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Biomedical subjects

P J Robb

Publications and source records attributed to P J Robb.

At least 19 recordsLinked to original sources

Copying clinic letters to patients: a survey of patient attitudes.

Guidance from the Department of Health, published in 2000, stated that, 'as a matter of right', communications between clinicians would be copied to patients. In further guidance, the department indicated that, from April 2004, patients would receive copies of correspondence exchanged between healthcare professionals. There has been little research on this issue, and the few existing publications have come from the hospital psychiatric clinic setting. We examined the attitudes of 100 patients attending an ENT clinic as well as those of 100 parents of children attending a paediatric ENT clinic in a general hospital out-patient setting. At the end of consultations, patients or parents were invited to take part in the survey by completing a short questionnaire. Forty-three per cent of the adult patients and 44 per cent of the parents requested a copy of the clinic letter. These people were followed up by a telephone survey, three weeks after the copy of the clinic letter to the general practitioner was posted to the patient or parent. Eighty-one per cent of the patients and 77 per cent of the parents were successfully contacted for the follow-up telephone survey. Sixty per cent of the adults and 77 per cent of the parents reported that the copy of the clinic letter was helpful. There were no differences in responses between the adult patient and paediatric patient groups. In this study, less than half of both groups requested a copy of the ENT clinic letter to their general practitioner. To follow Department of Health guidance and copy the letter without patient consent is arguably contradictory to best practice and also to the concept of patient choice. There are significant financial implications in adopting the departmental guidance. We propose patients should be offered a copy of their clinic letter on request.

Adult↗

Adenoidectomy: does it work?

Adenoidectomy is a common, routine paediatric operation for which the evidence base for effectiveness is lacking. While there is a broad evidence base of variable quality for other common children's ENT operations, most published data including adenoidectomy is combined with the effect of combined tonsillectomy or grommet surgery. For the common indications for adenoidectomy, does it work?

Adenoidectomy↗

Postoperative pain, nausea and vomiting following paediatric day-case tonsillectomy.

More than 30% of all surgical activity for children in England and Wales is accounted for by routine ENT operations. There is known to be a high incidence of postoperative pain, nausea and vomiting following paediatric tonsillectomy with or without adenoidectomy. This prospective study examined the incidence of these complications in 100 children admitted for routine, elective day-case tonsillectomy, with or without adenoidectomy. The children were anaesthetised in accordance with our standard paediatric day-case protocol. The incidence of vomiting on the day of surgery was significantly less in the group anaesthetised in accordance with the protocol, compared to those in previously published studies. Postoperative pain was well controlled, with 88% of the children having minimal pain on the day of surgery, and reporting a pain score of 0-2. Modifying the anaesthetic care to a protocol designed to reduce postoperative pain, nausea and vomiting achieved measurable improvements in the recovery of this group following surgery. It has enabled us to evolve from a 100% inpatient stay for these operations to 98% day-case discharge rate, with minimal post anaesthetic or surgical morbidity. We describe the protocol and discuss the implications of implementing such a protocol for children undergoing these common operations.

Adenoidectomy↗

Do surgeons wish to become doctors?

OBJECTIVES: To gauge opinion among otolaryngologists about their wish to retain the title Mr, Miss, Ms or Mrs or to adopt the title of doctor. DESIGN: An e-mail questionnaire sent to all members of ENT-UK (The British Association of Otolaryngologists-Head and Neck Surgeons), who had registered an e-mail address with the ENT-UK secretariat. SETTING: The specialty group of otolaryngologists in the UK. PARTICIPANTS: 723 recipients of e-mails, who were members or fellows of a surgical Royal College and, by convention in the UK, entitled to adopt the title Mr, Miss, Ms or Mrs. RESULTS: 304 recipients of the e-mail questionnaire responded. 39% were not aware of any proposals to change the convention, addressing surgeons as 'doctor' in the future. Overall, 61.8% were in favour of retaining the current convention and retaining the title Mr or a female equivalent. Applying the null hypothesis that most surgeons would not like to change a title, the chi(2) test produced a highly significant P value of 0.0002. Of female respondents, however, only 43% supported retention of the current convention. Using Fisher's exact test to compare female and male respondents, the two-sided P value was highly significant at 0.006, with female respondents favouring the title of doctor. CONCLUSIONS: A large proportion of ENT surgeons in the UK responded to the questionnaire. They were unaware of proposals to change the current convention of address for surgeons. A significant number of those responding were in favour of retaining the current convention. The small proportion of female respondents indicated a preference for being addressed as 'doctor'.

Attitude of Health Personnel↗

Infrared transtympanic temperature measurement and otitis media with effusion.

Body temperature is an important clinical measurement. It can be estimated by sublingual, rectal, axillary or skin measurement. Pulmonary artery temperature measurement is the gold standard in the research setting, but is obviously inapplicable for routine clinical use. Infrared estimation of core temperature at the tympanic membrane has been proposed as an effective and accurate method. We investigate whether the common condition of childhood otitis media with effusion (OME) interferes with this mode of body temperature measurement. Ninety-five children undergoing grommet tube insertion were assessed preoperatively by axillary and transtympanic routes. The presence or absence of middle ear fluid was noted at the time of surgery. Analysis of the data showed no influence of OME on the measurement of body temperature by the transtympanic route compared with axillary measurement.

Axilla↗

The clinical management of otorrhoea following grommet insertion: a survey of otolaryngologists and general practitioners.

A postal questionnaire of all Consultant Otolaryngologists in the British Isles, and of General Practitioners within the local family practitioner committee area, was designed to compare the current practice in the management of discharge from the ear following grommet insertion. 76% of the Otolaryngologists and 52% of the General Practitioners completed the questionnaire. Between the two groups, statistically significant differences were apparent in the management of this common complication of grommet surgery. A higher proportion of Consultants took a bacteriology swab of the ear as part of their treatment, which was significantly more frequently treated by antibiotic ear drops. Within the Consultant group, significant regional variations in choice of drugs and therefore the cost of treatment were apparent. The General Practitioners more commonly prescribed oral antibiotics. This common complication of grommet surgery is managed differently by General Practitioners and Otolaryngologists without a firm rational basis. Treatment based on current knowledge is discussed. Further evaluation of the efficacy of different treatment regimens by controlled prospective trials is required.

Cerebrospinal Fluid Otorrhea↗

Carbon dioxide laser cordectomy in the management of bilateral vocal cord paralysis.

Bilateral vocal cord paralysis is a rare but major complication of thyroid surgery. Since 1983, patients with bilateral cord paralysis have been managed in this department using the carbon dioxide laser. Six patients with bilateral cord paralysis secondary to thyroid surgery underwent partial cordectomy and arytenoidectomy. Two patients were operated on with tracheostomy tubes in situ, and both were successfully decannulated. In the remaining four patients, ventilation was maintained during anaesthesia using a Venturi jet ventilation system. None of these patients required a perioperative tracheostomy. Adequate airway improvement and satisfactory voice quality were achieved. Follow-up ranged from 6 to 17 months.

Adult↗

The laryngeal mask airway in paediatric anaesthesia.

Forty-eight children, aged between 2 and 10 years, admitted as day cases for otological surgery were allocated at random into two groups. The first group was anaesthetised using a standard facemask, and the second with a laryngeal mask airway. The laryngeal airway produced a satisfactory airway in all children, and was inserted on the first attempt in 67% of patients. Hypoxia was significantly less frequent in the laryngeal airway group (p less than 0.05), and there were significantly fewer interruptions to surgery than in the facemask group (p less than 0.001). Patient safety, operating and anaesthetic conditions were all considered superior in the laryngeal airway group.

Ambulatory Surgical Procedures↗

Granular cell myoblastoma of the supraglottis.

Granular cell myoblastoma is an unusual benign tumour, which, when occurring in the larynx usually affects the vocal cords and causes hoarseness. We present a case presenting with symptoms strongly suggestive of globus pharyngis. These tumours probably arise from neuroectodermal tissue, and the current nomenclature is a misnomer. Complete excision rather than biopsy is recommended, as biopsy material may be misinterpreted as squamous carcinoma. In this case, endoscopic removal of the tumour was successful in producing complete symptomatic relief.

Adult↗

Efficacy of oral oxpentifylline in the management of idiopathic tinnitus.

A prospective single-blind, placebo-controlled trial was effected in 30 patients presenting to an out-patient clinic complaining principally of tinnitus. Over a 6-week period, the subjects were assessed by routine audiometry and subjective reporting of change in their symptoms. A treatment group received the xanthine derivative, oxpentifylline (Hoechst UK), while a control group received identically presented inactive placebo. There was no significant difference between the placebo and treatment groups for any of the parameters measured, and, therefore, oxpentifylline cannot be recommended in the management of idiopathic tinnitus.

Administration, Oral↗