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Biomedical subjects

Tom Treasure

Publications and source records attributed to Tom Treasure.

44 records · Page 3Linked to original sources
PubMed2002

Booked inpatient admissions and hospital capacity: mathematical modelling study.

OBJECTIVES: To investigate the variability of patients' length of stay in intensive care after cardiac surgery. To investigate potential interactions between such variability, booked admissions, and capacity requirements. DESIGN: Mathematical modelling study using routinely collected data. SETTING: A cardiac surgery department. SOURCE OF DATA: Hospital records of 7014 people entering intensive care after cardiac surgery. MAIN OUTCOME MEASURES: Length of stay in intensive care; capacity requirements of an intensive care unit for a hypothetical booked admission system. RESULTS: Although the vast majority of patients (89.5%) had a length of stay in intensive care of < or = 48 hours, there was considerable overall variability and the distribution of stays has a lengthy tail. A mathematical model of the operation of a hypothetical booking system indicates that such variability has a considerable impact on intensive care capacity requirements, indicating that a high degree of reserve capacity is required to avoid high rates of operation cancellation because of unavailability of suitable postoperative care. CONCLUSION: Despite the considerable enthusiasm for booked admissions systems, queuing theory suggests that caution is required when considering such systems for inpatient admissions. Such systems may well result in frequent operational difficulties if there is a high degree of variability in length of stay and where reserve capacity is limited. Both of these are common in the NHS.

Admitting Department, Hospital↗
PubMed2002

Surgical performance measurement.

The need for effective surgical performance measurement has gained an increasingly high profile in recent years, particularly since events at Bristol Royal Infirmary, where apparent poor performance has prompted the UK Department of Health to instigate a major Public Inquiry. This paper describes issues that concern the measuring and monitoring of surgical performance, and methods that have been devised for judging a good surgeon from the less competent. The authors are a collaborative team composed of specialists in Cardiothoracic surgery and Operational Research analysts with experience of monitoring performance in cardiac surgery. This paper describes concrete examples from that knowledge base.

Clinical Competence↗
PubMed2002

Unrealistic expectations arising from mortality data reported in the cardiothoracic journals.

BACKGROUND: This study was undertaken to ascertain whether mortality data in the cardiac surgical literature mirror data reported in national databases. METHODS: This was a review of articles with 50 or more subjects reporting single-center mortality data for coronary artery bypass or aortic or mitral valve replacement published in the three major cardiothoracic surgical journals from 1997 through 2000. Mortality data and trends were examined. RESULTS: One hundred sixty-nine articles were found (coronary artery bypass, n = 119; aortic valve replacement, n = 34; mitral valve replacement, n = 16). Articles were predominantly case series (N = 95), with smaller numbers of comparative retrospective studies (n = 34), randomized trials (n = 29), and prospective noncomparative studies (n = 11). The median mortality figures for these studies were 1.5% (interquartile range, 0.3%-2.6%) for coronary artery bypass, 3.4% (interquartile range, 2.0%-5.3%) for aortic valve replacement, and 4.7% (interquartile range, 2.1%-6.9%) for mitral valve replacement. In contrast, the national registry mortality figures were 2.9%, 4.0%, and 6.0%, respectively, in the United States and 2.6%, 4.5% and 6.3%, respectively, in the United Kingdom. Coronary bypass studies with samples smaller than 100 patients reported lower mortality figures (median 0%) than did those with more than 100 patients (1.8%). Exploration with graphical plots suggested a bias toward reporting and publication of studies with below average mortality. CONCLUSIONS: Particularly for coronary artery bypass, published data tend to underrepresent the risk of death as seen in most centers. Outcomes and magnitudes of effects as reported in these research studies may not be replicable to the same degree in most centers. In particular, extreme caution should be taken in extrapolating results from studies with fewer than 100 patients to larger surgical populations.

Aortic Valve↗
PubMedDate not supplied

Pleural mesothelioma: little evidence, still time to do trials.

CONTEXT: The incidence of malignant pleural mesothelioma is increasing throughout most of the world. This cancer is uniformly fatal, and characterised by progressive breathlessness and unremitting pain in the chest wall. From the onset of symptoms, survival is from a few weeks to a few years. Desperation by patients and doctors has driven a search for effective treatments. Clinical benefits are marginal and evidence of a good quality is lamentably lacking. STARTING POINT: David Sugarbaker is the world's leading proponent of extrapleural pneumonectomy (EPP), an operation in which all the pleura is removed with the lung, pericardium, and diaphragm. He has recently reported the complications of this radical surgery in a series of 496 operations (J Thorac Cardiovasc Surg 2004; 128: 138-46). Although EPP as part of trimodality therapy (preoperative chemotherapy and postoperative radiation) is thought to be the best that can be offered and is regarded as the standard of care for selected patients given the morbidity associated with it, evidence for benefit is needed to justify its wider use. WHERE NEXT? With the increase in the number of cases there is increasing awareness of the disease, leading to earlier diagnosis, and an expectation that something must be done. Survival is short and the treatments on offer are onerous. The only responsible approach from a scientific, compassionate, or economic view (and why not combine all three?) is to find evidence of effectiveness to avoid futile and distressing treatment when possible.

Antineoplastic Agents↗