Biomedical subjects

A D Bullock

Publications and source records attributed to A D Bullock.

16 recordsLinked to original sources

PubMed2004

The impact of course attendance on the practice of dentists.

INTRODUCTION: This paper reports the impact of course attendance on the practice of dentists. METHOD: Phase One: A survey sent to all general dental practitioners (GDPs) in three deaneries in England. The survey included self-ratings of the impact of course attendance on practice. Phase Two: Interviews with 20 dentists before and two to three months after they had participated in a self-selected course. The response rate to the survey was 54% (n = 2082). Comparisons with national data showed no notable bias in the sample for gender, owners/partners and age/experience. An ordered logit model was used to explore the net effect of factors (including years' experience in general dental practice and gender) on dentists' ratings of course impact. RESULTS: Course attendance was judged to impact on practice. Impact rating was affected by participation rate and years' experience. Barriers to implementation included cost, time, NHS constraints and personal or staff issues. Impact was enhanced when selection of courses was based on learning needs although courses may also serve usefully to confirm current practice. CONCLUSION: There is much that dentists themselves can do to enhance the impact of courses, principally by reflecting on learning needs. They should be supported in the development of personal learning plans.

Education, Dental, Continuing↗

PubMed2004

Key skills for newly qualified dentists: an evaluation of a West Midlands initiative.

INTRODUCTION: This paper reports an evaluation of the West Midlands Key Skills initiative that provides a framework for learning during vocational training (VT). METHOD: The 48 vocational dental practitioners (VDPs) who began their VT in August 2001 in the West Midlands were surveyed at the start and end of training (45 completed both surveys). They rated their confidence and experience in the 31 components of the Six Key Skills on visual analogue scales. Views were elicited in a survey of both VDPs (47 returns) and their general practice trainers (44 returns). Semi-structured interviews were also held with a stratified sample of 9 trainers and all four VT advisors. RESULTS: In terms of VDP progress, a statistically significant increase in confidence and experience was found in each of the 31 components. Six themes were identified in the views data. (i) Supporting the development of Key Skills; (ii) workload implications; (iii) the "right" six? (iv) links with the advanced diploma (MFGDP(UK)); (v) assessment of VT; and, (vi) consistency and quality assurance. CONCLUSION: VT successfully develops the confidence and experience of newly qualified dentists in the Six Key Skills and has been well received by the majority of VDPs, trainers and advisors in the West Midlands.

Clinical Competence↗

PubMed2003

The selection of GP trainees in the West Midlands: second audit of assessment centre scores by ethnicity and country of qualification.

The new regional GP trainee selection process in the West Midlands aims to be fair, open and efficient in selecting the most suitable candidates for training posts. This paper is a follow-up audit of the results of the first selection round that have previously been published in this journal (Brown et al., 2001). Here we provide an analysis of candidates' performance in the selection process by ethnic background and country of qualification for the first four selection rounds (n=753). Performance is assessed in terms of the percentage of candidates passing the shortlist stage and being offered a training post in the West Midlands, and by an analysis of shortlist and total scores. This audit finds that UK-trained candidates are most likely to be shortlisted; African- and Asian-trained candidates are the least likely to be shortlisted; and Asian-trained candidates have relatively low success in being placed in the West Midlands.

Africa↗

PubMed2002

Recommendations for improving the assessment of postgraduate dental education.

This paper makes recommendations for the improvement of assessment in postgraduate dental education. The recommendations are based on a twelve-month study conducted in 1998/99 which evaluated the strengths and weaknesses of the existing assessment systems. Evidence was taken from examination syllabi, assessments and records. Semi-structured interviews were conducted with representatives from national bodies and with trainers and trainees in the West Midlands. Strengths in parts of the system include: commitment and professional experience; commissioned work; opportunity to share experience; a monitoring framework; procedures for maintaining standards and examples of broadbased assessments. Weaknesses include: lack of assessment of quality; existence of some forms of unregulated assessment; lack of transparency and lack of clarity between training and assessment. Development is recommended in three broad areas: a competence-based model of assessment; distinguishing assessment from the analysis of educational needs and quality assurance. The introduction of a competence-based model is the most significant and is addressed in some detail. Specific proposals for consideration by national regulatory bodies and education providers include: strengthening the management of assessment; national leadership in the development of a competence model of assessment; widening the assessment base; clearer criteria for inspection; revisions to how vocational training, HO/SHO training and general professional training are assessed and training for trainers.

Competency-Based Education↗

PubMed2001

The benefits and costs of continuing professional development (CPD) for general dental practice: a discussion.

This paper sets out the benefits and costs of continuing professional development (CPD) for general dental practice. These considerations are important in evaluating CPD yet they are rarely formally assessed. This paper draws on literature specifically on dentistry but also from across the medical profession and the economics of education and training. First, the costs of CPD are itemised with some suggestions as to how costs may be reduced. Second, the benefits are identified and the (limited) evidence on the value of CPD is surveyed. Finally, reasons why some GDPs might not undertake sufficient or appropriate CPD are explored and the need for guidance for dental practitioners is identified.

Clinical Competence↗

PubMed2001

Assessment in postgraduate dental education: an evaluation of strengths and weaknesses.

UNLABELLED: This paper describes a study designed to evaluate assessment in postgraduate dental education in England, identifying strengths and weaknesses and focusing specifically on its relevance, consistency and cost-effectiveness. METHODS: A four-phase qualitative method was used: a mapping of current career paths, assessment policy, and issues (phase 1); more detailed studies of the practice of assessment for a range of courses, and the systemic/management perspective of assessment (i.e. quality assurance) (phases 2 and 3), and analysis and reporting (phase 4). Data were analysed from documents, interviews, group consultations and observations. RESULTS AND DISCUSSION: Five key issues may be distilled from the findings: (i) lack of formal assessment of general professional training; (ii) trainer variation in assessment; (iii) the extent to which assessments are appropriate indicators of later success; (iv) the relationship between assessment and patient care, and (v) data to assess the costs of assessment. CONCLUSION: Current assessment procedures might be improved if consideration is given to: assessment which supports an integrated period of general professional training; training for trainers and inspection procedures to address variation; more authentic assessments, based directly on clinical work and grading cases and posts, and better data on allocation of resources, in particular clinicians' time given to assessment.

Cost-Benefit Analysis↗

PubMed2001

Testicular microlithiasis: US follow-up.

PURPOSE: To determine in patients with testicular microlithiasis (TM) the short-term natural history of classic TM (CTM) and limited TM (LTM). MATERIALS AND METHODS: In 104 patients, testicular microliths were identified on ultrasonographic (US) images; 39 patients had five or more microliths on at least one US image (criterion for CTM), and 65 patients had fewer than five microliths (criterion for LTM). Attempts were made to have all patients return for follow-up US to assess for change in TM or development of tumor. RESULTS: Seven (18%) of the 39 patients with CTM and one (2%) of the 65 patients with LTM had tumor at presentation (P =.004). Among all 104 patients, follow-up US was performed in 72 patients (31 with CTM, 41 with LTM), with mean follow-up of 45 months (range, 12-90 months). None of these patients had interval development of testicular neoplasm. LTM did not progress to CTM in any patient. Progression in number of microliths was seen in two patients with CTM. CONCLUSION: Patients with LTM have a lower prevalence of associated malignancy than do patients with CTM. The risk of developing malignancy in patients with isolated TM (LTM or CTM) is low at short-term follow-up. These results raise the question of the need for routine US in this patient population.

Adult↗

PubMed2000

A role for clinical audit and peer review in the identification of continuing professional development needs for general dental practitioners: a discussion.

The purpose of this paper is to discuss how the role of peer review and clinical audit may be used in the identification of the continuing professional development (CPD) needs of general dental practitioners (GDPs). Clinical audit and peer review are intrinsically valuable in terms of the continued professional development of GDPs. Collaborative clinical audit, in particular, can provide a framework for short course input and there are particular benefits to this combination of activities which might usefully be more widely encouraged. If open to analysis in a way which retains individual anonymity, peer review and clinical audit resumes, these could be used to inform the provision of CPD and, linked to the knowledge of audit facilitators, short courses might more closely match the CPD needs of local dentists.

Dental Audit↗

PubMed1999

A framework for the evaluation of continuing education short courses in dentistry.

The objective of this paper is to propose an evaluation framework for short courses in continuing education for general dental practitioners (GDPs) (so called, Section 63 courses). Existing monitoring and evaluation procedures in the West Midlands deanery were examined and an improved evaluation framework was then devised, piloted and revised. A 5 phase method was used incorporating the examination of existing practice (Phases 1 and 2), development of a new framework (Phase 3), piloting (Phase 4) and revision of the evaluation framework in the light of the pilot. This approach will be implemented in the West Midlands and may be adapted for national use (Phase 5). It was found that existing monitoring and evaluation was inconsistent in prevalence and scope. Those involved in short courses were in favour of a more consistent and visible evaluation, including some assessment of impact-on-practice and cost-effectiveness. In conclusion, meaningful evaluation needs to include four key processes: data gathering; data analysis; dissemination and, action planning (reviewing provision in the light of the data analysis). Thus, this evaluation framework feeds into a quality development cycle designed to ensure high quality and relevant short course provision for general dental practitioners.

Cost-Benefit Analysis↗

PubMed1999

Continuing education courses in dentistry: assessing impact on practice.

INTRODUCTION: In the context of movement towards mandatory continuing dental education, this paper describes how a delayed postal questionnaire can be used in course evaluation. Specifically, the value of the questionnaire as a tool for assessing the impact of short course attendance on general dental practice is examined. METHOD: Questionnaires were distributed to all those attending three courses, ranging in size, in the West Midlands region. As well as reflecting on the course, respondents were asked their views on the usefulness of the questionnaire, the length of time between course attendance and assessment of impact, and types of courses likely to have greatest impact. RESULTS: Respondents thought the questionnaire an appropriate tool for assessing impact on practice, that an appropriate interval of time between the course and the delayed questionnaire is about six weeks, and that courses most likely to impact on practice are those which offer updates on common clinical topics and are hands-on in nature. DISCUSSION: A delayed questionnaire could be a useful mechanism for evaluating the impact on practice of some types of courses. Response rates from those attending large lecture courses might be low. Course evaluation is also limited by resources and time. Criteria for identifying which courses should be subject to such evaluation might include high cost per participant and links with review cycles. CONCLUSION: There is scope for more structured evaluation of continuing dental education, including the assessment of impact on practice. The questionnaire described is a useful component of an evaluation framework.

Attitude of Health Personnel↗

PubMed1998

Use of lower prostate specific antigen cutoffs for prostate cancer screening in black and white men.

PURPOSE: We evaluated differences in the prostate cancer detection rate among black and white men with serum prostate specific antigen (PSA) levels between 2.6 and 4.0 ng./ml., and benign findings on digital rectal examination. MATERIALS AND METHODS: From May 1995 through June 1997 we screened 14,209 white and 1,004 black men 50 years old or older with serum PSA and rectal examinations at 6-month intervals. If PSA was greater than 2.5 ng./ml. or the rectal examination was suspicious for cancer, we recommended an ultrasound guided sextant biopsy of the prostate. We compared differences in clinical characteristics, compliance with the recommendation for biopsy, cancer detection rate, and stage and grade of tumors detected for 924 white and 57 black men. RESULTS: Black men were younger (60 versus 63 years old, p = 0.005) and presented with slightly higher PSA levels (3.3 versus 3.1 ng./ml., p = 0.03) than white men. Overall cancer detection rate was 27% (106 of 391 patients), with cancer detection 2-fold higher among black (13 of 29, 45%) than among white (93 of 362, 26%) men (p = 0.03, odds ratio 2.4, 95% confidence interval 1.1 to 5.1). Controlling for age, total PSA, PSA density, percent free PSA and number of prior screening visits, race remained a significant predictor of cancer (adjusted odds ratio 3.4, confidence interval 1.4 to 8.4). We found trends for worse pathological stage and grade among black men but these differences did not reach statistical significance. CONCLUSIONS: Black race was an independent predictor of prostate cancer even at lower PSA cutoffs (2.6 to 4.0 ng./ml.). Although the positive predictive value for cancer detection was relatively high in black men, long-term outcomes studies are necessary to determine whether the use of lower PSA cutoffs would result in favorable shifts in cancer stage and grade, and a reduction in racial differences in prostate cancer mortality rates.

Aged↗

PubMed1997

Racial differences in operating characteristics of prostate cancer screening tests.

PURPOSE: We evaluated racial differences in the operating characteristics of prostate specific antigen (PSA) and digital rectal examination as screening tests for early detection of prostate cancer. MATERIALS AND METHODS: We screened 18,527 white and 949 black men 50 years old or older using serum PSA measurement and digital rectal examination. We recommended biopsies if either test was suspicious for cancer. For PSA greater than 4.0 ng./ml. and rectal examination we calculated relative sensitivity (percentage of men with cancer who had a positive test), specificity (percentage of men without cancer who had a negative test) and positive predictive value (percentage of men with a positive test in whom cancer was detected) for the prediction of prostate cancer stratified by race. RESULTS: In white and black men PSA greater than 4.0 ng./ml. detected more cancers than rectal examination (p < 0.002) with a trend for a greater increase in sensitivity in black men. PSA was associated with fewer false-positives than rectal examination in white (p < 0.0001) but not in black (p > 0.05) men. Positive predictive value for prostate cancer of PSA and rectal examination was greater in black than in white men (48 versus 34 and 38 versus 22%, respectively). CONCLUSIONS: PSA detects more cancers than rectal examination in both races, although this advantage is more pronounced in black men. In white men PSA yielded fewer false-positive results than rectal examination. However, PSA had more false-positive results than rectal examination in black men. Cancer was detected in a higher percentage of black men with PSA greater than 4.0 ng./ml. and, therefore, the risk of cancer associated with PSA greater than 4.0 ng./ml. differs by race. In a screening setting the widely accepted 25 to 30% positive predictive value for PSA greater than 4.0 ng./ml. may only apply to white men. A higher risk estimate of 36 to 60% is more accurate in black men.

Black People↗

PubMed1996

Delayed infection of a pelvic lymphocele following pelvic lymphadenectomy.

Pelvic lymphocele is an infrequent complication of pelvic surgery, usually presenting shortly after surgery. We report a case of an infected pelvic lymphocele presenting more than 1 year after a staging pelvic lymphadenectomy for adenocarcinoma of the prostate. This case illustrates that late infection of pelvic lymphoceles can occur following a pelvic lymphadenectomy and radical prostatectomy.

Adenocarcinoma↗

PubMed1996

Racial differences in a prostate cancer screening study.

PURPOSE: We attempted to determine whether black men have a higher prostate cancer prevalence and more advanced disease. MATERIALS AND METHODS: We screened 17,157 white and 804 black men 50 years old or older by serum prostate specific antigen measurement and digital rectal examination. We recommended biopsy when either test was suspicious. RESULTS: Black men had a higher prevalence of elevated prostate specific antigen (13.1 versus 8.9%) and cancer (5.1 versus 3.2%) than white men, and a higher prevalence of clinically but not pathologically advanced cancer. Fewer black men in lower income zip codes complied with recommendations for biopsy. CONCLUSIONS: In our screening study black men had a higher prevalence of detectable cancer. However, unlike in clinical studies there was no striking racial difference in advanced cancer stage at diagnosis.

Aged↗

PubMed1995

Fascial closure of laparoscopic port sites: a new technique.

The laparoscopic operative procedure is not complete until the port sites are closed with a fascial suture. Herein, we report a simple new technique that uses a venous catheter for suture placement and direct laparoscopic visualization to secure the abdominal wall fascia and peritoneum.

Fasciotomy↗

PubMed1992

Experimental autoimmune cystitis: a potential murine model for ulcerative interstitial cystitis.

Interstitial cystitis is an inflammatory disease of unknown etiology. To facilitate the study of the pathophysiology of interstitial cystitis, an animal model that correlates with the clinical features of interstitial cystitis and expresses histologic features consistent with those observed in interstitial cystitis patients was developed. Various strains of mice were immunized with a syngeneic bladder homogenate to determine their susceptibility to the induction of autoimmune cystitis. Of 3 mouse strains tested, only the Balb/cAN mice reproducibly developed the clinical correlates and histological features consistent with those observed in interstitial cystitis. In a blinded pathologic review, autoreactive Balb/cAN bladders were correctly distinguished from chronic bacterial cystitis, sham treated bladders and normal control bladders. Edema, fibrosis, perivascular lymphocytic infiltrations and detrusor mast cell accumulation were apparent in 75% of the Balb/cAN mice 2 weeks after immunization and 100% at 4 weeks. These histologic features plateaued and remained stable for at least 6 months. Grossly, the immunized mouse bladders were fibrotic and contracted with a significantly (p < .05) decreased fluid capacity. On hydrodistension, increased vascular prominence and petechial hemorrhage (glomerulations) were evident. Instillation of 14C-urea demonstrated increased permeability in immunized bladders compared with controls. A cellular autoimmune basis for the cystitis is supported by adoptive transfer studies. Spleen cells from experimental mice but not controls transferred the histological features of the disease to naive mice. These studies outline the development of a new experimental autoimmune cystitis model that expresses features similar to those frequently observed in human interstitial cystitis, and may provide a model for the study of the inflammatory process associated with interstitial cystitis. Furthermore, these data suggest a possible role for cellular immune components in interstitial cystitis.

Animals↗