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Biomedical subjects

J Gabbay

Publications and source records attributed to J Gabbay.

At least 55 records · Page 3Linked to original sources
PubMed1993

Audit of start of anticoagulation treatment in inpatients.

AIMS: To develop a method for evaluating the start of anticoagulation treatment in inpatients. METHODS: One hundred case notes were audited using a proforma based on local guidelines in accordance with British Society for Haematology recommendations. RESULTS: Confirmatory investigations were done in 93% and 79% of patients with symptomatic deep venous thrombosis and pulmonary embolism, respectively. Identification of patients' risk factors for anticoagulation by history taking and laboratory tests was often inadequate: baseline coagulation screen, platelet count, liver function and renal function tests were done in 52%, 95%, 70% and 87% of cases, respectively. There was a tendency to undertreat patients: 33% of the activated partial thromboplastin times (APTT) and 58% of the International Normalised Ratios (INR) were subtherapeutic. The heparin-warfarin crossover period was particularly problematic: 37% stopped heparin without an INR that day, or had an INR of less than 2. Microscopic haematuria was monitored occasionally. Of the 62 patients continuing anticoagulation, 72% were discharged with the final INR in the therapeutic range. At discharge, only 74% of patients had documented appointments for the anticoagulant Clinic, the period between discharge and appointment ranging from 0 to 12 days. Of the 25 cases with an appointment exceeding four days after discharge, only six (24%) had arrangements for an interim INR check. CONCLUSIONS: The experience allowed the proforma to become streamlined to a more practical, reliable, and valid tool for use elsewhere. Findings will be fed back to the hospital staff to promote practice improvements before closing the audit loop by re-evaluating practice. Further studies are in progress to identify barriers experienced by doctors in implementing the guidelines and problems in the process of referral to the anticoagulant clinic.

Adult↗
PubMed1992

Evaluation of audit of medical inpatient records in a district general hospital.

OBJECTIVE: To evaluate an audit of medical inpatient records. DESIGN: Retrospective comparison of the quality of recording in inpatients' notes over three years (1988, 1989, 1990). SETTING: Central Middlesex Hospital. MATERIALS: Random sample of 188 notes per year drawn systematically from notes from four selected one month periods and audited by two audit nurses and most hospital physicians. MAIN MEASURES: General quality of routine clerking, assessment, clinical management, and discharge, according to a standardised, criterion based questionnaire developed in the hospital. RESULTS: 1988 was the year preceding the start of audit in the hospital, 1989 the year of active audit with implicit and loosely defined criteria, and 1990 the year after introduction and circulation of explicit criteria for note keeping. There was a significant trend over the three years in 21/56 items of the questionnaire, including recording of alcohol intake (x2 = 8.4, df = 1, p = 0.01), ethnic origin (x2 = 57, df = 1, p = 0.001), allergies and drug reactions (x2 = 10, df = 1, p = 0.01) at admission and of chest x ray findings (x2 = 8, df = 1, p = 0.01), final diagnosis (x2 = 5.6, df = 1, p = 0.025), and signed entries (x2 = 11.3, df = 1, p = 0.001). Documentation of discharge and notification of discharge to general practitioners was not significantly improved. CONCLUSIONS: Extended audit of note keeping failed to sustain an initial improvement in practice; this may be due to coincidental decline in feedback to doctors about their performance.

Documentation↗
PubMed1991

Use of a guideline based questionnaire to audit hospital care of acute asthma.

OBJECTIVES: To design an audit questionnaire and pilot its use by an audit assistant to monitor inpatient management of acute asthma and to compare the care given by chest physicians and general physicians. DESIGN: Retrospective review by a chest physician and audit assistant of a random sample of 76 case records of patients by a criterion based questionnaire developed from hospital guidelines on management of acute asthma. SETTING: One district general hospital. PATIENTS: 76 adult patients with acute asthma: 38 admitted with a relevant primary diagnosis between April 1988 and March 1989 and a further 38 admitted through the accident and emergency department between April 1989 and March 1990. MAIN OUTCOME MEASURES: Conformity with recognised standards for assessment and management of acute asthma before and after the audit and by chest physicians and general physicians. RESULTS: Age and sex did not differ significantly between the different groups of patients. Overall, deviations from the guidelines occurred in recording measures of severity of asthma, emergency treatment with beta 2 agonists (60/76, 79%) and steroids (43/76, 57%), and prescription of antibiotics in accordance with at least one criterion of the guidelines (29/45, 64%). Chest physicians were more rigorous than general physicians in recording severity measures, especially serum potassium concentration (chi 2 = 3.6, df = 1, p = 0.06), emergency steroid treatment within the correct period (chi 2 = 3.9, df = 1, p = 0.05), and referral for follow up at an outpatient chest clinic. Recording of arterial blood gas tensions improved significantly between the 1988-9 and 1989-90 samples (chi 2 = 7.0, df = 1, p = 0.08). CONCLUSIONS: The questionnaire proved easy to use for both doctor and audit assistant. The audit improved few standards of care and emphasises the need for further reinforcement and feedback.

Acute Disease↗
PubMed1991

Halitosis measurement by an industrial sulphide monitor.

Previous studies have established that hydrogen sulphide and mercaptans are the primary components of halitosis (bad breath). In the present investigation, we report a simple, rapid technique for measurement of halitosis-related sulphides. The technique is based on a portable instrument generally used for environmental safety applications. Seventy-five volunteers were measured using this technique, and the results (in peak ppb hydrogen sulphide equivalents) compared with organoleptic assessment by 7 judges. A highly significant overall correlation (r = 0.603; P less than 0.001) was obtained between these 2 methods. Moreover, in most cases, the organoleptic ratings of the individual judges correlated more highly with sulphide monitor values than with one another. The simplicity of the technique suggests its use in clinical studies as well as in diagnosis and treatment of patients with this complaint.

Adolescent↗
PubMed1991

Needs assessment needs assessment....

Needs assessment is now a high priority, but it is conceptually muddled and technically difficult. In the past a variety of academic disciplines addressing different aspects of health care have produced a range of definitions on 'need' applicable to their own setting. In the context of the National Health Service Review, 'need' may best be defined as the ability to benefit from 'health care', which depends both on morbidity and on the effectiveness of care. An analysis of its relationship with 'demand', which is the health care that people ask for, and 'supply', which is provided, exposes the limitations of current information sources, and confirms that the formal assessment of needs will inevitably be a lengthy task. Despite these difficulties there is much that can and should be done incrementally to influence contracts between providers and purchasers towards meeting health care needs.

Data Collection↗
PubMed1990

What did audit achieve? Lessons from preliminary evaluation of a year's medical audit.

OBJECTIVE: To evaluate the experience of a year's audit of care of medical inpatients. DESIGN: Audit of physicians by monthly review of two randomly selected sets of patients' notes by 12 reviewers using a detailed questionnaire dedicated to standards of medical records and to clinical management. Data were entered into a database and summary statistics presented quarterly at audit meetings. Assessment by improvement in questionnaire scores and by interviewing physicians. SETTING: 1 District general hospital. PARTICIPANTS: About 40 consultant physicians, senior registrars, and junior staff dealing with 140 inpatient records. MAIN OUTCOME MEASURES: Median scores (range 1 to 9) for each item in the questionnaire; two sets of notes were discussed monthly at "general" audit meetings and clinical management of selected common conditions at separate monthly meetings. RESULTS: A significant overall increase in median scores for questions on record keeping occurred after the start of the audit (p less than 0.01), but interobserver variation was high. The parallel audit meetings on clinical management proved to be more successful than the general audits in auditing medical care and were also considered to be more useful by junior staff. CONCLUSIONS AND ACTION: Medical audit apparently resulted in appreciable improvements in aspects of care such as clerking and record keeping. Analysis of the scores of the general audits has led to the introduction of agreed standards that can be objectively measured and are being used in a further audit, and from the results of the audits of clinical management have been developed explicit guidelines, which are being further developed for criterion based audit.

Attitude of Health Personnel↗
PubMed1990

Effect of ionization on microbial air pollution in the dental clinic.

The use of spray-producing instruments in the dental clinic continuously creates a potentially harmful contamination of the room environment. In the present study a 13.5-kV corona discharge ionizing generator was used in order to investigate the effect of ions on the microbial air pollution of the dental clinic. Samples of microbial air population were collected in 9-cm-diameter plates containing either Bacto-Brain Heart Infusion Agar or Bacto-Mitis Salivarius Agar and exposed to different time periods in various locations of an active dental clinic. Microbial air levels in the dental clinic were significantly reduced with the generator (by 40-50%). The data suggest that the ionizing generator can be used to reduce the microbial air pollution within the dental clinic, thus reducing the environmental hazard of infections to the staff.

Air Ionization↗
PubMed1989

Priorities in a London teaching hospital: a health services research approach to gynaecology provision.

In late 1987, as part of the response to an overspend of pounds 3.2 million, the health authority of an inner London teaching district, Paddington and North Kensington, proposed to close urgently 16 of the 56 gynaecology beds at the Samaritan hospital. They did so on the assumption that the hospital often served women who were neither local nor required the special expertise of a teaching hospital. To test this assumption, we reviewed the functions and funding of the hospital, how its activity level and size compared with other districts, and the nature of the workload, i.e. the extent to which the patients were local or non-local, or needed routine or specialist care. It was agreed that non-local routine patients are the district's lowest priority, and we demonstrated that such patients account for no more than six to 11 beds. This information helped to resolve negotiations over the bed numbers. This study demonstrates that it was possible to defuse a potential confrontation by using routinely available and additional survey data to inform the debate.

Catchment Area, Health↗
PubMed1988

How much day surgery? Delphic predictions.

A list was compiled of 83 of the commonest operations, which according to published reports may be performed on day patients but which in our district were usually performed on inpatients. The results of a national Delphi study among anaesthetists and general surgeons who were known to be in favour of day surgery produced estimates of the probable rates of day surgery for each of those operations under ideal conditions. Comparison of these figures with those from a Delphi study carried out in one district and with figures for day surgery carried out in that district and with waiting list figures enabled two health districts to focus their efforts to increase day surgery. The figures from the national Delphi study could be applied in other districts if the following are taken into account: Hospital Activity Analysis data must be validated; though there was consensus among the national Delphi consultants, personal clinical opinions varied; the case load may grow as waiting lists decrease.

Age Factors↗
PubMed1988

The new public health.

Explore the source record for details and available documents.

Public Health Administration↗