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Biomedical subjects

T Dent

Publications and source records attributed to T Dent.

13 recordsLinked to original sources
PubMed1999

Our time has come.

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Public Health Administration↗
PubMed1999

Maximizing the contribution doctors make to NHS management.

Management is an increasingly important issue for many doctors. If doctors wish to influence resource allocation, they must involve themselves in health service management. This article describes the results of an enquiry action learning project involving six doctors. As part of the project, clinical directors and their business managers were interviewed. In addition, the Police Force and BAA (formerly the British Airport Authority) were visited and their management structure, out-of-hours activities and planning for emergencies assessed. This article examines the reasons why many doctors do not involve themselves in management, such as increased time commitment and negative peer pressure, and suggests some solutions to these problems, including the need for a wider understanding of the role of clinical directors. It also considers how some organizations are already starting to address these issues, and how both doctors and hospitals can benefit from greater involvement of doctors in health service management.

Attitude of Health Personnel↗
PubMed1998

Part III. Performance measurements of primary care physicians in managed care.

A fundamental change occurring for physicians is that there are increasingly organized efforts to comprehensively assess physician performance. Managed care is the factor most instrumental in leading to an enhanced focus on physician measurements. Another major factor that has prompted increased attention to the measurement of physicians' performance is that patients are beginning to act more as consumers of health care. Efforts to measure physician performance in geographically dispersed primary care practices is inherently more difficult than measuring hospital care. However, according to some studies that have attempted to do this, the delivery in primary care offices of basic preventive services and the care given to patients with chronic illnesses is surprisingly poor. If primary care physicians don't address these issues, managed care companies will make it policy to refer some patients with chronic disease to specialists, who are comprehensively achieving higher measurement scores. What is being measured is at present quite variable in different primary care offices. Most of the initial measurements have been from claims data or from other data that might be obtained and aggregated outside of the primary care physician's office. As this data is not very rich in clinical information, significant misinterpretation is possible. In order to augment these shortcomings, office records are increasingly being reviewed. A standardization of primary care physicians' office medical records is rapidly occurring and is being driven by the measurable items reviewed by managed care organizations. Measurement of patient complaints and patient surveys is another means that managed care organizations presently use to assess primary care physicians' performance. Extreme caution should be used when interpreting this data, as often the small numbers of patients, multifactorial issues, and ambiguity about responsible parties may skew the results. Measurement processes are evolving to focus on how the health care system functions in an integrated fashion, instead of strictly on how the individual physician is performing. Present and planned measurement processes should be used to improve care of patients, and this is most likely to occur when physicians take an active role in understanding and responding to the measurement processes arising from managed care.

Clinical Competence↗
PubMed1995

Variations in clinical experience of pre-registration house officers: the effect of London.

A postal questionnaire was used to examine possible differences in clinical experience of pre-registration house officers (PHROs) in eight former English regions, and, within the Thames regions, between teaching hospitals, and non-teaching hospitals in Inner London, Outer London and outside London. The main measurements were the numbers of patients clerked in an average week as emergency, routine or day admissions or as outpatients; the number of patients under the respondents' care at time of reply; the experience of specific clinical conditions gained; the overall adequacy of clinical experience; and the suitability of posts for preparing respondents to work as casualty officers, senior house officers, or general practitioners. The results indicate that less clinical experience was acquired by PRHOs training in the Thames regions. They had fewer admissions per week, fewer patients, and exposure to fewer surgical conditions. Within the Thames regions, there was a gradient of improving educational quality (in all areas of this study) from the teaching hospitals, through the non-teaching hospitals in inner and in outer London, and then to the hospitals outside London. No differences were found between Thames region posts outside London and non-Thames regions.

Attitude of Health Personnel↗
PubMed1995

Education and audit can improve the identification of excessive drinkers among medical inpatients.

This study investigated the effect of education and audit on the identification and management of medical inpatients with excessive alcohol consumptions by use of a cross-sectional survey of medical and nursing notes, compared with historical controls. We report the proportion of medical and nursing notes containing qualitative and quantitative drinking histories, the use of the CAGE questionnaire, and notification of alcohol consumption in discharge summaries. A total of 1,979 out of 2,680 (74%) notes of eligible patients were examined. The number of medical notes containing quantitative alcohol histories rose from 175/792 (22%) among historical controls, to 242/690 (35%) after training of junior medical and nursing staff, and to 241/497 (48%) after feedback of results in a clinical audit meeting. The number of medical notes with no recorded alcohol history changed from 309/792 (39%) to 287/690 (42%) to 152/497 (31%), respectively (chi 2 for trend = 97.2, p < 0.0001). The number of nursing notes containing quantified alcohol histories rose from 31/792 (4%) among historical controls, to 123/690 (18%) after training, and to 237/497 (48%) after feedback of results in a clinical audit meeting. The number of nursing notes with no recorded alcohol history fell from 309/792 (90%), to 512/690 (74%), to 205/497 (41%) respectively (chi 2 for trend = 353.7, p < 0.0001). The proportion of patients found to be drinking excessively rose from 40/792 (5.1%) to 57/690 (8.3%) to 45/497 (9.1%) (chi 2 for trend = 8.25, p = 0.004). There was little worthwhile improvement in use of the CAGE questionnaire and in discharge summaries. Education and audit are effective ways of improving the identification of excessive drinkers by both junior doctors and nurses alike. Other aspects of management are less responsive.

Alcoholism↗
PubMed1985

Giant hamartoma of the colon: Peutz-Jeghers type.

We have seen a young man with multiple large-bowel polyps and a single immense colonic polyp of the Peutz-Jeghers type. It was completely removed primarily to control hemorrhage and to exclude focal adenomatous or carcinomatous change. We review the spectrum of colonic hamartomas.

Adult↗
PubMed1984

A totally implanted injection port system for blood sampling and chemotherapy administration.

We evaluated a totally implanted system consisting of a subcutaneous injection port connected to a silicone elastomer central venous catheter for vascular access, including blood drawing, in 35 patients with cancer. All patients lacked peripheral venous access sites and were undergoing aggressive chemotherapy programs. The cumulative duration of successful access exceeded 2,900 days (for individual patients: range, five to 203 days; median, 61 days). In no instance were infusions or injections unsuccessful. Blood-sampling attempts were successful 90% of the time. The system did not require flushing between uses, being filled with heparinized saline after each entry. There were no instances of irreversible catheter occlusion or shear and no system-related infections. Thus, this device appears to have advantages over other central venous catheters in terms of patient acceptance and lack of maintenance between uses.

Adolescent↗
PubMed1983

Early experience with endoscopic percutaneous gastrostomy.

We performed endoscopic percutaneous gastrostomy (EPG) on 22 patients. All procedures were performed using local anesthesia with intravenous diazepam sedation. Formal laparotomy was not required. The mean patient age was 58 years (range, 21 to 83 years). Indications for EPG placement included neurologic disorders in 17 patients, head and neck tumors in four patients, and esophageal disease in one patient. The mean operative time for EPG was 27.5 minutes, with a range of 11 to 60 minutes. Two major complications, a gastrocolic fistula and an intraperitoneal gastric leak, occurred early in the series. The technique has been modified with no similar complications. Pneumoperitoneum after EPG was demonstrated in eight patients without sequelae. Ileus following EPG was not observed in any patient, and enteral feedings were uniformly resumed 48 hours after tube placement. Our early experience with EPG suggests that this technique is a safe, cost-effective, and time-saving alternative to traditional gastrostomy tube placement.

Adult↗
PubMed1982

Hemophilia.

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Child Abuse↗