Search PubMed⌕ Search

Biomedical subjects

L J Donaldson

Publications and source records attributed to L J Donaldson.

At least 55 records · Page 3Linked to original sources
PubMed1991

The domiciliary consultation service: time to take stock.

OBJECTIVE: To review the use of the domiciliary consultation service in modern clinical practice in the Northern region. DESIGN: Retrospective study of data on domiciliary consultations from claim forms for payment submitted to the regional health authority by consultants during 1984-5 and prospective study during 1985-9. Peer review of patterns of practice by consultants. SETTING: 15 Of the 16 health districts in the Northern region, comprising a mixed urban and rural population of about 2.8 million. PARTICIPANTS: 760 Consultants in 28 specialties and 1666 general practitioners who were eligible to perform or request domiciliary consultations. MAIN OUTCOME MEASURES: Numbers of domiciliary consultations, general practitioners' requests for consultations, and consultants performing consultations and expenditure on the service by the region. RESULTS: Use of the domiciliary consultation service in the Northern region declined by 53% between 1984-5 and 1988-9, considerably in excess of the national rate of decline of 27%, and expenditure on the service was reduced, after allowing for inflation, by 604,000 pounds, or 38%, in real terms. Most consultants and general practitioners used the service sparingly whereas a small proportion used it heavily; a few specific consultants and general practitioners were responsible for a relatively high rate of domiciliary consultations. Contrary to the original definition of domiciliary consultation, the general practitioner accompanied the consultant on only one occasion in 17 and, in one specialty examined (paediatrics) patients who received domiciliary consultations seemed to have minor medical problems. CONCLUSIONS: Peer review examination of the pattern of practice in the domiciliary consultation service proved effective in rationalising use of the service, although a substantial minority of consultants and general practitioners continued to use the service heavily. The place of the service in modern clinical practice would benefit from a national review.

Consultants↗
PubMed1991

Variations in clinical decisions: a study of orthopaedic patients.

Three groups of patients were clinically reviewed within a new orthopaedics department: patients who were on an inpatient waiting list for surgery; new referrals from general practitioners; and patients who had been referred earlier and were awaiting an appointment for outpatient consultation. Approximately two-fifths of patients who were already on the inpatient waiting list, and who had confirmed their wish to remain on it, were considered on clinical review not to require inpatient treatment. A third of patients attending for first outpatient consultations were immediately returned to the continuing care of their general practitioner and this proportion was higher (47%) amongst patients who were waiting for outpatient appointments and who had not been referred to a named hospital consultant. These findings draw attention to the possible inappropriate use of specialist hospital facilities because of clinical decisions taken by some general practitioners and also to variations in the threshold for surgical intervention used by hospital consultants. It is important that the medical profession develops a consensus approach to the clinical management of patients with common conditions. It is also important that clinical review of patients on inpatient waiting lists, especially those who have been waiting a long time, becomes a routine part of waiting list management. Under the new British health care system, it is likely that purchasers of health care will seek to ensure that these issues are being dealt with by hospitals with which they are considering placing contracts.

Decision Making, Organizational↗
PubMed1991

Travelling for earlier surgical treatment: the patient's view.

As part of the northern region's programme within the national waiting list initiative, schemes have been funded to test the feasibility and acceptability of offering patients the opportunity to travel further afield in order to receive earlier treatment. A total of 484 patients experiencing a long wait for routine surgical operations in the northern region were offered the opportunity to receive earlier treatment outside their local health district; 74% of the patients accepted the offer. The initiative was well received by the participating patients and the majority stated that if the need arose on a future occasion they would prefer to travel for treatment rather than have to wait for lengthy periods for treatment at their local hospital. These findings, interpreted in the light of the National Health Service reforms introduced in April 1991, suggest that for some types of care, patients would welcome greater flexibility in the placing of contracts, not merely reinforcement of historical patterns of referral.

Adolescent↗
PubMed1990

Incidence of fractures in a geographically defined population.

STUDY OBJECTIVE: The aim was to describe the population based age and sex specific incidence of fractures at different sites in a large English health district. DESIGN: Recording of fractures was accomplished by a specially constructed outpatient index and by record linkage to hospital inpatient information, for the three years surrounding the 1981 census. SETTING: The fracture index was held by the Department of Community Health in Leicester using data from the fracture clinic at the central large district general hospital, supplemented by hospital inpatient data from Trent Region and the two adjoining regions. PARTICIPANTS: The denominator population was the Leicestershire Health Authority resident population. In the three years, 12,711 fractures amongst males and 10,565 amongst females were recorded. MEASUREMENTS AND MAIN RESULTS: The overall estimated annual incidence of fractures was 100 per 10,000 population for males and 81 per 10,000 population for females. Below the age of 55 years all fractures showed a higher incidence amongst males but amongst the over 55s, there was a consistent fall in the male:female incidence ratio with some sites showing a striking female preponderance. The results also show an apparent age specific temporal increase in incidence at certain fracture sites compared with earlier British data, but fracture incidence figures still suggest lower rates in this country than in North America and some Scandinavian countries. CONCLUSIONS: These findings provide population based incidence data on a major public health problem and are consistent with the major determinants of osteoporosis and increase in falls in postmenopausal women. The temporal and geographical variation in fracture incidence remain to be explained.

Age Factors↗
PubMed1989

Death certification in fractured neck of femur.

Fracture of the neck of the femur is a major public health problem within the elderly population of most industrialised countries whose health services are increasingly being taken up with its management. Moreover, within Britain, there is evidence of a real increase in its incidence even allowing for the ageing of the population. A condition whose aetiology is still far from clear (and where no strategy for prevention can therefore be formulated), and which is of such importance to the planning and provision of services demands detailed investigation and careful monitoring. Mortality data are an important part of epidemiological studies of disease problems and, in Britain, in resource allocation through the Resource Allocation Working Party (RAWP) formula. In this study, a cohort of 2,631 elderly patients, resident in the largest health district in the country, and admitted to hospitals over a seven year period with the diagnosis of fractured neck of femur, was assembled. Hospital records were linked to national mortality data to determine whether patients had died and, where this was so, to record underlying cause of death. A total of 930 deaths occurred within the study cohort but only 52 were certified as dying from fractured neck of femur; even amongst those who died in the hospital to which they were admitted with the fracture, less than a fifth of deaths were attributed to the fracture as underlying cause. Diseases of the circulatory system accounted for almost half of all underlying causes of death and bronchopneumonia a further 20%. These findings suggest a gross undercertification of fractured neck of femur as a cause of death in the elderly and are consistent with other studies. They may be explained by a failure of junior hospital doctors to understand the importance of accurate certification of cause of death and a misguided attempt to reduce the burden to coroners of having to consider each death from this cause.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

A census of patients waiting for treatment or consultation in surgical specialties in an English health region.

A census of waiting lists in five surgical specialties within the Northern Region has been carried out. In addition to enumerating those patients waiting for inpatient treatment and outpatient consultation, the census characterized lists in terms of the age and sex structure of those waiting; the length of time people had waited; their district of residence and (for inpatients only) the numbers waiting for certain specified operations or procedures. Patients waiting for inpatient treatment were older, overall, than the general population and, within specialties, ophthalmology lists contained a higher proportion of the very elderly whilst ear, nose and throat surgery lists had a younger age-structure. Three-quarters of ophthalmology inpatient lists were made up of patients waiting for cataract surgery, 14 per cent of patients awaiting orthopaedic inpatient treatment were waiting for hip joint replacement and 32 per cent of gynaecology lists comprised women needing sterilization. These data on age-structure and case composition are broadly similar to recent work carried out by Yates's group who restricted their study to longer waiting lists in the West Midlands Region and Wales. When data in the present study were related to the population from which the cases arose, it was found that the prevalence of outpatient waiting was greater than inpatient waiting except for general surgery (where a higher proportion of the population was awaiting inpatient treatment) and in gynaecology (where outpatient and inpatient waiting was equally common).2+ Standardized waiting list ratios (SWLRs) have been calculated to allow comparisons between districts and specialties, free of distortions produced by differing age-structure of populations.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Health and social status of elderly Asians: a community survey.

A sample based on general practices was the starting point for a community survey of Asians aged 65 years and over to describe: family structure and social contact; aspects of lifestyle; language and communication; capacity for self care; and knowledge about and use of services. A total of 726 (95% of those approached) old people were interviewed in their own languages. Almost all had been born in India, mainly in Gujarat or the Punjab, but most had come to Britain via east Africa. Over half of the over 75s were not fully independent in basic activities of daily living, and a fifth were occasionally or often incontinent of urine, though these levels of incapacity were little different from those found in the indigenous elderly. Few elderly Asians were aware of social services, such as meals on wheels, home helps, social workers, and particularly chiropody. Language also excluded them: 37% of men and only 2% of women could speak English. Moreover, two thirds of elderly Asian women were illiterate in all languages. Health education initiatives directed at these people must understand these cultural and language barriers and perhaps use alternative methods, such as Asian radio programmes and home videos, in providing information on health and welfare services.

Aged↗
PubMed1985

How likely is it that a district health authority can close its large mental hospitals?

A cross-sectional survey assessed all 1,087 patients who were in psychiatric beds provided by a large district health authority. The elderly predominated in all length of stay categories, and a high proportion of them had levels of social and physical incapacity which made it unlikely that they could be cared for other than in residential care. A substantial minority of younger patients with a length of stay between one and two years had levels of incapacity which suggested the need for major treatment, rehabilitation, or training efforts. The findings have major implications for Government policy to replace large mental hospitals.

Activities of Daily Living↗
PubMed1984

Analysing stages of care in hospital stay for fractured neck of femur.

All 216 patients with femoral-neck fractures presenting to the trauma and orthopaedic service of a large health district over a 20-week period were studied to identify the stage of care for each day of the hospital stay. Of the 5167 patient-days of acute hospital care 492 were spent awaiting surgery (10%), 141 being made fit for surgery (3%), 2690 recovering from surgery without complications (51%), 59 being treated for surgical complications (1%), 56 being treated for medical complications (1%), and 1437 awaiting discharge after medical and surgical care was complete (28%); 292 (6%) days were spent by patients receiving conservative treatment. The method described provides a basis for examining the problem of extended acute hospital stay and variations in length of stay between different centres for elderly patients with this and other disorders.

Aged↗
PubMed1984

Occurrence of cancer in Asians and non-Asians.

Cancer registration data for a defined geographical area, covering a seven year period, were modified to include the variable "Asian ethnic origin." The data were then used to test the hypothesis that a difference would be found between Asians and non-Asians in the pattern of cancer by site. Whereas the incidence of cancer of all sites appeared to be significantly lower in Asians (p less than 0.05), after taking account of this, and adjusting for the very different age distributions of the two populations, a highly significant difference (p less than 0.0005) was found between the two groups in the distribution of cancer between sites. Although, given the size and young age structure of the Asian population, absolute numbers of cases were small, a significant excess of Asian cases (compared with the expected) occurred for cancer of the tongue, oral cavity, pharynx, and oesophagus. For most sites there were fewer Asian cases than would be expected, particularly so for the stomach, testis, and skin. The results indicate the need for formal epidemiological study to test specific aetiological hypotheses which may account for these apparent differences.

Asia↗