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Query: UMLS:C0262471 (ENT)
 5,307 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

In the light of the White Paper Working for patients, this study addresses two questions: first, whether the current pattern of service use is a valid surrogate for the assessment of the service needs of a population; second, given that information systems which will provide accurate cost per case information are several years from being implemented, what differences might be made to a specialty budget by the adjustment of case costs by use of different case-mix measures. ENT has been chosen as a case study because of its relative 'market potential'. The study addresses the first question by examining the variations in the current level and type of service use across Districts in a Region. The large variation in utilization across Districts, both in total and for different degrees of case complexity, suggests that the current pattern of service use is a poor indicator of need. The second part of the study examines a Unit which has large inflows of complex patients. Adjusting for case-mix, however, produces a comparatively small effect on the overall specialty budget, whether the adjustment is made using the BUPA schedule of surgical procedures or using diagnosis-related groups. In the light of these results, it is suggested that the current emphasis on accurately costing case-mix could be misplaced, and that more resources should be diverted to scrutinizing the appropriateness of service use to health needs and priorities, in line with the aims of the NHS reforms.
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PMID:Information needs in a provider market: a case-study of ENT. 190 20

A short questionnaire on the subject of the management of epistaxis was sent to forty accident & emergency departments in two NHS regions. Thirty replies were received (response of 75%). It was found that all departments were involved in the initial management of epistaxis, but the extent of that involvement varied considerably. One of the most obvious factors contributing towards the degree of involvement was the liaison between the accident & emergency and the ENT departments. Three departments never referred patients to the ENT department for follow-up. Nine departments performed their own nasal cautery, but half of these did not use any form of local anaesthesia. Twenty-seven departments used various forms of nasal packing but, of these, two-thirds did not use any form of local anaesthesia. Twenty-three departments allowed patients to go home with a nasal pack in situ. The results of this survey are discussed and a guideline to the management of epistaxis in an accident & emergency setting is suggested.
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PMID:The management of epistaxis in accident and emergency departments: a survey of current practice. 213 75

Evaluation of the use of diagnosis-related groups (DRGs) has revealed a number of technical problems in coding of diagnoses and operative procedures, as well as unresolved issues in the clinical acceptability of existing groupings. An investigation of the statistical homogeneity of DRGs, in terms of duration of patient stay, is described. Consideration of data relating to some 990,000 episodes of in-patient care in three English Regions discloses wide variations in statistical homogeneity, both between DRGs and in relation to individual clinical specialties. The greatest homogeneity is found in ENT surgery and gynaecology; and the least in general medicine and orthopaedic surgery. The need for improved data collection and coding procedures is discussed, together with the advisability of sensitivity in the interpretation of DRGs, as well as the need for a co-ordinated approach to their refinement for application in any wider introduction in the NHS.
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PMID:Evaluation of diagnosis-related groups in the National Health Service. 251 88

The availability and use of surgical manpower and beds and certain measures of surgical workload were examined in the NHS in England and Wales from 1967 to 1977 using routine health statistics. Amongst the surgical specialties, there was no consistent relationship between changes in levels of manpower and beds and operating output. For example, ENT surgery and cardiothoracic surgery had more staff and fewer beds in 1977 than in 1967, but operating output in ENT surgery decreased by 18 per cent and in cardiothoracic surgery increased by 28 per cent. Although the efficiency of bed use may have improved (average length of stay was 10.5 days in 1967 and 8.8 days in 1977), the overall use of available beds in most specialties may have decreased. The number of operations performed in each specialty per consultant surgeon was less in 1977 than 1967 except for traumatic and orthopaedic surgery. Although interpretations of routine health statistics are rarely conclusive, the results of this study suggest the possibility of a less than optimum use in 1977 compared to 1967 of surgical beds and surgeons' operating potential which might be due to lack of other resources such as usable theatre time.
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PMID:Surgical manpower, beds and output in the NHS: 1967-1977. 682 95

Regional specialist societies offer a valuable mechanism for the conduct of medical audit. The experience of the audit sub-committee of The Scottish Otolaryngological Society in conducting an audit on laryngeal cancer encouraged us to undertake a larger audit of tonsillectomy practice in Scotland. Although the number of tonsillectomies performed has declined over the last 10 years, they still account for about 20 per cent of all operations performed by otolaryngologists and as such are a major consumer of resources (Personal communication--Directorate of Information Services, Information and Statistics Division. NHS in Scotland, Management Executive, Edinburgh). The Scottish tonsillectomy audit was devised to define current practice, review indications for surgery and recommend such modifications in practice as may be necessary to optimise patient care and the use of resources. Funding was obtained from the Clinical Resource and Audit Group (CRAG) of the Scottish Home and Health Department. Data on current practice was collected during the period February 1992 to January 1993. Proformas were completed by medical, administrative and secretarial staff in all participating hospitals, collected by an audit secretary and passed to the relevant data collection centre. Data was then entered into a specially designed database before being forwarded to the audit co-ordinator based in Dundee for collation. Six and 12 months following surgery, all inpatients were sent a questionnaire to obtain data on the efficacy of the operation. Data were obtained from a total of 9,773 patients. Two thousand and seventy-nine of these were seen as both outpatients and inpatients, 4,309 were outpatients only and 3,385 were inpatients only. Four thousand, one hundred and one patients returned at least one follow-up questionnaire. The topics audited included source and reason for referral, indications for surgery, grade of staff involved, type of surgery and length of stay in hospital. In agreement with previous studies (H.M.S.O., 1989), differences were found in the rates of tonsillectomy performed in different Health Boards. Although the highest referral and operation rates were found in the Highland region, referral and operation rates did not correlate in all other areas. Recurrent tonsillitis was the most frequent principal reason for the decision to operate although there were differences between Health Boards for other indications including obstructive symptoms. Most patients had symptoms for two to three years although some patients had been affected for 40 years prior to being listed for tonsillectomy. Some area ENT services were consultant-based while others involved more junior staff. The grade of staff involved did not appear to affect the decision made at the Outpatient Department (OPD) or the outcome of the operation. Ninety-eight per cent of patients who returned the questionnaire were glad that the operation had been performed. Recommendations regarding changes in tonsillectomy practice are given.
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PMID:The Scottish tonsillectomy audit. Audit Sub-Committee of the Scottish Otolaryngological Society. 891 2

Magnetic resonance imaging (MRI) is the imaging modality of choice in diagnosing vestibular schwannoma (VS). Perceived high costs have prevented clinicians from using it as a screening investigation, although MR scanners are now widely available in the United Kingdom. In a retrospective study, the clinical records of all the patients who presented to the ENT department of Taunton and Somerset NHS Trust with suspected symptoms of VS during the year 1994 were analysed. The cost of confirming or refuting the diagnosis of VS in each patient ranged from 220.72 pounds to 580.31 pounds depending on the number of hospital visits and investigations performed. This study shows that the routine use of MR scanning for detection of VS is cost effective and more effective than the use of conventional tests.
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PMID:A cost effective screening protocol for vestibular schwannoma in the late 90s. 901 24

Regional specialist societies offer a valuable mechanism for the conduct of medical audit. The experience of the audit sub-committee of The Scottish Otolaryngological Society in conducting an audit on laryngeal cancer encouraged us to undertake a larger audit of tonsillectomy practice in Scotland. Although the number of tonsillectomies performed has declined over the last 10 years, they still account for about 20 per cent of all operations performed by otolaryngologists and as such are a major consumer of resources (Personal communication-Directorate of Information Services, Information and Statistics Division. NHS in Scotland, Management Executive, Edinburgh). The Scottish tonsillectomy audit was devised to define current practice, review indications for surgery and recommend such modifications in practice as may be necessary to optimise patient care and the use of resources. Funding was obtained from the Clinical Resource and Audit Group (CRAG) of the Scottish Home and Health Department. Data on current practice was collected during the period February 1992 to January 1993. Proformas were completed by medical, administrative and secretarial staff in all participating hospitals, collected by an audit secretary and passed to the relevant data collection centre. Data was then entered into a specially designed database before being forwarded to the audit co-ordinator based in Dundee for collation. Six and 12 months following surgery, all inpatients were sent a questionnaire to obtain data on the efficacy of the operation. Data were obtained from a total of 9,773 patients. Two thousand and seventy-nine of these were seen as both outpatients and inpatients, 4,309 were outpatients only and 3,385 were inpatients only. Four thousand, one hundred and one patients returned at least one follow-up questionnaire. The topics audited included source and reason for referral, indications for surgery, grade of staff involved, type of surgery and length of stay in hospital. In agreement with previous studies (H.M.S.O., 1989), differences were found in the rates of tonsillectomy performed in different Health Boards. Although the highest referral and operation rates were found in the Highland region, referral and operation rates did not correlate in all other areas. Recurrent tonsillitis was the most frequent principal reason for the decision to operate although there were differences between Health Boards for other indications including obstructive symptoms. Most patients had symptoms for two to three years although some patients had been affected for 40 years prior to being listed for tonsillectomy. Some are ENT services were consultant-based while others involved more junior staff. The grade of staff involved did not appear to affect the decision made at the Outpatient Department (OPD) or the outcome of the operation. Ninety-eight per cent of patients who returned the questionnaire were glad that the operation had been performed. Recommendations regarding changes in tonsillectomy practice are given.
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PMID:The Scottish tonsillectomy audit. The Audit Sub-Committee of the Scottish Otolaryngological Society. 902 36

The aim of this study was to find out whether patients attending ENT clinics obtain health information about their medical condition and to assess satisfaction with the sources of health information, including the internet. Three hundred and thirty patients attending ENT outpatient clinics at District General Hospitals in Wigan and Warrington during June 2001 were asked to complete detailed questionnaires. Fifty-seven per cent of patients attempted to obtain health information before their visit to the specialist clinic. Forty-five per cent of patients had access to the internet, but only 13% used it to obtain health information. General practitioners were the source of health information for 64%, but the NHS-Direct help line was only used by 16%. Patients also trusted the health information provided by their GPs the most. In the twenty-first century, patients turn to their GP as the main source of health information.
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PMID:Has the internet overtaken other traditional sources of health information? Questionnaire survey of patients attending ENT outpatient clinics. 1247 25

Using the MEDLINE database (OVID), a retrospective review of the UK literature on head and neck oncology was performed for the period 1994-2000, each publication being categorised by department and first author. Tumours almost exclusively managed by general surgeons, cardiothoracic surgeons and neurosurgeons were excluded. In the years 1994 to 2000, there were a total of 120 UK publications, 72% of which came from non-academic NHS units; 23% of the publications were from ENT units, 23% from oral and maxillofacial (OMF) surgery units and 18% from plastic surgery units. The majority of plastic surgery publications described reconstructive techniques, whereas a wider range of topics was observed in the publications by ENT and OMP surgeons. Several irregularities in the MEDLINE database were discovered and are discussed. The findings of this study may be relevant to the future planning of head and neck oncology services.
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PMID:Head and neck oncology: the UK experience. Who is publishing what? 1252 96

The NHS plan promises the creation of general practitioners with a specialist interest (GPSIs) who will be able to provide an alternative referral resource for primary care. At present, only the specialties of orthopaedics, ophthalmology, ENT and dermatology, which have the longest waiting times for outpatient appointments, have been earmarked for GPSIs. The British Association of Dermatologists has examined, investigated and piloted several such schemes for dermatology provision. This paper summarises its principal conclusions.
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PMID:General practitioners with a special interest in dermatology--the dermatologist's perspective. 1499 77


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