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Biomedical subjects

M Callaway

Publications and source records attributed to M Callaway.

12 recordsLinked to original sources
PubMed2005

Fast-track barium enema: meeting the two-week wait rule for patients with suspected colorectal cancer.

OBJECTIVES: To meet the introduction of the two-week wait (TWW) rule for patients with suspected colorectal cancer, a fast-track barium enema (FTBE) service was set up. This study was conducted to evaluate the success of this approach in preparation for meeting the forthcoming targets on waiting times to treatment from referral and diagnosis. METHODS: All patients were offered a double-contrast barium enema within two-weeks, except those with a palpable rectal mass. FTBE were double-reported by specialist gastrointestinal radiologists. Patients with a suspected malignancy were booked for an urgent staging CT and outpatient appointment, whilst the remaining patients were referred back to their general practitioner with a report. Prospective data were collected and two 16-month periods analysed. RESULTS: Three hundred and nine patients had a FTBE over the first 16-month period and 277 (89.6%) were seen within two-weeks. Mean times from initial referral to staging CT and first outpatient appointment were 30.7 and 36.0 days, respectively. Cancer was confirmed histologically in 32 (10.4%) patients. Of 267 patients without a malignancy, 46 (17.2%) were referred back to the colorectal outpatient or endoscopy service within 6-months. The number of referrals increased with time from a mean of 19.3 per month in the first period to 27.8 in the second, but the percentage with a suspected malignancy remained similar at 13.6% and 10.1%, respectively. CONCLUSION: FTBE diagnosed malignancy accurately and facilitated rapid staging. The TWW target was met in almost 90% of patients, whilst the impact on the colorectal outpatient and endoscopy service was minimized.

Aged↗
PubMed2005

Pulmonary staging in colorectal cancer--is computerised tomography the answer?

INTRODUCTION: Pulmonary staging in colorectal cancer (CRC) has traditionally been carried out by means of plain chest radiograph (CXR), although computerised tomography (CT) imaging of the chest is increasingly being performed for this purpose. The aim of this study was to assess the value of pre-operative thoracic CT for pulmonary staging in CRC. PATIENTS AND METHODS: Data were collected prospectively on all patients referred into hospital over a 20-month study period for double contrast barium enema evaluation of symptoms suggestive of an underlying CRC. Patients with a CRC went on to have a staging intravenous, contrast-enhanced CT of the chest, abdomen and pelvis prior to an out-patient appointment with a colorectal surgeon. The CXRs of those patients in whom a radiological abnormality was seen on thoracic CT were reviewed blindly by an independent consultant radiologist. RESULTS: A total of 403 barium enemas were performed, of which 38 demonstrated a CRC (9%). In those patients diagnosed with CRC, nine (24%) had an abnormality on thoracic CT. Four patients with positive thoracic CTs had chemotherapy and or radiotherapy with no surgery. One patient underwent colectomy, and 2 patients who had primary lung tumours as opposed to metastases also underwent colectomies. One patient received palliative care only. In addition, one of the patients underwent multiple, non-diagnostic thoracic investigations prior to a diagnosis of sarcoidosis being made and then proceeding to surgery. An independent consultant radiologist reviewed seven out of the nine CXRs of patients with an abnormality on thoracic CT without knowledge of the clinical diagnosis, and reported three of the CXRs to be normal. CONCLUSIONS: Thoracic CT appears to improve the accuracy of pulmonary staging in CRC allowing a more appropriate level of intervention. However, CT is likely to identify more benign radiological abnormalities than CXR alone, and investigations should not occur to the detriment of treating the primary tumour.

Aged↗
PubMed2003

Comparison of ultrasound and manometric sphincter length and incontinence scores.

PURPOSE: Fecal incontinence can be assessed by a wide variety of means that vary in their clinical relevance. This study assesses the correlation between two methods of recording sphincter length and incontinence scores. METHODS: A retrospective review of results from 1999 to 2001 of 137 patients with fecal incontinence was undertaken on patients who had both ultrasound and manometric assessment. Incontinence scores, ultrasonic sphincter length, and manometrically derived sphincter length were recorded. The data were analyzed using the Spearman rank correlation coefficient (r(s)) for nonparametric data. RESULTS: There was negative correlation between incontinence scores and manometric sphincter length (r(s) = -0.27; P = 0.002) but not with ultrasonic length (r(s) = -0.08; P = 0.38). There was correlation between manometric and ultrasonic lengths (r(s) = 0.21; P = 0.02). In males, all three correlated but none of the values were significant (n = 12). Internal and external sphincter defects had no effect on correlation coefficients. CONCLUSION: Given that all measurements include a degree of subjectivity, manometry more closely correlates with the fecal incontinence scores than ultrasound measurements. There seems to be little benefit in measuring the sphincter length with ultrasound. Manometric sphincter length measurement seems to have a role in assessing patients with fecal incontinence.

Anal Canal↗
PubMed2001

Low molecular weight heparin and the risk of haemorrhage following percutaneous biopsy, despite a normal standard clotting screen.

There has been an increase of the use of low molecular weight heparin in the treatment of thrombotic events. This case report describes a complication of a pelvic mass biopsy performed whilst the patient was being treated with low molecular weight heparin (LMWH). Despite an uncomplicated biopsy procedure and confirmation of normal clotting screen, INR (International normalised ratio), APTR (Activated partial thromboplastin ratio) and platelet levels, the biopsy was complicated by severe haemorrhage.

Aged↗
PubMed2000

Oesophageal perforation following perioperative transoesophageal echocardiography.

Transoesophageal echocardiography (TOE) is being used more often by cardiothoracic anaesthetists for the perioperative management of cardiac problems. Reports of iatrogenic oesophageal perforation by instrumentation of the oesophagus are increasing. Although TOE is considered safe, it may be more risky during surgery, because the probe is passed and manipulated in an anaesthetized patient. It may be in place for several hours so the risk of mucosal pressure and thermal damage is increased. Patients on cardiopulmonary bypass are also fully anticoagulated. We describe a case of oesophageal perforation following insertion of the TOE probe in a patient with gross cardiomegaly. Oesophageal distortion by cardiac enlargement may increase the risk of oesophageal perforation. Difficulty in passage of the TOE probe should be regarded with suspicion and withdrawal should be contemplated because the symptoms of oesophageal perforation are often delayed and non-specific. Delay in investigation, diagnosis and treatment will increase morbidity and mortality.

Anesthesia↗
PubMed1998

The relationship between preceptor expectations and student performance on 2 pediatric objective structured clinical examination stations.

BACKGROUND: We designed 2 pediatric objective structured clinical examination stations, 1 anemia case associated with lead exposure and 1 failure-to-gain-weight case associated with extended breast-feeding, to evaluate third-year medical students who had studied in pediatric community preceptors' offices as part of a 12-week multidisciplinary ambulatory clerkship rotation. OBJECTIVE: To examine the relationship between preceptor expectations and student performance on these 2 objective structured clinical examination stations. METHODS: To elicit community preceptors' expectations of student performance, we constructed a 46-item survey replicating checklists filled out by simulated patients evaluating student performance on the objective structured clinical examination stations. The percentage agreement among preceptors for each checklist item as well as the percentage agreement between preceptor responses and student responses on each checklist item were calculated. A summary score of preceptor responses across all checklist items and a summary score for student responses across all checklist items on each station were calculated. The correlation coefficients between preceptor and student summary scores were then examined. RESULTS: Fifty-nine preceptor surveys were mailed and 38 were returned (64% response rate). Data were usable from 37 surveys. Eighty-nine percent (33 of 37)of the preceptors agreed that a third-year clerkship student should have the knowledge to care for the patient with anemia and 92% (34 of 37)of the preceptors agreed similarly for the growth-delay case. Agreement among preceptors on individual checklist items varied widely for both cases. Fifty-seven students studied at the anemia station and 34 students studied at the growth-delay station. The mean+/-SD agreement across the 26 items on the anemia case between preceptor responses and student responses was 62%+/-23% and, for the 21 items on the growth-delay case, 60%+/-17%. The mean+/-SD preceptor summary score for the anemia case was 17.4+/-3.8 (maximum, 26) and 16.0+/-3.6 (maximum, 21) for the growth-delay case. The mean student score on the anemia case was 15.5+/-3.7 (maximum, 26) and, for the growth-delay case, 10.0+/-4.5 (maximum, 21). The Pearson correlation coefficient between the preceptor and student scores on the anemia case was 0.19 (P=.15), and for the growth-delay case,-0.41 (P=.06). CONCLUSIONS: These data suggest community preceptors agree on topic areas in which students should be clinically competent. There was, however, considerable variation in agreement among preceptors about what preceptors believe students should be able to do and how the students actually perform. The overall percentage agreement between preceptor expectations and student performance appears to be no better than chance.

Attitude of Health Personnel↗
PubMed1998

Left ventricular volume reduction for end-stage heart failure: intrapapillary or extrapapillary resection, mitral valve repair or replacement?

We report on two patients with end-stage dilated cardiomyopathy and functional mitral valve insufficiency who underwent left ventricular volume reduction. Intrapapillary resection and correction of the mitral valve regurgitation produced inadequate reduction of the ventricular cavity and resulted in inability to wean the patients from cardiopulmonary bypass. Following extension of the resection to include the papillary muscles and mitral valve replacement, there was a significant improvement in cardiac function. Both patients survived surgery; subsequent echocardiography provided evidence of improved myocardial function and NYHA functional class.

Aged↗
PubMed1995

Human sleep-wake cycles in the high Arctic: effects of unusual photoperiodicity in a natural setting.

Studies of human circadian rhythms are typically conducted in artificial environments that are low in ecological validity. In the current study, six subjects and the field director lived in temporal isolation in a completely natural environment with constant daylight (a high Arctic research camp) for six weeks. Detailed daily sleep logs were kept. In keeping with past findings, five of the six subjects developed a free-running sleep-wake cycle longer than 24 hours. Unlike past results, the isolated subjects did not exhibit any synchronicity in their rhythins. There was a high degree of intersubject variability in circadian patterns. The findings have important implications for the comparison of the results of laboratory and field investigations of sleep-wake cycles.

Adult↗
PubMed1995

Residents' assessment of a community-based alcohol initiative in the Canadian Arctic.

This paper evaluated a community-based initiative to control alcohol abuse in the Canadian Arctic by identifying, from an Inuit perspective, what components have been successful in the reduction of alcohol abuse and what components require improvement. Data were collected through interviews with community leaders, supplemented by a broadly-based survey. The most successful strategy in the reduction of alcohol abuse was the imposition of restrictions on the availability of alcohol. Counselling services did to some extent heighten community awareness about the deleterious effects of alcohol misuse, but have had marginal impact on the reduction of abuse. Residents and community leaders involved in running the alcohol program believe that a combination of the establishment of self-help groups, further counsellor training, increased community support, and improved outreach strategies would provide a greater impetus for change leading to the reduction of alcohol abuse within the community.

Adolescent↗
PubMedDate not supplied

Left ventricular volume reduction: new dawn or false horizon? Basic science and clinical doubts.

Left ventricular volume reduction surgery (LVVR) for end-stage dilated cardiomyopathy is a surgical option used selectively but with unclear long-term results. Increasing numbers of reports are appearing in the literature. These should be pooled into an international registry through collaborative efforts that allow for more effective analysis. Furthermore, high priority must be given to identify subgroups of patients who will potentially gain most benefit from LVVR. Basic science may add invaluable data and in this article we describe how intraoperative myocardial biopsies from patients with idiopathic dilated cardiomyopathy were utilized to isolate myocytes in an effort to determine differential physiological characteristics at the cellular level. The result showed various degrees of contractile anomalies in response to electrical stimulation associated with defective calcium handling as reflected by measurements of calcium transients. It is hoped that this approach may be extended to preoperative catheter biopsy to gain information that will facilitate patient selection to avoid unnecessary surgical failures.

Aged↗