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Biomedical subjects

I Finlay

Publications and source records attributed to I Finlay.

At least 19 recordsLinked to original sources
PubMed2004

Improving risk disclosure during the consent process.

OBJECTIVES: To provide guidance about the risks which should be disclosed to patients and documented during the consent process. METHODS: The Delphi Consensus Technique was used to decide what constitutes mandatory risk disclosure for three index procedures. Documentation of risk on consent forms was audited and compared to these locally agreed standards. A four stage strategy for change was undertaken following which practice was reviewed. RESULTS: Mean mandatory risk documentation rose from 61.2% (95% CI: 58.1-64.4) pre-intervention, to 78.1% (95% CI: 72.6-83.6) post-intervention (ccc2; P < 0.001). CONCLUSIONS: Although we demonstrated some benefit from this simple approach, the need for pragmatic means of achieving and sustaining complete discussion and documentation of risks across all surgical interventions based on universally accepted standards remains.

Humans↗
PubMed2002

Assessing education in palliative medicine: development of a tool based on the Association for Palliative Medicine core curriculum.

The Association for Palliative Medicine (APM) of Great Britain and Ireland has developed a core curriculum for palliative medicine. To establish the appropriateness of this core curriculum as a standard against which training can be measured, we have examined how doctors from different medical, social and cultural backgrounds view its various elements. In 1998, we succeeded in tracing 304 of 390 doctors, past students of the University of Wales College of Medicine's Diploma in Palliative Medicine. Each was sent a postal questionnaire that asked them to rate the importance to their own clinical practice of each element of the APM core curriculum. Two-hundred sixty-three questionnaires were returned--a response rate of 87%. The ages ranged from 30 to 71 (mean 44) years; 56% (147) were female. Forty per cent (105) were general practitioners, and 37% (97) hospice and 23% (61) hospital-based. Eighty-three per cent (220) were from the UK, 5% (14) from the rest of Europe, 8% (21) from the Far East and 3% (8) from other countries. The majority of respondents agreed that all elements of the APM core curriculum were of 'very great' or 'great' importance to their current clinical practice. Respondents' medical, social or cultural setting had only very minor effects on their attitude to individual elements. The elements of the curriculum perceived as being of greatest importance were: communication with patients and their families, assessment, diagnosis and treatment of pain, multiprofessional team working and psychological responses to illness and bereavement. Clinicians from a wide variety of backgrounds confirm the relevance of the APM core curriculum. This justifies its adoption as the audit standard against which the quality of training and educational programmes in Palliative Medicine should be judged.

Adult↗
PubMed2002

Hepatic intra-arterial injection of 1,25-dihydroxyvitamin D3 in lipiodol: Pilot study in patients with hepatocellular carcinoma.

1,25-dihydroxycholecalciferol [1,25-(OH)2 D3] has been shown to have antiproliferative effects in a wide variety of cancer cell lines. In vivo studies, although often limited by the development of hypercalcemia, have also shown the potential usefulness of 1,25-(OH)2 D3 in inhibiting tumor growth. The potential usefulness of the drug has been hampered by the development of hypercalcemia. This pilot clinical study was designed to evaluate the preclinical results that have shown, locoregional administration of 1,25-(OH)2 D3 in lipiodol can prevent the development of hypercalcemia. Eight patients with refractory HCC were given a single intrahepatic arterial dose (50, 75 or 100 microg) of 1,25-(OH)2 D3 dissolved in 5 ml of lipiodol. Following this, for 4 weeks serum calcium, 1,25-(OH)2 D3, alpha-fetoprotein and a range of biochemical indices were monitored. While, in 3 patients the calcium levels exceeded the normal range, even at these extremely high doses, non of the patients developed grade 3 hypercalcemia. 1,25-(OH)2 D3 administration also led to transient stabilization of serum alpha-fetoprotein in these patients. The data obtained support the hypothesis that, in patients with HCC, locoregional delivery of 1,25-(OH)2 D3 in lipiodol can allow administration of supra-pharmacological doses of the drug without the development of hypercalcemia.

Aged↗
PubMed2001

1alpha,25-Dihydroxyvitamin D3 and its analogues, EB1089 and CB1093, profoundly inhibit the in vitro proliferation of the human hepatoblastoma cell line HepG2.

BACKGROUND: 1alpha,25-dihydroxyvitamin D3 (1,25[OH]2D3) has been shown to inhibit the proliferation of various cancer cells including colon, prostate, melanoma, osteosarcoma and breast cancer. METHODS: The human hepatoma cell line (HepG2) was cultured with 1,25(OH)2D3 or one of two analogues EB1089 or CB1093 for various durations. Cellular proliferation was measured by uptake of [3H]thymidine, and cell numbers were determined by trypan blue exclusion counting. RESULTS: 1,25(OH)2D3, EB1089 and CB1093 all inhibited proliferation of HepG2 by up to 90% after 5 days of treatment, compared to the untreated controls. Decreased proliferation was associated with an approximately 50% reduction in cell numbers at concentrations of up to 10(-10) mol/L after 5 days of treatment with 1,25(OH)2D3. Cell proliferation rapidly recovered in cultures treated with lower concentrations of 1,25(OH)2D3 (10(-10) and 10(-11) mol/L) when 1,25(OH)2D3 was removed from the cultures by placing cells in serum containing medium without 1,25(OH)2D3. When HepG2 cells were treated with 10(-8) mol/L 1,25(OH)2D3 for 5 weeks, there was still significant inhibition of proliferation, although at week 5 there was 66% inhibition compared to 93% at the end of week 1. CONCLUSIONS: 1,25(OH)2D3, EB1089 and CB1093 all significantly inhibit the proliferation of HepG2 hepatoblastoma cells, with EB1089 being the most potent at lower concentrations. Inhibition can be maintained for at least 4 weeks, but is reversed after removal of vitamin D3.

Antineoplastic Agents↗
PubMed2001

Pragmatic randomised trial to evaluate the use of patient held records for the continuing care of patients with cancer.

OBJECTIVE: To evaluate the use of a multidisciplinary record held by patients with cancer in the community. DESIGN: Pragmatic randomised controlled trial. SETTING: The environs of Swansea in south west Wales. PARTICIPANTS: 501 patients under the care of the Department of Oncology, Singleton Hospital, Swansea. INTERVENTION: A patient held record used by the patient and healthcare professionals. Main outcome measures-Health related quality of life (EORTC QLQ-C30) measured at entry into the study and at 6 months; patients' views at 6 months; healthcare professionals' views collected after the completion of patient follow up; NHS resource and booklet use. RESULTS: 1148 patients were eligible for the study; 501 were recruited (44%) and 344 completed the study (172 in each group). There was no significant difference between the two groups in change in quality of life or NHS resource use. The patient held record did not have an impact on communication but was significantly helpful to patients in preparing for appointments, reducing difficulties in monitoring their own progress, and helping them to feel more in control (p<0.05). Fifty three percent of patients would have preferred not to have a patient held record. There was a low level of use of the record by healthcare professionals but most of those who remembered using it indicated that they would prefer patients to have it. CONCLUSIONS: The patient held record is valued by some patients and professionals but has no significant impact on the quality of life of patients or NHS resource use. It has a positive impact on quality by helping patients feel more in control and prepare for meetings with healthcare staff. Patients who find it useful tend to be younger and have more professionals involved in their care. It is recommended that it should be made available to patients on request and used by them according to need.

Adolescent↗
PubMed2001

Death plans.

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Advance Directives↗
PubMed2001

Chronic pain.

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Chronic Disease↗
PubMed1999

Potential uses of topical opioids in palliative care--report of 6 cases.

Opioids used topically may exercise several useful clinical effects. Opioids may cause immediate local analgesia and also may work indirectly through decreasing the inflammation process. In this article we describe six patients treated with topical opioids because of cutaneous pain due to tumor infiltration. skin ulcers of malignant and non-malignant origin, severe oral mucositis, pain due to knee arthrosis and severe tenesmoid pain. In all but one case, topical morphine provided rapid relief which lasted usually for 7-8 h. The side effects of topical opioids were none or minimal. Possible mechanisms of topical analgesia are discussed.

Administration, Topical↗
PubMed1999

End-of-life care in patients dying of gynecologic cancer.

In this article, the patient is considered from the time of disease recurrence, when any treatment is of necessity only palliative, through death. Good symptom control and psychosocial support are needed from the time of diagnosis. As death approaches, specific issues about cessation of active treatment and ethical issues over emergencies become important.

Female↗
PubMed1997

The incidence of suicide in palliative care patients.

Anecdotal reports from hospices show a low incidence of suicide, yet depression is increased in cancer patients, and the likelihood of suicide is increased in depressed patients. Suicide would be expected to be more common in terminally ill patients. A postal survey was undertaken of 43 palliative care units. They were asked to report the number of suicides, parasuicides and the total number of referrals for the five-year period from 1990 to 1994. Thirty-four units replied (79%). Complete data were available from 24 (56%) units. Total referrals were 72,633 in the five-year period. Nine units (38%) had one or more suicides, with a total of 21 suicides reported. Sixteen units (67%) had one or more attempted suicides (total 37). There are implications in the study both for direct patient care, but also data collection, staff support and training.

Hospital Units↗