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Biomedical subjects

B Jennett

Publications and source records attributed to B Jennett.

At least 55 records · Page 3Linked to original sources
PubMed1990

Head injuries in accident and emergency departments. How different are children from adults?

STUDY OBJECTIVE: The aim of the study was to examine the differences between child and adult patients attending accident and emergency departments after recent head injuries. DESIGN AND SETTING: A retrospective survey based on existing case records from 23 Scottish accident and emergency departments for 1985 was compared with prospective data from one hospital over 9 months in 1984. PATIENTS: 3838 children under 15 and 4775 adults attended hospital with head injuries during the period analysed. MAIN RESULTS: Only 9% of children and 20% of adults had evidence of brain damage (altered consciousness on arrival, or history of altered consciousness with amnesia on arrival). Scalp lacerations were recorded in approximately 40% of both children and adults, more commonly in those without brain damage. Fewer children than adults had a skull x ray; in both age groups x rays were more often done if there was evidence of brain damage, headache, or vomiting, and less often when there was a scalp laceration. Only 11% of children were admitted compared with 20% of adults. Admission rates per 100,000 population per year were 4011 for children and 1473 for adults (1967 overall); admission rates for brain damage were 290 for children and 341 for adults (331 overall). CONCLUSIONS: These are the first population based estimates of frequency of head injuries presenting at accident and emergency departments, analysed by age, gender and cause of injury. They should be of value when planning services for the head injured.

Adolescent↗
PubMed1989

Quality of care and cost containment in the U.S. and U.K.

Many activities of doctors in the acute hospital sector do not improve patient outcome because they are inappropriate. Curtailing interventions that are unnecessary (because the patient is not bad enough) or are unsuccessful (because the condition is too advanced) could both save resources and improve care. Rational rationing depends on knowledge about the expected benefits of various technologies when used in different clinical circumstances.

Cost Control↗
PubMed1989

Surgery to prevent stroke. High hopes and deep disappointment.

Carotid endarterectomy and EC/IC bypass grafting have been widely adopted for patients considered at risk from stroke, without good evidence of efficacy. Unjustified claims for surgery usually derive from overestimating the dangers of the disease without surgery, while perioperative risks are underestimated. Inadequate follow-up and choosing irrelevant outcome measures often add to the confusion. All these factors apply to surgery for stroke. A trial of EC/IC bypass in 1,377 patients from three continents took 8 years to complete and showed no benefit in patients randomized to surgery. Reluctance to accept this result led to detailed critiques of this trial in several journals, largely based on the discovery that many patients had been operated on in some centers without having been randomized. In reply, the investigators showed that these cases did not affect the "resounding negativity of the results." Lack of good data about the prognosis of patients with TIAs or minor strokes was the fundamental reason for so much misplaced surgical effort. This applies equally to carotid endarterectomy, for which large trials are currently being completed. Had there been a reliable data base of patients at risk of stroke, prospectively collected and followed, the efficacy of these two operations could have been determined much sooner, and inappropriate diffusion might have been prevented.

Canada↗
PubMed1988

Assessment of clinical technologies. Importance for provision and use.

The author contends that the diffusion and use of modern medical technologies has had a profound impact on the hospital environment, the doctor-patient relationship, and the humanity of the patient. On these grounds the author argues for a rigorous, comprehensive, and ongoing assessment of diagnostic and therapeutic technologies. He stresses the importance of developing standards by which to judge the human and economic impact of particular technologies. These studies would decrease the inappropriate use of medical technology and would provide guidelines to improve current use.

Clinical Trials as Topic↗
PubMed1988

The role of the universities in assessing technology and disseminating information.

Universities, especially those with medical schools whose academics engage in clinical research, have a vital role in shaping the way in which medical technology is used. Academic clinicians are a bridge between laboratory research, where new technologies are developed, and clinical practice, where these technologies are applied in treating patients. Academic clinicians are particularly suited to doing clinical assessment of medical technologies, and academic clinical departments should devote more time to the assessment and application of technology on a broad scale.

Academic Medical Centers↗
PubMed1987

How accurately are fractures of the skull diagnosed in an accident and emergency department.

Over a 9-month period 3424 patients with a head injury were examined in the Accident and Emergency Department of Monklands District General Hospital. Casualty officers diagnosed 66 fractures of the skull on radiographs but 27 of these were subsequently reported by a radiologist as not being fractures. Of the 45 fractures reported by the radiologist 6 had been missed by the casualty officer. This study demonstrates the performance of junior medical staff who have no formal training in radiology. It emphasizes the need to instruct such staff when they are assigned to work in accident and emergency departments.

Adult↗
PubMed1987

Technology assessment for countries in different stages of development.

Technology, in the form of tools, can lead to more effective and less hazardous diagnosis, monitoring and treatment. Criticisms of undue cost and of inhumanity reflect inappropriate use--when a technology is either unnecessary or is bound to be unsuccessful. Strategic objectives for managing technology include determining the limits of appropriate use in the particular country and the level of affordable provisions. Competition between patients for access to a technology should depend on the relative probability of benefit. Competition between technologies for provision should depend on the relative cost of a quality adjusted life year (QALY). Once data on technology assessment is available, steps should be taken to inform providers about appropriate macro-allocation, and clinicians about micro-allocation. There are imperatives to inappropriate use of technologies, especially those that marginally improve or extend the lives of the hopelessly ill. Ethics and economics demand a prior consensus by groups of doctors and others about limiting technological treatment in such circumstances. This should make it easier for individual clinicians to make wise decisions and to minimise inhumanity and waste of resources.

Cost-Benefit Analysis↗