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Biomedical subjects

R T Edwards

Publications and source records attributed to R T Edwards.

13 recordsLinked to original sources
PubMed2001

Steering a course around the genetic iceberg.

A US company is now marketing worldwide, via the Internet, genetic testing for predisposition to breast and ovarian cancer. This paper explores some of the divergent concerns about the implications of private genetic testing for the United States and United Kingdom, with their differing health care systems. As the UK National Health Service faces calls for expansion in its genetic services to meet growing demand, there is now a need for evaluation of the costs and effectiveness of such services so that they may be efficiently targeted to those women who can benefit most from them. In the cases of breast and ovarian cancer, it is relatively straightforward to calculate the benefits in terms of added life expectancy and health-related quality of life resulting from earlier diagnosis and treatment of affected women, but these women are likely to be a small proportion of the total number of women who are referred or self-refer to genetic services. This paper asks how we are to measure and value the benefits of information about risk of cancer to a particular woman or to members of her family; how we are to measure and value the benefits of effective counselling, which encourages autonomous, informed decision-making about whether or not to undergo genetic testing, and which facilitates comprehension of complex results; and ultimately, in the face of advances in genetic science, how we are to steer the NHS around the genetic iceberg.

Breast Neoplasms↗
PubMed2000

Weights for waits: lessons from Salisbury.

OBJECTIVES: This paper describes a waiting list patients' points scheme under development in Salisbury, UK, for the fair management of elective inpatient and day case waiting lists. The paper illustrates how points can be assigned to patients on a waiting list to indicate their relative unmet need, and illustrates the impact on case mix and resource use of the implementations of the points system versus 'first come, first served'. The paper explores a range of philosophical and technical questions raised by the points system. METHODS: The Salisbury Priority Scoring System enables surgeons to assign relative priority to patients at the time they are placed on a waiting list for elective health care. Points are assigned to patients to reflect the rate of progress of their disease, pain or distress, disability or dependence on others, loss of usual occupation and time already waited. In recognition of the need for resource planning alongside the prioritization of elective inpatients and day case waiting lists, a range of iso-resource groups has been developed for all procedures on these lists. These categorize procedures in terms of their resource use (i.e. bed days and theatre time required). RESULTS: In a modelling exercise, application of the Salisbury Points Scheme to a 'first come, first served' orthopaedic waiting list produced considerable changes in the order of patients to be treated. Only seven patients appeared in the first 20 patients to be treated under both regimes. The Salisbury Scheme required fewer resources to treat its first 20 patients than 'first come, first served' and met more Salisbury-defined 'need', but eliminated fewer days of waiting from the list. CONCLUSIONS: Development of a points scheme and iso-resource groupings opens up opportunities for more sophisticated purchasing, based on treating patients in order of unmet need rather than according to arbitrary maximum waiting time guarantees, as has been the dominant policy on waiting lists pursued in the UK, Australia, and Sweden, to date. However, such schemes raise three issues: first, the necessity of defining need as a composite of clinical and social factors; second the necessity to determine the acceptability of explicit prioritization to both health care professionals and patients; third, the thorny issue of whether such prioritization schemes will lead to 'gaming' by well-meaning general practitioners and specialists, aiming to secure the priority of their own patients and clinical specialty. Rigorous piloting of schemes, such as that developed at Salisbury, will be required to identify their dynamic effect over time on case mix, waiting time and resource use.

Delivery of Health Care↗
PubMed1999

Acoustic transient classification with a template correlation processor.

I present an architecture for acoustic pattern classification using trinary-trinary template correlation. In spite of its computational simplicity, the algorithm and architecture represent a method which greatly reduces bandwidth of the input, storage requirements of the classifier memory, and power consumption of the system without compromising classification accuracy. The linear system should be amenable to training using recently-developed methods such as Independent Component Analysis (ICA), and we predict that behavior will be qualitatively similar to that of structures in the auditory cortex.

Algorithms↗
PubMed1995

New South Wales group pathology services--the Southpath model.

There has been significant rationalisation of public pathology service provision in New South Wales through the formation of group pathology services. These services are a fundamental change in the method of service organisation and delivery and little has been reported detailing their organisational and financial structures. Southpath, the group pathology service of the Southern Sydney Area Health Service, has improved service delivery, improved productivity by 18.2 per cent and reduced pathology expenditure per admission by 19.2 per cent. This paper describes the organisation of Southpath as knowledge of the organisational structures and performance of the group pathology service is necessary for the evaluation of this change in the method of service delivery and is essential to the current debate on the value of public pathology services.

Budgets↗
PubMed1993

A comparison of pathology usage in three New South Wales public hospitals.

Data on pathology testing in New South Wales public hospitals are extremely limited. Pathology laboratory billing files and hospital admissions and transfer files were used to obtain data on the pathology testing frequency and cost of testing at three New South Wales public hospitals. Data were also extracted that allowed a comparison of test ordering frequency and cost of testing for various groups of admitting specialists. A high degree of similarity was found in the test ordering patterns at each hospital with 16 common tests or test groups in the top 20 tests or test groups at each hospital. These 16 tests or test groups accounted for 78, 82 and 88% of the total pathology expenditure at each hospital. The total cost of pathology per occupied bed day was found to be A$26.23, A$34.63 and A$44.66 at each hospital and represented 5.5, 5.2 and 6.8% of the total cost per occupied bed day, respectively, at each hospital. Variation was found between hospitals in the cost per occupied bed day for surgery, medicine, obstetrics and gynaecology and paediatrics. Three major reasons for the variations in pathology costs were identified as variations in outpatient loads, variations in test ordering patterns among medical practitioners and casemix.

Ambulatory Care↗
PubMed1983

Colorectal carcinoma in the elderly: a geriatric and surgical practice compared.

Two hundred and eighty-eight patients with colorectal cancer over the age of 65 years admitted to either the geriatric unit or a surgical unit have been compared. Significant differences in presentation and outcome were found and are discussed. Despite adverse factors, acceptable results were obtained for surgical treatment in the geriatric group.

Aged↗