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Biomedical subjects

I G Finlay

Publications and source records attributed to I G Finlay.

At least 73 records · Page 4Linked to original sources
PubMed1996

Biliary dyskinesia in idiopathic slow-transit constipation.

BACKGROUND: Idiopathic slow-transit constipation may be a pangastrointestinal motility disorder. We have screened patients referred to surgery for constipation for the presence of biliary dyskinesia. METHOD: Patients had cholecystokinin-augmented trimethyl-3-bromo iminodiacetic acid scans to measure gallbladder ejection fraction. RESULTS: There is a significant difference in gallbladder ejection fraction between patients with idiopathic slow-transit constipation (median value, 28.5) compared with patients with other causes of constipation (median value, 71; Mann-Whitney, P = 0.0025). CONCLUSION: Idiopathic slow-transit constipation may be a pangastrointestinal motility disorder.

Adult↗
PubMed1996

The effect of topical 0.75% metronidazole gel on malodorous cutaneous ulcers.

The unpleasant smell of infected fungating tumors and benign cutaneous ulcers is a distressing clinical problem, known to be associated with anaerobic infection. Topical metronidazole 0.8% gel has been shown to decrease smell from fungating malodorous tumors. This study was conducted to assess prospectively the subjective and bacteriological response to 0.75% metronidazole gel to decrease smell from these lesions and to assess whether bacterial contamination of the tubes of gel occurs during use. Forty-seven patients with benign or malignant cutaneous lesions associated with a foul smell were assessed for smell, pain, appearance, and bacteriological profile before entry and at 7 and 14 days. Forty-one (95%) of the 43 patients assessed at 14 days reported decreased smell. Anaerobic infection was initially found in 25 (53%) of patients and was eliminated in 21 (84%) of these. At review after 7 days, patients reported less pain from the lesions. Discharge and associated cellulitis were also observed to decrease significantly.

Administration, Topical↗
PubMed1996

Hypnotherapy in palliative care.

Complementary therapies have found increasing vogue in the management of patients with cancer, although little formal evaluation has been undertaken. We report on our experience of offering hynotherapy to palliative care outpatients in a hospice day care setting. During 2 1/2 years, 256 patients had hypnotherapy, all singly; two-thirds (n = 104) were women. Only 13% (n = 21) had four or more treatment sessions. At the time of survey, the 52 patients still alive were mailed an evaluation sheet, of whom 41 responded. 61% reported improved coping with their illness. 7% (n = 3) reported harmful or negative effects from hypnotherapy. Amongst those whose coping was unchanged, many found the therapy a pleasant experience. 35 respondents (85%) appended positive comments to their questionnaire returns. Despite the limitations of a retrospective questionnaire, our findings suggest that hypnotherapy, used within strict guidelines in patients with advanced cancer, is a safe complementary therapy to enhance coping.

Adult↗
PubMed1995

Setons in the surgical management of fistula in ano.

Seton techniques have been used in the successful management of fistula in ano for thousands of years. In particular, the cutting seton is useful for complex high anal fistula, and drainage setons may have a significant role in the treatment of sepsis related to Crohn's disease and in immunocompromised patients.

Drainage↗
PubMed1995

The assessment of communication skills in palliative medicine: a comparison of the scores of examiners and simulated patients.

The Diploma in Palliative Medicine was established in 1991 and included communication skills as a major part of the curriculum. In order to assess the efficacy of doctors' communication skills in the Diploma examination, an assessment tool was developed based on the modified Prevara Score. Simulated (actor) patients are used for the consultation in the examination; the doctors' performance is assessed independently by the examiner and by the actor. This provides an opportunity to consider the methods used for describing agreement between raters. There was high correlation between examiners' and actors' scores and high acceptability of the scoring method. However, satisfactory agreement in terms of the mean differences between scores and their standard deviation between examiners' and actors' scores was not achieved. We have found the simulated patient interview to be a useful teaching and assessment tool. The good correlation between the observer's (examiner) and the recipient's (actor-patient) perception of the doctor's interviewing skills provides evidence of the validity of the assessment. However the actor-patients' ratings tended to be higher and the two groups of assessors could not be used interchangeably. We conclude that actor-patients are of value in teaching and in assessing the communication skills of doctors but produce different scores to clinical examiners.

Clinical Competence↗
PubMed1994

Quality of life assessment in palliative care.

Palliative care aims to improve the quality of life of patients through attention to physical, psychological, social and spiritual distress. Assessment of quality of life, expressed as a global score, is difficult because patients are too ill for long interviews, but relatives and professionals are poor proxy respondents for patients. Quality of life assessment tools must be multidimensional, considering both physical and psychosocial issues, must be quick and easy to administer and score and must be sufficiently sensitive to detect changes with time. Quality of life assessment has audit and routine clinical uses; it is an essential consideration in any research involving the patient with advanced cancer. The different types of questionnaire assessment tool are discussed in detail.

Humans↗
PubMed1994

Portfolio learning: a proposal for undergraduate cancer teaching.

This paper describes a randomized study to evaluate a longitudinal approach to undergraduate education using cancer patients and cancer medicine as a model. Medical students were randomized to the study or control group. Those in the study were allocated to tutors (general practitioners or consultants) in groups of three. Each student was allocated three consenting patients with cancer to follow longitudinally. They compiled a portfolio to record events, interactions, relevant articles, etc. based around the patients' case histories. The students received tutorials to provide direction, discussion and support bimonthly during the course. Evaluation was by central review of the portfolios, appraisal in the clinical competence examination and hidden questions in the standard MCQ examinations. The aim was to provide the learner with a personal experience of cancer patients at all stages of the disease, an understanding of the natural history of cancer and an insight into the impact of the disease and its treatment on the patient and family. The study evaluates whether these aims were achieved to a greater extent in those students receiving the portfolio teaching compared with a control group receiving the standard curriculum teaching only.

Curriculum↗
PubMed1993

Relationship between intra-abdominal and intrarectal pressure in the proctometrogram.

During normal defaecation the intrarectal pressure increases but, in the absence of a reference catheter in the pelvis, the contribution of abdominal straining and rectal contraction to this rise is unclear. Anorectal manometry was performed in ten consecutive women with no gastrointestinal symptoms in an attempt to measure intrapelvic pressure using a catheter in the bladder. During filling the mean (s.e.m.) rectal pressure increased from 2(1) to 18(4) cmH2O. The mean(s.e.m.) intravesical pressure remained unchanged at 2(1) cmH2O. Evacuation of the rectal balloon produced an increase in mean (s.e.m.) intrarectal pressure from 18(4) (end-filling pressure) to 68(15) cmH2O. The mean (s.e.m.) intravesical pressure increased from 2(1) to 51(18) cmH2O. The true intrarectal pressure (intrarectal minus intravesical) did not rise during defaecation. The rise in intrarectal pressure during rectal evacuation occurs by increased intrapelvic pressure alone.

Abdominal Muscles↗
PubMed1993

Idiopathic slow-transit constipation.

Until recently, the surgical management of idiopathic slow-transit constipation had remained unchanged since the condition was first described by Arbuthnot Lane in 1908. Although colectomy and ileorectal anastomosis is a successful treatment for the majority of patients, symptoms persist or are worse in some cases following such surgery. The previously inaccessible colon is now an area of interest in both health and disease; recent observations on aetiology, clinical investigation, neuropathology and surgical outcome lead us to question the rationale of colectomy for all patients with severe constipation.

Anastomosis, Surgical↗
PubMed1993

Perineal herniation.

In a retrospective study of 800 evacuating proctograms, 37 patients were found to have a varying degree of perineal herniation. The radiological and surgical correlation of this interesting abnormality was discussed.

Adolescent↗
PubMed1992

Manual dilatation of the anus.

A group of 100 consecutive patients undergoing manual dilatation of the anus between 1980 and 1983 were reviewed retrospectively by examining the clinical presentation, diagnosis, treatment and outcome. Anal fissure was diagnosed in 46 patients, 22 had either first- or second-degree haemorrhoids, and stenosis of the anal canal was identified in seven. Manual dilatation of the anus was performed on 25 patients in the absence of a diagnosis. Dilatation failed to treat 26 anal fissures successfully. Where it was employed alone in ten cases of haemorrhoids and seven of anal stenosis, manual dilatation failed to cure seven and five patients respectively. Of the patients with no diagnosis, 23 were relieved of their symptoms following dilatation. Episodes of incontinence occurred in 27 patients, 21 of whom were female. There should be a reduced role for manual anal dilatation in the treatment of common anorectal disorders.

Adolescent↗