes and by incorporating ultrasound technology into conventional endoscopes, 'new tricks' in cardiac imaging were discovered. Posterior structures of the heart are now able to be imaged clearly by the ultrasound probe from the oesophagus. Consequently, better resolution of cardiac anatomy allows more accurate diagnosis of cardiac pathologies which is not possible using conventional transthoracic (TT) approach. Over a period of two years, 1200 cases of transoesophageal echocardiography (TOE) were undertaken in our institution. The major indications were diseases of the aorta (10%), source of cardioembolism (28%), assessment of native and prosthetic valve function (20%), suspected endocarditis and its complication (17%), pre and post percutaneous transluminal mitral valvotomy (PTMV [13%], congenital heart disease (2%) and others (10%). The greatest impact with TOE is in the diagnosis of aortic dissection and transection. TOE is superior to conventional TT approach in detecting potential source of embolism, valvular vegetations and its complication, native and prosthetic valve dysfunction and LA thrombus prior to PTMV. Observations by TOE such as spontaneous echo contrast (SEC) in the left atrium open new challenges for further research in its role in the pathogenesis of LA thrombus and its association with cardioembolic event. Other areas of interest include; reclassification of distal aortic dissection and the use of TOE in intra-operative work.

Aortic Diseases↗
PubMed1992

Clinical audit and neurology.

Medical audit has been defined as "a systematic critical analysis of the quality of medical care, including the procedures used for diagnosis and treatment, the use of resources, and the resulting outcome for the patient". In Britain, recent reforms of the Health Service increase the need for neurologists to undertake audit. The basic principles of audit in relation to the management of common conditions such as headache and epilepsy are described. Audit must consider not only efficiency but also effectiveness, but the difficulty of developing valid outcome measures should not be underestimated, especially in chronic disabling conditions.

Health Resources↗
PubMed1992

Epilepsy.

Explore the source record for details and available documents.

Anticonvulsants↗
PubMed1991

Putting a foot right.

Explore the source record for details and available documents.

Attitude of Health Personnel↗
PubMed1990

How easy is it to contact the duty medical doctor responsible for acute admissions?

OBJECTIVE: To ascertain ease or difficulty of contacting duty junior doctors responsible for acute medical admissions by telephone. DESIGN: Telephone survey of hospitals in six health regions in England and Wales. SETTING: 70 Randomly selected hospitals, 15 of which were excluded because of non-acceptance of acute medical admissions. PARTICIPANTS: 71 Duty doctors (duty house physicians, senior house officers, or registrars responsible for acute medical admissions) in 48 hospitals; seven duty doctors in seven hospitals were excluded (four declined to participate and three required a written explanation of the survey). 67 Doctors gave full information to all questions. MAIN OUTCOME MEASURES: Time taken for hospital switchboards and duty doctors to reply to telephone call, diagnoses of patients recently admitted, and on call rotas and hours of sleep of duty doctors. RESULTS: Hospital switchboards responded within 30 seconds in 87 (74%) calls, and in 76 calls (64%) the duty doctor requested was contacted within a further two minutes. Chest pain, possibly due to myocardial infarction, was the most common reason for acute medical admissions. Nearly half (48%) of the duty doctors in larger hospitals reported having 4-5 hours sleep or less on their nights on call. Most (30) were on a one in three rota; two were on a one in two rota. CONCLUSIONS: Despite impressions to the contrary contacting the duty medical team by telephone seemed fairly easy. Although most junior doctors were on a rota of one in three or better, insufficient recognition may be given to their deprivation of sleep during nights on duty.

Communication↗
PubMed1990

The social recognition of repetition strain injuries: an Australian/American comparison.

In the mid 1980s the problem of occupational overuse injuries, particularly among keyboard operators, gained widespread recognition in Australia. The country appeared to be experiencing an epidemic, the like of which was unknown elsewhere in the world. Three explanations are canvassed in the paper: first, the psychiatric theory that it was a case of 'epidemic hysteria'; second the hypothesis that there really were more such injuries in Australia than elsewhere; and third, the hypothesis that the institutions of Australian society facilitated recognition of the problem, while those of other countries repress awareness of it. The paper focuses on this last hypothesis and seeks to demonstrate it by means of a comparison between Australia and the United States. It shows how, in particular, the system of workers' compensation in the Australian public service facilitated recognition of the problem, while the compensation system in the United States makes it very difficult for sufferers to have their disability acknowledged. Since workers' compensation is virtually the only source of injury statistics, this has led to the visibility of the problem in Australia and its invisibility in the United States.

Australia↗
PubMed1990

Generating a model of epileptic stigma: the role of qualitative analysis.

This paper uses an account of the goals, methods and results of a British community study of coping with epilepsy to consider the nature and range of the contributions qualitative analyses can make to theory formation. Different functions and contexts of qualitative analyses are described, and illustrations given of ways in which these helped generate and inform a particular model of the impact of the stigma of epilepsy on day-to-day life.

Adaptation, Psychological↗
PubMed1990

The clinical role of transoesophageal echocardiography.

The role of transoesophageal echocardiography (TEE) was evaluated in a consecutive series of 100 procedures performed in 86 patients (age 17-81, mean 56 years). All patients had prior transthoracic echocardiography (TTE). TEE was performed with a 5 MHz phased array transoesophageal transducer with pulsed wave Doppler and colour flow mapping capability. Forty-four per cent of patients received intravenous sedation and 36% received antibiotic prophylaxis. There were no complications of TEE. The TTE and TEE findings were compared. In patients referred for possible cardiac source of embolism, left atrial thrombi were detected in 8/27 TEE studies but in none of 27 TTE studies. In 12 patients with prosthetic valve dysfunction TEE distinguished prosthetic from periprosthetic regurgitation in 9/12 studies compared to 3/12 with TTE. In 11 patients with suspected aortic dissection TEE correctly detected dissection in all seven cases in which the diagnosis was subsequently confirmed, whereas TTE showed only equivocal findings in two cases. Vegetations were detected by TEE in 4/5 studies in patients with proven native valve endocarditis and by TTE in 2/5. No vegetations were detected by TTE or TEE in five studies in patients with proven prosthetic valve endocarditis. Compared with other investigations there were no false positive TEE studies and one possible false negative study. We conclude that TEE is a safe procedure which often provides additional clinical information to transthoracic echocardiography.

Adolescent↗