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Biomedical subjects

K Forbes

Publications and source records attributed to K Forbes.

At least 19 recordsLinked to original sources
PubMed1999

So where are we?

Explore the source record for details and available documents.

Attitude to Health↗
PubMed1998

The use of power Doppler ultrasound in the diagnosis of isolated deep venous thrombosis of the calf.

While ultrasound has been well accepted as an accurate test for the diagnosis of both femoral and popliteal deep venous thrombosis (DVT), its role in the detection of calf DVT has been less clear. There have been variable results between studies in the accuracy of colour Doppler or compression sonographic techniques in demonstrating calf DVT. Many of these studies have suffered from high rates of technically inadequate examinations. Power Doppler (colour Doppler energy) has a higher sensitivity than conventional colour Doppler. It should therefore allow the detection of slow venous flow in patent vessels, that may not be demonstrated by conventional colour Doppler. This should decrease the number of technically inadequate examinations as well as decreasing the false-positive rate of the test. A prospective blinded reader study was undertaken comparing power Doppler to the gold standard venography, in the diagnosis of isolated calf deep venous thrombosis (DVT). Both examinations were successfully performed in 50 patients, in whom proximal DVT had been excluded by compression ultrasonography. Fifteen patients had positive evidence of an isolated calf DVT on the gold standard technique, venography. Power Doppler demonstrated a sensitivity of 100%, a specificity of 79%, a positive predictive value of 71% and a negative predictive value of 100%, in detecting an isolated calf DVT. There were no technically inadequate ultrasound examinations. Where venous flow is demonstrated, power Doppler is a highly accurate test in excluding a calf DVT. The specificity of the test, however, is limited, as the absence of flow does not always signify a DVT.

Humans↗
PubMed1998

Esophageal stents may interfere with the swallowing reflex: an illustrative case history.

Dysphagia is an important and distressing symptom which has a significant impact on the quality of life of patients with carcinoma of the esophagus. Although endoscopic palliation of dysphagia due to unresectable or recurrent esophageal carcinoma can be provided by esophageal dilatation and intubation, laser ablation, injection of alcohol or sclerosants, or brachytherapy, these techniques are often unsuitable for the palliation of high esophageal tumors. We present a patient with recurrent carcinoma of the proximal esophagus who developed an inability to swallow as a complication of intubation with an esophageal stent. The dysphagia improved dramatically after the stent was removed.

Aged↗
PubMed1998

Voice changes in women treated for endometriosis and related conditions: the need for comprehensive vocal assessment.

Hormonal treatments which have an androgenic effect have the potential to cause vocal changes. The changes in vocal fold structure and voice quality are considered to be irreversible. To date, studies have documented subjective vocal changes or documented single cases without detailed, baseline voice assessments. The impact on laryngeal function of women taking these androgenic treatments requires further detailed, objective assessment. The need for increased awareness of the actions of androgenic hormones on womens' voices, and the benefits of a thorough voice assessment are discussed.

Danazol↗
PubMed1997

Palliative care in patients with cancer of the head and neck.

Palliative care is the active total care of patients whose disease is not responsive to curative treatment. Patients with end-stage head and neck cancer have particular problems because of the impact of the tumour on the airway, the upper gastrointestinal tract and the major senses. Patients referred for palliative care were identified from the hospice database and the nature, incidence and management of their problems, and the role of the hospice in their care, was reviewed from in-patient and home care notes and patient-generated problem lists. Thirty-two male and six female patients with a median age of 64 years were identified. Locoregional recurrence was present in 79% of patients. Pain, weight loss, feeding difficulties, dysphagia, respiratory symptoms, xerostomia, oral thrush and communication difficulties were the major problems. The management of each, and of the terminal events encountered in the group, is discussed.

Adult↗
PubMed1997

Opioid responsiveness.

Cancer pain generally responds in a predictable way to analgesic drugs and drug therapy is the mainstay of treatment. A small proportion of patients, of the order of 20%, have pain that does not respond well to conventional analgesic management. Because opioid analgesics are the most important part of this pharmacological approach, a terminology has developed which centres around whether or not pain will respond to opioid analgesics. The terms opioid-responsive-pain and opioid-non-responsive pain, or opioid-resistant-pain, have been used to differentiate between patients whose pain falls into these two broad groups. This terminology is not satisfactory because it implies an all or none phenomenon, that is that pain either does or does not respond to opioid analgesics. Rarely is there such a clear distinction in practice. This is because the end point when titrating dose against pain with strong opioid analgesics is not simply pain relief or lack of relief: adverse effects may limit dose titration. It is preferable to describe patients with pain which is relatively less sensitive to opioids and/or patients where there is an inbalance between analgesia and unwanted effects as having "opioid-poorly-responsive pain". A pragmatic definition of opioid-poorly-responsive pain is pain that is inadequately relieved by opioid analgesics given in a dose that causes intolerable side effects despite routine measures to control them. Included in this definition is so called paradoxical pain which is not a distinct entity. Neuropathic pain is the most common form of opioid-poorly-responsive pain. The underlying pathophysiology remains unclear but abnormal metabolism of morphine is not the cause of a poor response to this drug. Patients with opioid-poorly-responsive-pain should be considered for treatment with the same opioid by an alternative (spinal) route or with an alternative opioid agonist administered by the same route (whether oral or parenteral), in conjunction with adjuvant analgesics such as tricyclic antidepressants. The most commonly used alternative oral opioids are phenazocine and methadone; transdermal fentanyl is an additional option.

Analgesics, Opioid↗
PubMed1997

Development of a microcomputer-based system to monitor healing from injury.

It is well documented that induction of electric current in bone not only prevents the bone loss of functional disuse, but also induces new bone formation. Moreover, the literature suggests that the skeletal response is optimal at a distinct frequency range 10-30 Hz. Indeed, even at peak strains, well below those typical of habitual physiological loading, applications of 30 Hz were shown to be osteogenic. This evidence supports the concept that inducing even very low strains may generate an effective osteogenic stimulus, provided that they are induced at optimal frequency (10 to 30 Hz). Bone appears to respond with greater selectivity and sensitivity to this frequency range of electrical stimulation. Inducing insulin-like growth factors, which are negatively charged, will provide the required electrical stimulus. Traditionally, the progression of the cellular events during trauma is normally followed by x-ray to determine a healing rate. Frequent use of this method can result in serious side effects to the vital and reproductive organs. The objective of this study is to develop a microcomputer-based system to monitor the cellular events associated with healing. The system is capable of transmitting an electrical signal directly to the site of injury to improve the healing process and to monitor the progress of osteogenesis. The system consists of a base unit and implanted units. One implanted unit will be inserted in the femur with induced trauma and the other implant will be in the control femur. The base unit will transmit low frequency electromagnetic waves to the implanted units as well as receive periodic information about the ion movement in both femurs.

Biosensing Techniques↗
PubMed1996

Sharing antenatal care: client satisfaction and use of the 'patient-held record'.

Two hundred women (148 shared care patients and 52 clinic patients) completed a questionnaire about care received during pregnancy and the use of a patient-held record. Women receiving shared care reported higher levels of satisfaction with their care than clinic patients (p < 0.0001). Thirty-six percent of the women in shared care forgot to take their record to an appointment on at least 1 occasion. During the pregnancy, over half of the respondents in both groups made contact with the hospital for reasons other than for their regular visit. For both groups, convenience was the most frequently reported reason for choosing their model of care. Other important issues for shared care patients were that the service was more personal and more information was provided. Among clinic patients, safety and quality of care were identified as important. Problems involved with the patient holding the only complete pregnancy record are discussed.

Family Practice↗