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Biomedical subjects

B W Ellis

Publications and source records attributed to B W Ellis.

At least 19 recordsLinked to original sources
PubMed2000

The nurse cystoscopist: a feasible option?

OBJECTIVES: To compare the accuracy achieved by a trained urology nurse practitioner (UNP) and consultant urologist in detecting bladder tumours during flexible cystoscopy. PATIENTS AND METHODS: Eighty-three patients underwent flexible cystoscopy by both the UNP and consultant urologist, each unaware of the other's findings. Before comparing the findings, each declared whether there was tumour or any suspicious lesion requiring biopsy. RESULTS: Of 83 patients examined by flexible cystoscopy, 26 were found to have a tumour or a suspicious lesion. One tumour was missed by the UNP and one by the urologist; each tumour was minute. Analysis using the chance-corrected proportional agreement (Kappa) was 0.94, indicating very close agreement. CONCLUSION: A UNP can be trained to perform cystoscopy and detect suspicious lesions as accurately as can a consultant urologist. Legal and training issues in implementation are important.

Cystoscopy↗
PubMed1997

A clinical view of pathways of care in disease management.

Pathways of care define in detail the individual components of treatment for a group of patients. A well written pathway can give rise to consistent care or the highest quality. There are both educational and audit advantages to the approach. Details the means by which groups are selected and the care pathways written. Gives an example of the benefits that can accrue, based on the authors' experience at Ashford Hospital, UK of running a pathway for patients having prostate surgery. The pathways are appreciated by patients, nurses, doctors and managers. Care is improved and costs contained.

Analysis of Variance↗
PubMed1996

The management of superficial bladder cancer: an interactive seminar.

OBJECTIVES: To determine the current management of superficial bladder cancer in the United Kingdom. METHODS: An interactive seminar with a series of questions about management and hypothetical clinical scenarios was conducted at the 1995 conference of the British Association of Urological Surgeons. The responses of the audience were recorded electronically and analysed. RESULTS: The results showed that there is a wide variation in practice and some confusion over the place of intravesical treatment using cytotoxic drugs and bacille Calmette-Guérin. CONCLUSIONS: The management of superficial bladder cancer could be improved by a more widespread use of intravesical therapy, along with the introduction of local protocols and national guidelines.

Administration, Intravesical↗
PubMed1992

Seminoma or sarcoid?

A 33-year-old man subsequently diagnosed as having sarcoidosis presented with the clinical features of a testicular tumour with metastatic spread to para-aortic lymph nodes. Histological examination of the testis and para-aortic lymph node biopsy showed florid granulomatous change and a Kveim test was positive. This is a previously unreported presentation of sarcoidosis and emphasizes that histological confirmation of malignancy is essential prior to institution of cytotoxic therapy.

Adult↗
PubMed1992

Clinical information system that enhances the use of resources in endoscopic prostatic procedures.

In this study we evaluated, by means of an automated management system, the identification of subgroups of patients within certain operative categories whose predictable length of stay was compatible with treatment on a 5-day ward. This was achieved by using a computer directed analysis of urological workload on prospectively collected clinical data. Graphical presentation of the results was achieved by a technique known as the patient-bed dissociation curve. Patients with bladder outflow obstruction treated by transurethral prostatic resection (701) and bladder neck incision (113) were selected from a total of 7,162 hospital admissions. The main outcome measures were length of stay and complication rates for the 2 procedures. The results demonstrated that a group of patients about to undergo transurethral resection could be selected by age and source which would indicate an 18% greater probability of discharge within 5 days. These patients were easily identifiable in advance and would be suitable for treatment on a 5-day ward. It was concluded that computer-held clinical data were easily accessible to the surgeon. The process of detailed analysis need not take time. With properly directed studies the information retrieved could be used to effect change. The patient-bed dissociation curve may prove a valuable tool in examining and comparing discharge patterns in any groups of patients.

Adult↗
PubMed1991

Management importance of common treatments: contribution of top 20 procedures to surgical workload and cost.

OBJECTIVE: To assess the contribution of the most frequently performed procedures to surgical workload and to evaluate the financial implications. DESIGN: Analysis of data held on the department's computerised clinical information system. SETTING: Department of surgery in a district general hospital. PATIENTS: 4845 patients were treated by surgeons in three consultant firms over an 18 month period and 5346 patients by surgeons in a single firm over a five year period. MAIN OUTCOME MEASURES: Percentage and cumulative percentage contribution to workload in order of frequency by procedure. Costs of the commonest and costliest treatments. RESULTS: Half of the workload of the department was encompassed by eight procedures. Twenty procedures accounted for 70% of the work. For a single firm 20 procedures represented over 80% of all the surgical work. Transurethral prostatectomy was the treatment that consumed most resources (pounds 240,900 for 198 patients in 18 months). The costliest patients were those who had undergone complicated large bowel surgery, vascular reconstructions, or amputation. CONCLUSIONS: Clinicians and managers need to appreciate the importance of the most common surgical procedures. It is vital that performance and costing of these procedures are optimum as they contribute disproportionately to overall results and finance.

England↗
PubMed1991

Comparative audit: a new method of delivering audit.

A new method of audit delivery is described, based on the first large scale comparative audit meeting held at The Royal College of Surgeons of England. The concept of comparative audit is introduced and the methods of undertaking such an exercise are described. This comparative audit processed the clinical activity of 45 general surgeons during 1989 amounting to 49,005 patient admissions. As an illustration of this technique the comparative analysis of 3,710 inguinal hernia procedures accounting for 12,600 total stay days is used in order to illustrate data manipulation, ranking and presentation in chart form. Conclusions are drawn and suggestions as to the future role of the technique are outlined.

Data Interpretation, Statistical↗
PubMed1990

Extending the use of clinical audit data: a resource planning model.

OBJECTIVE: To create a means by which we can examine and understand the interrelations among the fundamental elements of hospital inpatient care (patients, beds, theatre time, and staff). DESIGN: Predictive study of resource utilisation based on a computerised clinical information system of five years' audit data from a surgical management system. SETTING: One surgical firm (of one consultant, one registrar, and one preregistration houseman) in a district general hospital. PATIENTS: 5267 Patients whose admission records were part of the five years' audit of surgical management. MAIN OUTCOME MEASURES: Mean length of stay; number of occupied beds; turnover interval; throughput (patients/bed); percentage elective theatre occupancy; waiting time for elective admissions; and theatre, hotel, and total costs. RESULTS: Predicted outcome was analysed in the model, taking the actual outcomes in 1988-9 as baseline values, for four clinical scenarios: an increase in accident and emergency admissions, a reduction in beds, a reduced length of stay, and creation of a new firm. Baseline values showed a mean stay of just over five days in 15 beds and with a theatre occupancy of 94%; the total cost was 812,000 pounds (hotel costs 597,000 pounds). Increasing the accident and emergency admissions to 460/year (19%), based on projected trends from 1984 to 1988, resulted in increased hotel costs (55,000 pounds) and reducing bed numbers (by halving admissions) in decreased use of theatres to 71%, decreased throughput, and increased waiting time, from 20 to 92 weeks, at a saving of 99,000 pounds (12%). Reducing stay marginally reduced bed occupancy (8%) and hotel costs (14%), and creating a new surgical team considerably reduced bed occupancy (14%) and waiting time for elective operations (by 20%). The minimum number of beds for referrals, accident and emergency admissions, and planned admissions was 9.0; that for urgent elective admissions was 3.3 and for non-urgent admissions was 2.4. CONCLUSION: A well designed clinical information system with the routine collection of data can provide the necessary output data to enable resource modelling. IMPLICATION: Use of such a model will allow clinicians to participate in resource planning on the basis of what is actually happening within the hospital.

Data Interpretation, Statistical↗
PubMed1988

Surgical aspects of international drug smuggling.

The internal concealment of cocaine and other drugs in packets by "body packers"--those who swallow packets of drugs or hide them in their vagina or rectum--to avoid detection by customs officials has been increasing in both the United States and Europe. The types of package and how they are concealed are changing as the traffickers become more sophisticated in their methods. The latest parcels are less likely to burst, but obstruction of the bowel may occur. Awareness of the problem is important for staff of emergency medical services near international ports of arrival.

Adult↗
PubMed1988

Clinical audit.

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England↗