Biomedical subjects
Publications and source records attributed to Matt Thomas.
We describe a 74-year-old woman who presented with a history of falling from bed in association with vivid dreams and physical violence towards her spouse. A clinical diagnosis of rapid eye movement sleep behaviour disorder was made and complete resolution of her symptoms was achieved with first line treatment.
Two pilot Potential Unlimited Programmes (PUPs) were examined to determine participant outcomes related to adjustment to acquired brain injury (ABI) and to investigate the contribution of the group work component of the programme. A mixed qualitative and quantitative longitudinal design was employed with 14 participants and a demographically matched comparison group of eight respondents. Results showed significant and sustained improvement in participants' subjective quality of life. Analysis of interview data provided insights into how the programmes provided opportunities for participants to engage in key tasks of adjustment to injury. Participants who regularly attended the follow-up group stages of the programmes made significantly greater gains than non-attendees. In conclusion, the combination of outdoor experiential education with extensive group work found in the PUPs is likely to represent a unique and powerful approach for addressing many of the issues associated with the process of psychosocial adjustment to injury and restoring quality of life, following ABI.
OBJECTIVES: To report a novel method of accomplishing laparoscopic lower pole partial nephrectomy in an acute porcine model using a bipolar needle electrode without the need for renal arterial occlusion. METHODS: Six animals (12 renal units) underwent laparoscopic polar nephrectomy using the bipolar needle electrode. After complete laparoscopic mobilization of the lower pole of the kidney, the bipolar needle electrode was repeatedly inserted full-thickness into the renal parenchyma and applied transversely, creating regional ischemia to the entire lower pole without renal vascular occlusion. The specimen was then amputated using laparoscopic scissors. RESULTS: For the 12 laparoscopic partial nephrectomies, the mean operative time was 39 +/- 30 minutes, and the mean blood loss was 90 +/- 112 mL. Of the 12 cases, 10 (83%) were performed successfully with the bipolar needle electrocautery as the only source of hemostasis and without the need for ancillary hemostatic measures. Two of the procedures (17%) required temporary arterial control for hemostasis. For the successful procedures, the mean operative time was 29 +/- 4 minutes, and the mean blood loss was 48 +/- 11 mL. Histologic analysis of the specimens demonstrated coagulative necrosis between 2 and 4 mm from the line of the surgical incision. CONCLUSIONS: Bipolar needle electrocautery is a promising device that can be used to facilitate laparoscopic partial nephrectomy with minimal blood loss and without the need for renal arterial occlusion and warm ischemia. Additional studies are required to optimize the delivery parameters of this device.
RATIONALE, AIMS AND OBJECTIVES: Clinical governance has been advanced as a mechanism for continuous quality improvement within the UK National Health Service (NHS). This study aimed to assess whether evidence exists to support this claim. METHODS: A Medline search for evidence to link the introduction of clinical governance to improvements in the quality of health care was conducted. RESULTS: Of the 335 papers retrieved initially, 114 were potentially relevant to the question, but only 10 attributed changes in quality to clinical governance directly. Of these, only three attempted to provide data to support the assertion. CONCLUSION: No sound evidence currently exists to support the claim that clinical governance will increase service quality and moves towards its implementation must therefore be questioned.