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Biomedical subjects

M Goldacre

Publications and source records attributed to M Goldacre.

14 recordsLinked to original sources
PubMed1992

Incidence of disease after vasectomy: a record linkage retrospective cohort study.

OBJECTIVE: To determine whether vasectomy is associated with an increased risk of several diseases, and in particular testicular cancer, after operation. DESIGN: Retrospective cohort study using linked medical record abstracts. SETTING: Six health districts in Oxford region. SUBJECTS: 13,246 men aged 25-49 years who had undergone vasectomy between 1970 and 1986, and 22,196 comparison subjects who had been admitted during the same period for one of three specified elective operations, appendicitis, or injuries. MAIN OUTCOME MEASURES: Hospital admission and death after vasectomy or comparison event. RESULTS: The mean durations of follow up were 6.6 years for men with a vasectomy and 7.5 years for men with a comparison condition. The relative risk of cancer of the testis in the vasectomy cohort (4 cases) compared with that in the other cohorts (17 cases) was 0.46 (95% confidence interval 0.1 to 1.4), that of cancer of the prostate (1 v 5 cases) 0.44 (0.1 to 4.0), and that of myocardial infarction (97 v 226 cases) 1.00 (0.8 to 1.3). There was no evidence of an increase associated with vasectomy in the incidence of a range of other diseases. CONCLUSIONS: Vasectomy was not associated with an increased risk of testicular cancer or the other diseases studied. With respect to prostatic cancer, while we found no cause for concern, longer periods of observation on large numbers of men are required.

Adult↗
PubMed1991

Elective total hip replacement: incidence, emergency readmission rate, and postoperative mortality.

OBJECTIVES: To report the incidence of elective total hip replacement and postoperative mortality, emergency readmission rates, and the demographic factors associated with these rates in a large defined population. DESIGN: Analysis of linked, routine abstracts of hospital inpatient records and death certificates. SETTING: 10 hospitals in six districts in Oxford Regional Health Authority covered by the Oxford record linkage study. SUBJECTS: Records for 11,607 total hip replacements performed electively in 1976-85. MAIN OUTCOME MEASURES: Incidence of operation, postoperative mortality, relative mortality ratios, and incidence of emergency readmission. RESULTS: NHS operation rates increased over time from 43 to 58 operations/100,000 population. Variation in operation rates between districts reduced over time. Operation rates were on average 25% higher in women than men. There were 93 deaths (11/1000 operations) within 90 days of the operation and 208 emergency readmissions (28/1000 operations) within 28 days of discharge. Postoperative mortality and emergency readmission rates increased with age. No significant trend with time was found. Mortality in the 90 days after the operation was 2.5-fold higher (1.9 to 3.0) than in the rest of the first postoperative year. This represented an estimated excess of 6.5 (4.2 to 8.8) early postoperative deaths/1000 operations. Most deaths were ascribed to cardiovascular events. Thromboembolic disease was the commonest reason for emergency readmission. CONCLUSIONS: The pronounced increase in operations in districts with initially low rates suggests a trend towards greater equity in the local provision of NHS hip arthroplasty. The early postoperative clusters of deaths attributed to cardiovascular disease and of readmissions for thromboembolic disease suggest that there is scope for investigating ways of reducing the incidence of major adverse postoperative events.

Adult↗
PubMed1991

Use of psychiatric services by patients in a general hospital.

OBJECTIVE: To identify physical disorders associated with increased rate of use of psychiatric services. DESIGN: Retrospective analysis of routine abstracts of general hospital inpatient records linked with those of psychiatric care, for inpatients with physical disorders with possible psychiatric associations and for controls. SETTING: Oxfordshire health district. SUBJECTS: Inpatients aged 15-64 years discharged from general hospitals during 1975-85 with a diagnosis among 14 selected diagnostic groups (including potentially life threatening conditions, chronic disabling diseases, and non-specific symptomatic conditions) and control inpatients with acute conditions. MAIN OUTCOME MEASURES: Observed and expected numbers of patients receiving psychiatric care. RESULTS: Observed use of psychiatric services before and after index admission was close to that expected for controls. For most other diagnoses the observed use was significantly increased in the year preceding and that subsequent to the admission. For four diagnostic groups it was significantly greater in the year after admission than in that before (acute myocardial infarction (ratio before to after 2.17, 95% confidence interval 1.5 to 3.3), cancer (2.05, 1.7 to 2.5), diabetes mellitus (1.89, 1.4 to 2.9), and chest pain (1.78, 1.3 to 2.4)). During four years after the admission the use of psychiatric services was significantly higher than in the general population for nonspecific symptomatic conditions (observed/expected: abdominal pain 1.7, chest pain 2.0, and headache 4.2), cirrhosis of the liver (10.4), and fractures in road accidents and other fractures (1.3, 1.6). CONCLUSIONS: More patients with certain physical conditions used psychiatric services. Alternative methods of service delivery may be needed, especially for disabling chronic physical illness, alcohol related disorders, and non-specific symptomatic conditions.

Adolescent↗
PubMed1989

General practitioners' referrals to specialist outpatient clinics. I. Why general practitioners refer patients to specialist outpatient clinics.

There has been much concern about the wide variations in general practitioners' referral rates and the consequent implications for cost and quality of care. This has led to a call to evaluate the appropriateness and effectiveness of referrals. A collaborative audit of referrals to outpatient clinics was conducted by 127 general practitioners in 33 practices in the Oxford region. Records were kept of 18,754 referrals, which included data on diagnoses and reasons for referral. Overall, 6553 (35.4%) of the referrals were for particular treatments or operations and a further 6475 (34.9%) were for specific investigation or diagnosis. Advice on management was the main reason for referral in 2656 (14.3%) cases, and in 1719 (9.3%) cases the general practitioners wanted the consultants to take over managing their patients. Reassurance of either the general practitioner or the patient was recorded as the main reason in only 762 (4.1%) referrals. There seems to be scope for rationalising the referral process. A programme with three stages for evaluating referrals to outpatient clinics is recommended.

England↗
PubMed1989

General practitioners' referrals to specialist outpatient clinics. II. Locations of specialist outpatient clinics to which general practitioners refer patients.

Although linkage by computer of hospital administration systems across all clinics in a health district is becoming a practical possibility, complete records of general practitioners' referrals to outpatient clinics will be difficult to achieve. Data from a large study of general practitioners' referrals to such clinics were used to calculate the proportion of referrals that crossed district boundaries, the proportion that were made to the private sector; and the number of locations that each practice referred patients to. Of the 17,601 referrals from practices in Oxford Regional Health Authority, 13,857 (78.7%) were made to NHS outpatient clinics within practices' own districts, 1524 (8.7%) to clinics in other districts in the same region, 420 (2.4%) to NHS clinics in other regions, and 1800 (10.2%) to the private sector; but these proportions varied considerably among the practices. The mean number of different NHS hospitals or clinics that each practice referred patients to was 15.8 (range 4-42).

Catchment Area, Health↗
PubMed1989

Do referral rates vary widely between practices and does supply of services affect demand? A study in Milton Keynes and the Oxford region.

Two commonly held beliefs about referral rates were investigated in this study: first that demand for services is determined by supply and secondly that there is wide variation between general practices in their referral rates. All referrals to specialist outpatient clinics were recorded during two 11-week periods by general practitioners in eight practices in the new town of Milton Keynes and in 17 practices elsewhere in the Oxford region. During the first period, only a limited outpatient service was available in the new town; for many specialist services, people had to be referred to hospitals outside the district. Referral rates from Milton Keynes were very similar to those from the rest of the region. By the second period the range of specialist facilities available locally had expanded considerably with the opening of the new district general hospital and during this period there was a statistically significant but rather small increase in referral rates from Milton Keynes. Variation in referral rates between general practices within each geographical group was greater than that between the two groups. Overall, there was about a three-fold variation between general practices in outpatient referral rates which is considerably less than that commonly thought to exist.

Delivery of Health Care↗
PubMed1986

Community hospitals in Oxfordshire: their effect on the use of specialist inpatient services.

About one-third of the general practices in the Oxfordshire Health District have access to beds in community hospitals as well as district general hospitals. Hospital Activity Analysis data were used to calculate the average number of hospital beds occupied daily by patients registered with each general practice in the district. Practices with and without access to community hospitals were compared to determine whether such access was associated with a reduction in the use of beds in general medical, geriatric, and other specialties, and an increase in overall utilisation rates. The rate of use of general medical and geriatric beds in district general hospitals by practice populations with access to community hospitals was about half that of populations without such access. Utilisation rates overall, combining the use of beds in both district general hospitals and community hospitals, were a little higher in populations with access to both community hospitals and district general hospitals than in those with access to district general hospitals only.

Age Factors↗
PubMed1986

Repetition of accidents in young children.

Data from the Oxford Record Linkage Study have been used to describe rates of accident repetition for children aged under 5 years. As reflected by hospital admissions, accident rates for children who have already had one accident were approximately twice those of children of the same age and sex who had previously been accident free.

Accident Proneness↗
PubMed1985

Repetition of self-poisoning and subsequent death in adolescents who take overdoses.

Hospital Activity Analysis data and record linkage were used to investigate repetition of self-poisoning, and deaths, among 2,492 people, aged 12 to 20 years, who took overdoses between 1974 and 1978. Repetition occurred most frequently during the first few months after an initial admission; 9.5% of patients repeated within the study period (mean follow-up of 2.8 years). Ten of the 2,492 subjects died during the study period, and the average annual death rate in the cohort was approximately four times higher than the national average annual death rate in this age-group as a whole. Six of the deaths were probably suicides. Repetition and suicide rates were highest among males aged 16 to 20 years.

Adolescent↗
PubMed1982

Hospital admissions for adverse effects of medicinal agents (mainly self-poisoning) among adolescents in the Oxford Region.

Hospital statistics for episodes coded as adverse effects of medicinal agents' were used to study deliberate self-poisoning among people aged 12-20 years in the Oxford Region. Admission rates rose sharply from the age of 12 years, more so for females than males, up to the age of 16 years in females and 18 years in males. Analgesics, antipyretics and psychotropic drugs were the agents most commonly used by both sexes and accounted for three-quarters of all admissions. Admission rates varied from year to year, but increased overall between 1974 and 1979, notably among people under 16 years of age. Admissions for 'adverse effects of medicinal agents' accounted for 4.7 per cent of all general admissions among people aged 12-20 years.

Adolescent↗