Biomedical subjects
M Emberton
Publications and source records attributed to M Emberton.
Acute urinary retention.
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Do we do what they say we do? coding errors in urology.
OBJECTIVE: To determine the accuracy of routine data coding in a large multispeciality urological unit. Materials and methods From the clinical records, the diagnosis and procedure codes were ascribed to 106 finished consultant episodes (FCEs) in urology, by two urological trainees. The codes were compared with those ascribed by professional hospital coders (and of which the trainees were unaware) from information written on the audit form by junior medical staff. Where there were discrepancies in codes an error was recorded and the stage in the coding process in which it occurred was determined. RESULTS: Forty-eight coding errors were found in 38 of the 106 (36%) FCEs; 34 (71%) were caused by inaccurate coding and 14 (29%) were the result of the incorrect completion of audit forms. CONCLUSION: The clinical codes generated from the authors' department do not accurately reflect the clinical practice. If coding errors of this magnitude are typical of urology units in general, the concept of hospital performance tables (which will be generated using routine clinical data) is untenable unless data recording is given higher priority.
Towards a minimum dataset in urology.
OBJECTIVE: To establish and prospectively collect data for a minimum dataset in urology by agreeing a dataset amongst a group of urologists, designing structured forms around the data items and implementing them in clinical practice. METHODS: Consultant urologists decided the initial dataset. Structured forms, which incorporated the dataset items, were designed. These forms were piloted before implementation in two urology departments. They were used to document clinical information instead of writing this in the traditional medical record. After use forms were 'scanned' before being filed in the medical record, thus storing the data in an electronic format. RESULTS: Nine forms were designed; inpatient and outpatient activity was captured separately. There were six outpatient forms; a generic new patient form and five specific follow-up forms (lower urinary tract symptoms, oncology, erectile dysfunction, female urology and stones). Three generic inpatient forms were designed. The forms were used by nine registrars, five senior house officers and six clinical nurse practitioners, who required minimal training. CONCLUSION: It is possible to agree a minimum dataset amongst a relatively small group of urologists. The information can be acquired prospectively using structured forms instead of the traditional medical record. This locally agreed dataset could form the basis for a national consensus on a minimum dataset in urology.
The NHS patient information lottery: it is whom you see rather than what you need.
OBJECTIVE: To examine the current scale of provision of patient information materials by consultant surgeons in UK NHS and private sector hospitals. DESIGN: Secondary analysis of the responses of 12,555 surgical patients to surveys evaluating surgical services provided by specific consultants. SETTING: 7 NHS Trusts and one private sector hospital distributed throughout the UK. MAIN OUTCOME MEASURES: Provision of information materials by hospital, surgeon, and case-mix. Comparison of this service with patients' evaluations of surgeons' verbal communication in the outpatient clinic. RESULTS: Great variation exists between surgeons of the same specialty, and between hospital surgical directorates as a whole in the routine provision of supportive information materials to patients undergoing surgery. This variation cannot be explained solely by clinical need. Patients treated in private hospitals were less likely to receive information materials compared to patients treated within the NHS. CONCLUSIONS: Provision of printed information materials to patients by clinicians appears to be arbitrary. With the prospect of national performance frameworks in the foreseeable future, it is reasonable to assume that not only will the content of patient information be determined by quality standards but, in addition, its availability will be decided by clinical need rather than the clinician's preferences or interests.
The patient with haemospermia.
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Acute urinary retention in men: an age old problem.
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What urologists say they do for men with prostate cancer.
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Quality of life research in urology.
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Tackling the quality agenda in surgery: taking comparative audit into the next century.
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A computer generated interactive transurethral prostatic resection simulator.
PURPOSE: We developed a computer generated model of the prostate gland and an interactive simulator for use in training urologists in transurethral resection of the prostate. MATERIALS AND METHODS: Software was developed on a standard personal computer which allowed images of the lumen of the prostatic urethra and resectoscope loop to be generated and interacted with using a magnetic position sensor input device attached to a dummy resectoscope. RESULTS: An anatomically accurate computer model of the prostate was generated at low cost which permitted user interaction and which simulated key elements of transurethral prostatic resection. CONCLUSIONS: Although not a substitute for learning transurethral prostatic resection on patients, the simulator enabled the user to become familiar with the technique of transurethral prostatic resection in the absence of time constraints and without risk to patients. The simulator may become an important tool in training and assessing surgeon competency, and may reduce the costs of training. Further development is needed to refine the transurethral prostatic resection simulator and expand its surgical range.
Retrieving semen from a dead patient.
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Changing trends in the management of phaeochromocytoma.
BACKGROUND: The recent experience of a specialist endocrine surgery unit in the management of phaeochromocytoma is reviewed. METHODS: Over a 14-year period (June 1978 to June 1992) 43 patients (14 men, 29 women) with a mean age of 42 years were referred with phaeochromocytoma. RESULTS: Biochemical confirmation was usually by measurement of 24-h urinary vallinylmandelic acid. From 1980 venous sampling was replaced by computed tomography as the primary localizing procedure. 131I-meta-iodobenzylguanidine scintigraphy was used in all patients between 1984 and 1987, but selectively after that. With regard to the operative approach used, between 1978 and 1983 midline or flank incisions were used, and from 1984 to 1992 subcostal or posterior approaches were used predominantly. There was one operative (30-day) death. One patient died 24 months after operation from recurrent malignant phaeochromocytoma, and three patient died during follow-up from unrelated causes. The remaining patients (mean follow-up 30 months) have no evidence of recurrent phaeochromocytoma, although four remain on antihypertensive medication. CONCLUSION: Improved imaging of phaeochromocytoma obviates the need for transperitoneal exploration, allowing selected phaeochromocytomas to be successfully managed using an extraperitoneal approach.
The management of men with acute urinary retention. National Prostatectomy Audit Steering Group.
OBJECTIVES: To determine the outcome of men with acute urinary retention undergoing prostatectomy and to assess whether discharge with a catheter before subsequent planned re-admission for prostatectomy had an adverse effect on outcome. PATIENTS AND METHODS: A prospective cohort study was conducted of all men undergoing prostatectomy in five health care regions over a 6-month period in 56 hospitals where prostatectomies were performed under the care of 103 surgeons. The study included 3966 men undergoing prostatectomy, of whom 1242 presented with acute urinary retention; the complication rates and symptomatic outcome were assessed. RESULTS: Compared with those who underwent elective prostatectomy for symptoms alone, men presenting with acute retention had an excess risk of death at 30 days (relative risk [RR], 26.6, 95% confidence interval [CI], 3.5-204.5) and at 90 days after operation (RR 4.4, 95% CI 2.5-7.6), and an increased risk of perioperative complications. Although men with retention were older, had larger glands and had more comorbidity, these factors did not totally explain the excess risk. The final symptomatic outcome of men with acute retention was no different from that of men presenting for elective treatment. Men with retention who were managed by initial catheterization, sent home and subsequently re-admitted for planned operation had similar pretreatment characteristics, post-operative complications and outcomes to those who were kept in hospital throughout, although the men kept in hospital had a total increased length of stay. CONCLUSIONS: Men with acute retention have a high risk of developing complications after undergoing prostatectomy. We were unable to confirm that a short-term period of catheter drainage at home before re-admission for planned surgery carried increased risks of peri-operative complications.
From surgical audit to clinical effectiveness.
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Surgery, drugs, and the male orgasm.
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Symptomatic unilateral hydronephrosis: a late complication of aortobifemoral bypass graft surgery.
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Written consent is haphazard for minor urological procedures.
OBJECTIVE: To determine the current practice among British urologists for obtaining written consent for flexible cystoscopy and other minor procedures under local anaesthesia. METHODS: Postal questionnaires were sent to full members of The British Association of Urological Surgeons practising in the UK asking if they obtained written informed consent for local anesthetic procedures, e.g. flexible cystoscopy, urethral dilatation, and urethral catheterization for retention, for urodynamics or for intravesical chemotherapy. They were also asked whether they recorded that the risks and benefits of the procedure had been explained to the patient. RESULTS: Respondents were divided on whether they obtained written consent for flexible cystoscopy and urethral dilatation. Most did not obtain written consent for catheterization for retention, urodynamics, intravesical chemotherapy or suprapubic catheterization. The policy was inconsistent both between and within urologists. CONCLUSION: Given the medicolegal importance of informed consent, consensus among urologists is required so that national guidelines can be developed and a more rational policy applied.