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Biomedical subjects

M McKee

Publications and source records attributed to M McKee.

At least 199 records · Page 11Linked to original sources
PubMed1993

Junior doctors' work at night: what is done and how much is appropriate?

Regional task forces have given some public health physicians a central role in attempts to reduce junior doctors' hours. This topic is the subject of many diverse opinions and little research. A key issue that has received little attention is the appropriateness of the work undertaken by junior doctors at night. This paper determines whether this work can either be postponed to the following morning or done by someone else. It was undertaken in two phases: a descriptive study using diaries, interviews and collection of data from registers; and identification of consensus on appropriateness of activities by a nominal group technique. The first phase took place in hospitals in the South East of England. The nominal groups consisted of six panels comprising medical, nursing and laboratory scientific staff. The panels identified activities done at night that can either be postponed to the following day or done by someone else and activities where there is disagreement, requiring further research. A third of general surgical and orthopaedic operations could safely be postponed until the following day. Up to a third of the tasks of house officers could be performed by nursing or clerical staff. Many laboratory investigations at night could be postponed until the following day. In conclusion, the work of junior doctors at night could be reduced by producing guidelines on the need to operate at night, by transferring tasks to other professionals, and by reducing the number of sites at which services are provided.

Humans↗
PubMed1993

Disease staging--a case-mix system for purchasers?

The National Health Service (NHS) internal market has directed renewed attention at hospital activity data. Purchasers require information on the cost of care provided for them, the quality of service and the extent to which their population's needs are being met. There is a need for a means of condensing the large number of diagnostic codes into groups containing patients with similar outcome or resource use, i.e. case-mix systems. These systems have been developed in the United States to overcome this problem. Unfortunately, they may not be valid or acceptable in other countries. We describe the evaluation of one such system, Disease Staging, in the United Kingdom. We conclude that it can be used with UK data to produce groups that are homogeneous both in terms of length of stay and mortality. Its logic is acceptable to UK clinicians. We discuss the major issues involved in using routine hospital data and suggest ways in which Disease Staging might be used by purchasers in the UK internal market.

Contract Services↗
PubMed1993

Three-dimensional reconstruction of Coxiella burnetii-infected L929 cells by high-voltage electron microscopy.

Previous examination of thin sections of L929 cells heavily infected with the Q fever Priscilla isolate by conventional transmission electron microscopy indicated that the rickettsiae resided within multiple vacuoles. The present study using high-voltage electron microscopy and three-dimensional reconstruction revealed that, in heavily infected cells, the rickettsiae, in fact, reside in one multilobed vacuole. As a result of asymmetric cell division, the multilobed vacuole containing the rickettsiae apparently segregates into one daughter cell, while the companion daughter cell emerges parasite free. This likely explains the appearance of naive uninfected cells in long-term-infected (i.e., ca. 2 years) cell populations that had not been supplemented with uninfected L929 host cells.

Animals↗
PubMed1993

What is the requirement for out-of-hours operating in orthopaedics?

Recent reports have emphasized the need to reduce the amount of unsupervised surgery performed at night by junior doctors. However there is little guidance about when an operation must be performed urgently and when it can be postponed safely. This study describes the existing pattern of out-of-hours trauma and orthopaedic surgery in four hospitals and reports the views of a panel of surgeons and anaesthetists on the extent to which operating could be postponed until the following day. Operations at night are uncommon--a mean of 0.6 per night and occurring on only 40% of nights--though their frequency shows two-fold variation between hospitals. With certain assumptions it is estimated that up to a third of out-of-hours operations could be postponed safely to the following day. Further evaluation is required of those operations about which the panel failed to reach agreement. While most of the procedures undertaken at night are within the competence of a registrar, some require the direct involvement of a consultant.

Humans↗
PubMed1993

Hospital pharmacists' participation in audit in the United Kingdom.

OBJECTIVE: To investigate systematically participation in audit of NHS hospital pharmacists in the United Kingdom. DESIGN: Questionnaire census survey. SETTING: All NHS hospital pharmacies in the UK providing clinical pharmacy services. SUBJECTS: 462 hospital pharmacies. MAIN MEASURES: Extent and nature of participation in medical, clinical, and pharmacy audits according to hospital management and teaching status, educational level and specialisation of pharmacists, and perceived availability of resources. RESULTS: 416 questionnaires were returned (response rate 90%). Pharmacists contributed to medical audit in 50% (204/410) of hospitals, pharmacy audit in 27% (108/404), and clinical audit in only 7% (29/404). Many pharmacies (59% (235/399)) were involved in one or more types of audit but few (4%, (15/399)) in all three. Participation increased in medical and pharmacy audits with trust status (medical audit: 57% (65/115) trust hospital v 47% (132/281) non-trust hospital; pharmacy audit: 34% (39/114) v 24% (65/276)) and teaching status (medical audit: 58% (60/104) teaching hospital v 47% (130/279) non-teaching hospital; pharmacy audit 30% (31/104) v 25% (68/273)) and similarly for highly qualified pharmacists (MPhil or PhD, MSc, diplomas) (medical audit: 54% (163/302) with these qualifications v 38% (39/103) without; pharmacy audit: 32% (95/298) v 13% (13/102)) and specialists pharmacists (medical audit: 61% (112/184) specialist v 41% (90/221) non-specialist; pharmacy audit: 37% (67/182) v 19% (41/218)). Pharmacies contributing to medical audit commonly provided financial information on drug use (86% 169/197). Pharmacy audits often concentrated on audit of clinical pharmacy services. CONCLUSION: Pharmacists are beginning to participate in the critical evaluation of health care, mainly in medical audit.

Educational Status↗
PubMed1993

Medical audit in the United Kingdom: the past, present, and future.

In defining medical audit as the term describing in the United Kingdom the quality assurance of medical care, the authors draw out a scheme of its historical development, of its changes in time towards a much more innovative organization of the medical profession, of its present state, its compliance with official policies at local level, and of the identification of eventual future challenges.

History, 20th Century↗
PubMed1993

[International solutions for promoting social medicine competence in training courses--the London School of Hygiene and Tropical Medicine].

The London School of Hygiene & Tropical Medicine is an important institution for postgraduate teaching and research in public health and tropical medicine. Advanced training is provided in a wide range of disciplines leading to different qualifications. As an example the Master of Science course in Public Health Medicine is used: Training is provided by a one-year course divided in three terms. The first term starts with an orientation period and shared-core components. In the second term teaching is largely based on study units. Term three is mainly project work. A training course for membership examination of the Faculty of Public Health Medicine is also offered.

Cross-Cultural Comparison↗