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Biomedical subjects

C du Boulay

Publications and source records attributed to C du Boulay.

12 recordsLinked to original sources
PubMed2006

Will Rogers revisited: prospective observational study of survival of 3592 patients with colorectal cancer according to number of nodes examined by pathologists.

To investigate the relationship between survival in colorectal cancer patients and the number of lymph nodes examined by a pathologist, previously attributed to stage migration, we used data from a cohort of 5174 colorectal cancer patients recruited between September 1991 and August 1994, and followed-up for 5 years. We selected cases with data present on all prognostic variables, and stratified them into three groups by number of nodes examined. We made a multivariate survival comparison using a Cox regression model. In all, there were 3592 cases with data present on all prognostic variables. Patients who had >10 nodes identified had a significant survival advantage over those who had 5-10 identified, who had in turn a similar advantage over those with 0-4 identified (P<0.001). This effect was present in the whole group and at all Dukes' stages, although statistically significant only in stages B (P=0.004) and C (P=0.019). The effect remained after adjustment in a Cox regression model in which the mean number of nodes taken out by each surgical firm did not predict survival. In a sub-group with data on lymphocytic infiltration into the primary tumour a survival advantage was noted in those with prominent rather than mild infiltration (P<0.001): the former also tended to have more nodes found (P=0.015). Stage migration alone cannot explain these results, as survival advantages are noted across the whole population independent of stage. Lymphocytic infiltration into the primary tumour is prognostically important, and is associated with the number of nodes found. Reactive enlargement of lymph nodes in the mesentery may make them easier to find, reflect immune response to the tumour, and thus indirectly impact upon survival.

Adenocarcinoma↗
PubMed1999

The clinical skills resource: a review of current practice.

This review is based on the findings of the Southampton Clinical Skills Project, which was a needs assessment and feasibility study to consider the development of a multiprofessional Clinical Skills Resource at Southampton. The project spanned a period of 18 months and used a range of methods of data collection, including visits to 12 clinical skills facilities in the UK. Most existing clinical skills centres have developed in response to changing healthcare policy, curricular initiatives and increasing emphasis on the quality of assessments and competencies. There is also increasing recognition that clinicians are no longer able to teach effectively all skills to students in the traditional ways, and that clinical skills training and assessment, particularly for undergraduates, is an area of deficiency. The potential scope of clinical skills centres is broad and encompasses not only clinical and communication skills but medical informatics, computer assisted learning, multiprofessional learning and assessment. Skills centres can also promote self directed and lifelong learning methods. The planning of skills centres involves a variety of stakeholders and users, including undergraduates, postgraduates, acute and community Trusts, Postgraduate Deans and medical schools. A successful skills centre needs to be flexible in its design, integral to the curriculum and relevant to educational and training requirements. This requires planning, organization and resources. Different organizational models can be used, depending on local factors. The management of skills centres involves consideration of issues such as security, safety, supervision of learners and staff development, informed by a network of experts and everyday users. The development of skills centres should include ongoing educational evaluation of outcomes and educational research. The use of a clinical skills centre has potential benefits for staff and students, including the provision of a safe environment in which to learn and practise skills before using them in the real clinical setting. This can reduce anxiety in students and protect patients from novice practice. Clinical skills centres provide a setting for structured learning with feedback as well as assessment of competence. The limitations of a skills centre are that it can only provide simulated experiences which are an adjunct to, but can never replace real clinical experience.

Clinical Competence↗
PubMed1997

Continuing medical education for pathologists: an evaluation of the Royal College of Pathologists' Wessex pilot scheme.

AIM: To discover the attitudes to continuing medical education (CME) of the Wessex pathologists who participated in the Wessex CME pilot scheme and to identify their preferences and difficulties in pursuing CME activities. METHOD: The views of pathologists in the scheme were collected during a period of one year using workshops and discussions. A confidential, anonymous postal questionnaire based on these issues was sent to the 103 pathologists in Wessex who participated in the pilot scheme. RESULTS: A 64% response rate was obtained. The respondents identified lack of time and funded study leave as major barriers to CME and highlighted the gap between CME activity and its recognition and funding by employers. They wanted a wide variety of locally based CME activities to be recognised, and they valued local activities that linked theory with practice. They believed that the college scheme tended to favour academic activities over more practical and locally based ones. They found the paired peer review process time consuming but valuable for identifying their learning needs in some cases, but demonstrated that they have mixed preferences about the way they do their CME. CONCLUSIONS: The Wessex pathologists believe that CME is important and have positive attitudes to it. Their attitudes to CME echo the current literature about what makes CME effective. Unless individuals' preferences and difficulties are taken into account, CME programmes in which they participate are not likely to succeed.

Attitude↗
PubMed1996

Hereditary desmoid disease due to a frameshift mutation at codon 1924 of the APC gene.

Desmoid tumors are slowly growing fibrous tumors highly resistant to therapy and often fatal. Here, we report hereditary desmoid disease (HDD), a novel autosomal dominant trait with 100% penetrance affecting a three-generation kindred. Desmoid tumors are usually a complication of familial adenomatous polyposis, a predisposition to the early development of premalignant adenomatous polyps in the colorectum due to chain-terminating mutations of the APC gene. In general, one or more members in approximately 10% of the FAP families manifest desmoid tumors. Affected individuals from the HDD kindred are characterized by multifocal fibromatosis of the paraspinal muscles, breast, occiput, arms, lower ribs, abdominal wall, and mesentery. Osteomas, epidermal cysts, and other congenital features were also observed. We show that HDD segregates with an unusual germ-line chain-terminating mutation at the 3' end of the APC gene (codon 1924) with somatic loss of the wild-type allele leading to tumor development.

Adolescent↗
PubMed1993

A clinicopathological survey of gallstones in the autopsy population.

This prospective study looked at the autopsy prevalence of gallstones and their relationship with symptoms and gallbladder pathology. Fifty consecutive autopsies were selected. The gallbladder was examined macroscopically and microscopically and gallstones were examined, cut and classified. Four females at autopsy had had previous cholecystectomies. Thirty three percent of patients had gallstones at post-mortem with a male to female ratio of 1:1.24. Histological features of the gallbladders were: normal 39.1%, cholecystitis 37.0%, hypertrophy 8.7% and fibrosis 15.2%. Increasing age was significantly associated with increasing common bile duct (CBD) circumference. Muscle hypertrophy and fibrosis may represent part of a spectrum of "burnt out" gallbladder disease. Fifteen percent of autopsy patients had calcular cholecystitis but were asymptomatic and the reason for this is unclear.

Adult↗
PubMed1986

Induction of hypoxia in normal and malignant tissues by changing the oxygen affinity of hemoglobin--implications for therapy.

The drug BW12C, which increases the oxygen affinity of hemoglobin, reduces oxygen availability to tissues. This results in protection against radiation damage to the hemopoietic system and epidermal Langerhans cells in CBA mice. The drug also protects against beta-irradiation damage in pig epidermis. BW12C increases the hypoxic cell fraction in tumors and histological examination of an experimental T cell lymphoma shows that the induced hypoxia leads to tumor necrosis.

Aldehydes↗
PubMed1986

Relationship between disease activity indices and colonoscopic findings in patients with colonic inflammatory bowel disease.

The Crohn's disease activity index, a similar index devised for patients with ulcerative colitis, and other commonly used laboratory indicators of disease activity have been studied in 50 patients with colonic inflammatory bowel disease undergoing routine colonoscopic assessment and compared with the histological extent and activity of disease. There was only poor correlation between the colonoscopic or histological findings and the indices of disease activity studied, showing that these are not reliable measures of disease activity or extent at the tissue level.

Blood Sedimentation↗