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Practitioner Records (practitioner + record)

Distribution by Scientific Domains
Medical Sciences100%

Kinds of Practitioner Records

  • general practitioner record
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    Selected Abstracts

    Improving general practitioner records in France by a two-round medical audit

    JOURNAL OF EVALUATION IN CLINICAL PRACTICE, Issue 2 2002
    Jean Brami MD
    Abstract Rationale, aims and objectives,The effectiveness of clinical audits in changing the practice of health care professionals is a moot point. Methods of implementation impinge directly upon outcomes. We investigated whether a network of local opinion leaders could contribute towards a successful audit. Our objectives were to: (i) bring about an improvement in record keeping in general practice; and (ii) increase GPs' awareness of medical evaluation. Methods,The GPs were recruited by local opinion leaders who had been briefed by the French National Agency for Accreditation and Evaluation in Health Care (ANAES, formerly ANDEM). On a given day (first round of the audit) they were invited to examine whether the medical records of their 10 first patients met 13 set criteria. Overall results were analysed by ANAES. Each GP was informed of how well they had fared compared with the regional and national averages and was provided with a standard set of recommendations. Anonymity was ensured by the local leaders. A second round was conducted 6 months later. Results,A total of 244 GPs took part in both rounds of the audit; 32 dropped out after the first round. Their results were of a significantly lower standard. A significant improvement in results (P < 0.025) was recorded between the two rounds for all 13 criteria of the questionnaire. Overall scores improved between the two rounds for 69% of the GPs and improved above average for 49%. The greatest scatter in results was noted for items relating to medical history rather than to personal identity (administrative data). Conclusions,Self-assessment can help improve general standards of medical record keeping. A network of local opinion leaders, briefed by a national agency whose mission is to promote quality improvement in health care, seems to be an effective means of inducing participation in self-assessment. [source]

    OUTCOMES AFTER OESOPHAGOGASTRECTOMY FOR CARCINOMA OF THE OESOPHAGUS

    ANZ JOURNAL OF SURGERY, Issue 1-2 2007
    Mark Omundsen
    Background: Carcinoma of the oesophagus is a rare but a highly lethal malignancy. The incidence of adenocarcinoma in particular is increasing in the Western world. Despite improvements in staging, perioperative care and the use of adjuvant/neoadjuvant regimen the prognosis remains poor. Methods: All patients who had biopsy-proven oesophageal carcinoma between the years 1992 and 2004 in the Wellington region, New Zealand, were retrospectively reviewed. The personal and tumour characteristics, operation details, complications and the details of hospital stay of patients who had had a resection were recorded in a database . Survival data were recovered from the notes, hospital database or general practitioner records and were available for all patients who had surgery. Survival analyses were calculated using Kaplan,Meier estimates. Results: One hundred and ninety-one patients were diagnosed with oesophageal carcinoma during the study period (59% adenocarcinoma, 32% squamous cell carcinoma). Only 35% (n = 67) had a resection (81% adenocarcinoma, 13% squamous cell carcinoma). Fifty-one (77%) had an Ivor Lewis procedure, 9 (14%) had only a laparotomy and 6 (9%) had a laparotomy, right thoracotomy and cervical incision. Forty-six (70%) tumours were in the distal third of the oesophagus and 13 (20%) were at the oesophagogastric junction. Perioperative mortality was 10% (n = 7) and anastomotic leak rate 9% (n = 6). Five-year survival was 23%. Conclusion: Results from our institution for the resection of oesophageal cancer compare favourably with those in the published work. Staging with computed tomography and laparoscopy has resulted in acceptable resection and survival rates. Survival for this disease is still largely stage dependent and earlier diagnosis probably holds the key to improved prognosis. [source]

    4 Audit of androgen deprivation therapy (ADT) register in Auckland region

    BJU INTERNATIONAL, Issue 2006
    H. ZARGAR
    Aim:, To determine the indications for therapy and disease state of men with prostate cancer on Luteinizing Hormone Releasing Hormone (LHRH) analogue treatment entered in the Auckland regional ADT register. Method:, Patients were identified from ADT register and further information was obtained using hospital electronic databases (Concerto and CRIS) and general practitioner records. Results:, Two hundred and eleven patients were registered from Jan 2000 to June 2005 on ADT register. The median age at diagnosis was 73 (45,91). 151 patients (71%) were alive at the time of audit. 118 of patients (56%)had a bone scan, 60 of which confirmed bony metastases (28% of all patients). Based on PSA score at diagnosis (>20), Gleason score (8,9,10) and stage of clinical disease (T3 or higher), high-risk patients were identified. The most common indication for LHRH analogue therapy as first line therapy was advanced local/metastatic disease (39%). 81 (38%) of patient developed hormone refractory disease while on treatment. The patients in high-risk group were more likely to develop hormone refractory disease (Chi Square test P = 0.009). PSA Doubling Time (PSADT) of less than 10 months was associated with significance risk of developing local/bony complications (Chi Square test P = 0.002) and mortality (Chi Square test P = 0.034). Presence of metastatic disease was associated with increased mortality (Chi Square test P = 0.012). Conclusion:, Patients in high-risk group are more likely to develop hormone refractory disease. PSADT can be used as an indicator for identifying patients with increased risk of developing complications. Presence of metastatic disease at the time of diagnosis is associated with increased mortality. [source]

    Scleral wrap increases the long-term complication risk of bone-derived hydroxyapatite orbital implants

    CLINICAL & EXPERIMENTAL OPHTHALMOLOGY, Issue 8 2008
    Tze'Yo Toh MBBS(Hons)
    Abstract Background:, This study was prompted by previous findings that suggested that scleral wrapping increased the rate of complications following insertion of bone-derived hydroxyapatite orbital implants and compared the long-term results of implants inserted with and without scleral wraps. Methods:, This retrospective case series reviewed the long-term outcomes of 159 patients who had undergone enucleation with insertion of a bone-derived hydroxyapatite orbital implant at Dunedin Hospital between 1977 and 2006. Implants were inserted with and without scleral wraps in 85 and 74 cases, respectively. Follow up was 0.5,27.5 years (mean 8.2 years) for the whole series and 9.7 years for the sclera group and 6.7 years for the group without sclera. Patient details were obtained from theatre records, case note review, patient interview and examination, interview of patient relatives and family general practitioner records. The main outcome measures were the rates of minor or major complications and their treatments and outcomes. Results:, Twenty-seven cases (17%) suffered minor complications of limited implant exposure that either healed spontaneously, with implant drilling or wound resuturing and 11 cases (7%) suffered major complications requiring explantation. Of 38 patients with postoperative complications, 31 (82%) had scleral wraps compared with 7 (18%) without sclera (P < 0.001; OR 5.14, 95% CI 2.00,14.78). Conclusion:, Bone-derived hydroxyapatite orbital implants inserted without scleral wrap were associated with better clinical outcomes and a lower rate of long-term complications. It is therefore recommended that these implants be inserted without a scleral wrap. [source]