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Biomedical subjects

N Black

Publications and source records attributed to N Black.

At least 91 records · Page 5Linked to original sources
PubMed1994

Trends in the age and sex of patients undergoing coronary revascularisation in the United Kingdom 1987-93.

OBJECTIVES: To describe how coronary revascularisation rates in the United Kingdom (in the public and private sectors) vary by age and sex; how these relations have changed between 1987 and 1993; whether significant differences exist between geographical areas, public and private sectors, and hospitals; and to make comparisons with trends in North America. DESIGNS: Secondary analysis of data on the age, sex, procedure, NHS/private, and health district of residence of patients. SETTING: Resident population of South East Thames, East Anglian, and North Western health regions and Greater Glasgow, Lanarkshire, and Ayr/Arran health boards (11.6 million; 20% United Kingdom population). PATIENTS: All 19,665 residents who underwent either coronary artery bypass grafting or percutaneous coronary angioplasty without any concomitant procedure during 1987-8, 1989-90, 1991-2 and 1992-3 in either NHS or independent hospitals. MAIN MEASURES: Population based rates of revascularisation by age, sex, area of residence, and NHS/private treatment. Secular trends in the age (mean, standard deviation, range), and sex ratio (male to female) of patients. RESULTS: Revascularisation rates in men were about four times higher than in women (1992-3: 1340 v 362/10(6) aged 25 years or more). The highest rates were in those aged 55-64 years (for men) and 55-64 and 65-74 years (for women). In 1992-3 the mean age of female patients was three years older than that for men (61.2 v 58.3) and that for coronary artery grafting was over two years older than for angioplasty (59.4 v 56.9). Between 1987-8 and 1992-3 the male to female ratio decreased (4.2:1 to 3.55:1) and the mean age of patients increased steadily by about six months each year. Intervention rates for the older groups increased faster than those for the younger, particularly in high rate regions. The age and sex mix of patients varied between regions and districts/boards. The mean age of patients varied by nine years and the sex ratio varied twofold between NHS hospitals. The male to female ratio was higher in private than NHS patients (1992-3: 5.5:1 v 3.6:1), suggesting greater access to care for men than women in the private sector. The trends observed in the United Kingdom are similar to those that have occurred in North America, with the exception of a decrease in the male to female ratio, which has not previously been reported. CONCLUSION: The increase in the revascularisation rate has been accompanied by an increasing proportion of women and older people. The extent of these changes varies between geographical areas. The change in the sex ratio has occurred despite an increasing contribution by the private sector, to which women have less access than men.

Adult↗
PubMed1993

Obstacles to medical audit: British doctors speak.

Currently, British doctors are being encouraged by government, managers and their professional associations to undertake medical audit. How easy a task will it be to introduce audit? In an attempt to find out, doctors working in general, geriatric and accident and emergency medicine in four district general hospitals were interviewed. Twenty-eight consultants and 34 junior doctors participated. Generally speaking, doctors accepted the need for audit. In this paper we have focussed deliberately on their worries, since it is these which are of most importance in developing better methods of implementation. The 19 obstacles to audit that respondents identified can be grouped into four categories: perceptions of the need for and the role of audit; practical considerations; the effects of audit; and anxieties about the use of audit. In general, criticisms were levelled at the way audit was being implemented rather than at the principles of the approach. While some obstacles could be overcome by simple, practical measures, others will require a change in doctors' knowledge, beliefs and attitudes. The difficulty of achieving such changes should not be underestimated.

Adult↗
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

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

Comparison of NHS and private patients undergoing elective transurethral resection of the prostate for benign prostatic hypertrophy.

OBJECTIVES: To compare the operative thresholds and clinical management of men undergoing elective transurethral resection of the prostate for benign prostatic hypertrophy in the NHS and privately. DESIGN: Cohort study of patients recruited by 25 surgeons during 1988. SETTING: Hospitals in Oxford and North West Thames regions. PATIENTS: Of 400 consecutive patients, 129 were excluded because of open surgery (nine), lack of surgeons' information (three), and emergency admission (117) and three failed to give information, leaving 268 patients, 214 NHS patients and 54 private patients. MAIN MEASURES: Sociodemographic factors, prevalence and severity of symptoms, comorbidity, general health (Nottingham health profile) obtained from patient questionnaire preoperatively and reasons for operating, and operative management obtained from surgeons perioperatively. RESULTS: NHS and private patients were similar in severity of symptoms and prevalence of urinary tract abnormalities. They differed in four respects: NHS patients' general health was poorer as a consequence of more comorbid conditions (49, 23% v 7, 13% in severe category); the condition had a greater detrimental effect on their lives (36, 17% v 2, 4% severely affected; p < 0.01); private patients received more personalised care more quickly and were investigated more before surgery, (29, 54% v 60, 20% receiving ultrasonography of the urinary tract); and NHS patients stayed in hospital longer (57, 27% v 3, 6% more than seven days; p < 0.001). CONCLUSIONS: Private patients' need for surgery, judged by symptom severity, was as great as that of NHS patients, and there was no evidence of different operative thresholds in the two sectors, but, judged by impact on lifestyle, NHS patients' need was greater.

Comorbidity↗
PubMed1993

Day surgery; development of a questionnaire for eliciting patients' experiences.

OBJECTIVE: To develop a single, short, acceptable, and validated postal questionnaire for assessing patients' experiences of the process and outcome of day surgery. DESIGN: Interviews and review of existing questionnaires; piloting and field testing of draft questionnaires; consistency and validity checks. SETTING: Four hospitals, in Coventry (two), Swindon, and Milton Keynes. PATIENTS: 373 patients undergoing day surgery in 1990. MAIN MEASURES: Postoperative symptoms, complications, health and functional status, general satisfaction, and satisfaction with specific aspects of care. RESULTS: Response rates of 50% were obtained on field testing draft questionnaires preoperatively and one week and one month after surgery. 28% of initial non-responders replied on receiving a postal reminder, regardless of whether or not a duplicate questionnaire was sent; a second reminder had little impact. Many patients who expressed overall satisfaction with their care were nevertheless dissatisfied with some specific aspects. Outcome and satisfaction were related to three aspects of case mix; patient's age, sex, and type of operative procedure. The final questionnaire produced as a result of this work included 28 questions with precoded answers plus opportunities to provide qualitative comments. Several factors (only one, shorter questionnaire to complete, fewer categories of nonresponders, and administration locally) suggested that a response rate of at least 65% (with one postal reminder) could be expected. CONCLUSION: A validated questionnaire for day surgery was developed, which will be used to establish a national comparative database.

Ambulatory Surgical Procedures↗
PubMed1993

Day surgery: development of a national comparative audit service.

OBJECTIVES: To develop software for hospitals to analyse their own survey data on patients' experiences of day surgery and to create and test the feasibility of a national comparative audit service. DESIGN: Software development and testing; database analysis. SETTING: Eleven general hospitals in England. PATIENTS: 1741 day surgery patients undergoing procedures during 1991-2. MAIN MEASURES: Postoperative symptoms, complications, health and functional status, general satisfaction, and satisfaction with specific aspects of care. RESULTS: Software for data entry and analysis by hospitals was successfully used at the pilot sites. The overall response rate for the 11 hospitals using the questionnaire was 60%, ranging from 33% to 90% depending on the way the survey was managed. Data from all 11 hospitals were included in the national comparative audit database. Hospitals showed little variation in measures of patients' overall satisfaction (around 85%), but significant differences were apparent for specific aspects such as receiving adequate written information before admission (range 50%-89%), provision of adequate parking facilities (14%-92%) and experiencing a significant amount of postoperative pain (8%-42%). The proportion of day case patients undergoing procedures that could have been performed in outpatient departments varied from 0 to 27% between hospitals. Further comparisons of outcome, in particular measures of effectiveness, must await the development of validated case mix adjustment methods. CONCLUSION: Establishing a comparative audit database is feasible but several methodological problems remain to be resolved.

Ambulatory Surgical Procedures↗
PubMed1993

Measuring hospital workload in general medicine.

The study described here used routine data sources to consider three aspects of hospital workload-volume and case-mix of inpatients; volume of outpatients; and volume of procedures.

Age Distribution↗
PubMed1993

Does labour substitution occur in district general hospitals?

A survey of 31 district general hospitals found a large variation in hours of medical and nursing time available per inpatient episode in general medicine and its associated specialties. These differences could not be attributed to case-mix variation or severity. The application of weightings to different grades of nursing and medical staff had little effect on either the rankings of hospitals by staff hours per episode, or the overall degree of variation in staffing levels. The results show no evidence to suggest that hospitals with relatively low levels for one category of staff are compensated by relatively high levels of another. It would appear that those hospitals with high levels for one category of staff are also well provided for the others. This evidence of inequality may reflect historic patterns of resource allocation that recent manpower policies might seek to redress. Studies of the relationship between staffing levels and quality of patient care should be undertaken before adopting a policy of labour redistribution.

Data Collection↗
PubMed1992

Disruptions in intracellular membrane trafficking and structure preclude the glucocorticoid-dependent maturation of mouse mammary tumor virus proteins in rat hepatoma cells.

We have previously shown that glucocorticoids regulate the trafficking and processing of mouse mammary tumor virus (MMTV) proteins in viral-infected M1.54 rat hepatoma cells. To examine the role of intracellular membrane integrity on MMTV protein maturation, brefeldin A (BFA) was utilized to disrupt membrane flow between the endoplasmic reticulum and Golgi. Immunoprecipitation and immunofluorescence microscopy revealed that in the presence of dexamethasone, BFA inhibited the proteolytic processing, cell surface delivery, and externalization of MMTV glycoproteins. Glycosidase digestion and inhibitors of protein glycosylation confirmed that the observed differences in apparent sizes of MMTV glycoprotein products are due to BFA-induced changes in oligosaccharide processing. BFA treatment inhibited the proteolytic processing of the MMTV phosphoprotein precursor, which normally associates with the cytoplasmic face of intracellular membranes. Similarities in salt extraction efficiency revealed that BFA did not affect the membrane affinity of the uncleaved phosphorylated precursor. In a complementary approach, proteolytic processing of the phosphorylated polyprotein did not occur in glucocorticoid-treated HTC cells transfected with a mutant MMTV provirus encoding a normal phosphorylated precursor, but which express a truncated MMTV glycoprotein missing its transmembrane domain and cytoplasmic tail. These results suggest that the MMTV glycoproteins and phosphoproteins may interact at a late step in the transport pathway in a manner required for their mutual processing in response to glucocorticoids and establishes the importance of functional interactions with intracellular membranes for maturation of the cytoplasmic MMTV phosphoproteins.

Animals↗
PubMed1992

Day-case surgery.

Explore the source record for details and available documents.

Ambulatory Surgical Procedures↗
PubMed1992

Does the current use of junior doctors in the United Kingdom affect the quality of medical care?

Current proposals in the U.K. envisage a reduction in both junior staff numbers and the hours which they work. The proponents of change argue that this will improve patient care, although there are also opposing arguments, based mainly on the need to maintain continuity of care and ensure juniors gain sufficient clinical experience. By means of a literature review and interviews with junior doctors, this paper examines the effect of the existing system of hospital medical staffing on quality of care. There is evidence that the existing system reduces the quality of care, principally through mistakes associated with inadequate supervision, and lowered humanity of care due to tiredness. The training value of night-time and weekend work is low, and many doctors find it unsatisfying. In contrast, many doctors value providing continuity of care and a few appreciate the opportunity to gain unsupervised experience. Overall, the disadvantages of the existing system outweight the advantages, and change is required to improve the quality of care. There are, however, several obstacles to change, and there are doubts about the extent to which the current proposals will be implemented.

Continuity of Patient Care↗