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Biomedical subjects

F S Doran

Publications and source records attributed to F S Doran.

At least 19 recordsLinked to original sources
PubMed1981

The management of recurrent varicose veins.

Recurrent varicose veins are due to unidentified connections between the deep and superficial venous systems. Conventional clinical and radiological methods of identification are inefficient. In a series of 662 operations the rate of recurrence was over 40%. By changing to a different radiological technique, using an image intensifier, it was found that the gastrocnemius veins in the popliteal fossa were a common cause of recurrence. This radiological technique also differentiated between those recurrences that required a second operation and those which ought to be treated by Fegan's method.

Humans↗
PubMed1980

The surgical staffing of the future.

An analysis of the amount of surgical work carried out in the hospitals of the West Midlands Health Region during the year 1975 has been carried out. From this it is calculated that the number of surgeons on permanent contract will have to be increased by between 50 and 100%, that of registrars being reduced by 50% and that of the rest of the junior staff by 15-20%, to enable an equivalent amount of work to be done in the future.

Emergency Service, Hospital↗
PubMed1976

Clinical trials in surgery.

Scientific knowledge is reliable because it has been built on accurate measurements. Clinical knowledge is not. The science of biometry was started in 1835 by the Belgian astronomer Adolphe Quetelet. In the last fifty years a precise set of rules have been invented for this science. The method is suitable for a wide range of problems in clinical medicine and as the result of its application in recent years a firm foundation has been laid upon which scientific clinical knowledge can be built. Surge-ns, particularly, have been slow to apply biometrical methods to their clinical problems; but a start has now been made. The outcome of a particular type of treatment is determined by a complex set of inter-acting factors. The basis of the appropriate biometrical method is the elimination of all bias in favour of one of the rival techniques being compared. If this precaution is taken the observed results of the trial can be fitted onto Quetelet's distribution graph, and the probability of the observed difference in the results being due to chance, and nothing else, can be measured mathematically. The accuracy of this measurement deteriorates the greater are the number of the patients who can not be found and examined at the end of the trial. To make this point two trials conducted by the author are used. In the trial designed to discover if postoperative deep vein thrombosis and pulmonary embolism could be prevented by electrically stimulating the patients legs during the operation there was no difficulty. All the patients were examined at the end of the trial, because it ended before any of the patients left the hospital. The trial to discover if the primary treatment of varicose veins ought to be by Fegan's sclerotherapy or by operation was the exact opposite. At the end of the first year of the two year trial 15% of the patients could not be traced. The results in these patients, therefore, was unknown. Because of this, elaborate mathematical calculations had to be made to try and reach a reliable conclusion to the trial. The loss of patients before the end of the trial is a very serious practical difficulty which besets all long-term clinical trials.

Clinical Trials as Topic↗
PubMed1975

A clinical trial designed to discover if the primary treatment of varicose veins should be by Fegan's method or by an operation.

1. The current practice of operating upon patients with varicose veins as the treatment of choice costs more than xi15 million a year. 2. The bulk of this expense is due to the length of time that patients are kept in the ward. If they were treated as outpatients, either by Fegan's method or by operation, the cost would be reduced to one-tenth of what is now spent. Even if the operation were done on a "short-stay" basis the cost would be reduced to one-third or less. 3. Although the long term results of Fegan's method are uncertain there is no doubt that it gives better immediate results than an operation. Moreover, there is no particular type of varicosity of shape of limb which precludes its use.

Bandages↗