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Biomedical subjects

A Mordue

Publications and source records attributed to A Mordue.

12 recordsLinked to original sources
PubMed1997

The development of an approach to evaluate NHS manager's competence in medical informatics.

This paper describes the research and development of Checkpoint, a self-assessment instrument. It outlines how the instrument has helped managers in the NHS identify their strengths and weaknesses with respect to their management and use of informatics. The paper presents trends and feedback from the use of Checkpoint and the implications for future education and training of managers in the NHS.

Administrative Personnel↗
PubMed1995

Building an information culture: the top team.

This paper describes a learning process, used by the NHS, which aims to improve the management of information in NHS organizations by enabling the top team to develop a more strategic view of information management and technology in line with the Management in the 1990s approach.

Focus Groups↗
PubMed1994

Thresholds for treatment in cataract surgery.

BACKGROUND: The aim of the study was to identify the criteria used by ophthalmologists when assessing patients who may require cataract surgery, examine the extent of variation in their application and explore their relationship with current patterns of supply and demand. METHODS: This was a descriptive study involving semi-structured interviews with ophthalmologists, examination of hospital clinical records, and analysis of routinely available data on waiting times and hospital activity. The setting was ophthalmology units within the Northern Region of England. The subjects were 27 consultant ophthalmologists and 160 patients undergoing cataract extraction. RESULTS: There was agreement amongst ophthalmologists on the criteria used to select patients for treatment, and on the visual acuity level at which they would usually recommend surgery. All assess the degree of handicap resulting from cataract; most consider this more important than visual acuity. Over half of the patients were over 75 years old; two-thirds were women. Median visual acuity at listing was 6/36, but over 40 per cent were 6/60 or worse. Visual acuity at treatment was not recorded for 32 per cent of patients. Wide variation in visual acuity at listing existed between both units and consultants, and for both the affected and other eye. Second extractions may be performed at a better level of visual acuity than for first extractions. Median visual acuity at listing was significantly correlated with total waiting times for individual consultants. Lower cataract extraction rates are associated with long waiting times and poorer visual acuity at listing. CONCLUSIONS: There is considerable unmet need for cataract treatment within the Northern Region and significant variation in the current meeting of needs and demands. It may be that more needs could be met simply by changing referral and treatment patterns without increasing total service activity. Although visual acuity is a reasonably objective measure in routine use, the level of visual handicap is more important, and its assessment is more subjective; development of a standard method to assess this could help in producing guidelines for patient referral and selection. Audit of treatment thresholds could allow a better matching of service provision to population needs.

Aged↗
PubMed1994

Effect of guidelines on management of head injury on record keeping and decision making in accident and emergency departments.

OBJECTIVE: To compare record keeping and decision making in accident and emergency departments before and after distribution of guidelines on head injury management as indices of implementation. DESIGN: Before (1987) and after (1990) study of accident and emergency medical records. SETTING: Two accident and emergency departments in England. PATIENTS: 1144 adult patients with head injury in department 1 (533 in 1987, 613 in 1990) and 734 in department 2 (370, 364 respectively). MAIN MEASURES: Recording of relevant symptoms and signs as determined in the guidelines; presence of, indications for, and rates and appropriateness of skull x ray examination and admission. RESULTS: The median number of guidelines variables recorded for all study periods ranged from 7 to 9 out of a possible maximum of 27. For key decision making variables the presence or absence of penetrating injury was least likely to be recorded (< or = 1%) and that of loss of consciousness most likely (> or = 75%). Altogether, the proportion of patients receiving skull x ray examination or admitted varied from 25%-60% and 7%-23% respectively; overall, 69% (1280/1856) and 64% (1177/1851) of patients were managed appropriately. However, no consistent change occurred in the departments between the study periods. For instance, in department 1 the proportion of appropriate x ray examinations rose significantly after distribution of the guidelines (from 61% (202/330) to 73% (305/417)) and appropriate decisions on whether to x ray or not also rose (from 65% (340/522) to 72% (435/608)). There was no significant change in department 2, although the proportion of appropriate admissions fell (from 33% (55/166) to 15% (19/130)). CONCLUSIONS: Recording practice and decision making were variable and had not consistently improved after dissemination of the guidelines. Strategies are required to ensure effective implementation of guidelines.

Adult↗
PubMed1993

An audit of distribution and use of guidelines for management of head injury.

Ensuring effective distribution of guidelines is an important step towards their implementation. To examine the effectiveness of dissemination of a guidelines card on management of head injury and determine its usefulness to senior house officers (SHOs), a questionnaire survey was performed in May 1990, after distribution of the cards in induction packs for new doctors and at postgraduate lectures and displaying the guidelines in accident and emergency departments and wards. A further survey, in March 1992, assessed the impact of modifying the distribution. All (175) SHOs working in general surgery, accident and emergency medicine, orthopaedics, and neurosciences on 1 February 1990 in 19 hospitals including two neurosurgical units in Northern region were sent self completion questionnaires about awareness, receipt, use, and perceived usefulness of the guidelines. 131 of 163(80%) SHOs in post responded (median response from hospitals 83% (range 50%-100%)). Over three quarters (103, 79%) of SHOs were aware of the guidelines and 82(63%) had ever possessed a guidelines card. Only 36(44%) acquired the card in the induction pack. 92%(98/107) found them useful and 81% (89/110) referred to them to some extent. Owning and carrying the card and referring to guidelines were associated with departmental encouragement to use the guidelines. Increasing the displays of guidelines in wards and departments and the supply of cards to consultants in accident and emergency medicine as a result of this survey did not increase the number of SHOs who received cards (52/83, 63%), but more (71/83, 86%) were aware of the guidelines. The guidelines were welcomed by SHOs and used in treating patients with head injury, but their distribution requires improvement. Increased use of the guidelines may be achieved by introducing other distribution methods and as a result of encouragement by senior staff.

Craniocerebral Trauma↗
PubMed1989

An appraisal of waiting list problems.

The identification of problem waiting lists is important in effectively targeting scarce resources. This paper discusses the data available on waiting lists, and develops an information profile which can be used as a screening device to construct a short list of the 'worst' waiting lists. This profile was tested using the waiting experience of one specialty in the Northern region, and the results are presented here. Further developments to the profile are largely dependent upon improvements to the information currently collected on waiting lists.

Appointments and Schedules↗