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N J Taffinder

Publications and source records attributed to N J Taffinder.

8 recordsLinked to original sources
PubMed2004

Retrograde commercial colonic hydrotherapy.

OBJECTIVE: To ascertain the current practice of commercial colonic hydrotherapy in the UK and to collect data on the profiles of both the practitioners and their clients. In addition to understand how colonic hydrotherapy is perceived by those who use it and how much economic benefit it generates for the practitioners. Information as to training and complications was sought. PATIENTS AND METHODS: A questionnaire was sent to all 80 practitioners registered with the Association of Colonic Hydrotherapists (ACH) of the UK. The practitioners who responded were sent 10 questionnaires to be given to a group of consecutive clients. This client questionnaire included an SF-36 self-administered scoring system and a satisfaction survey. To understand the methodology and ritual of the hydrotherapy procedure a field trip was arranged and two of the authors (NJT and PJM) underwent one colonic hydrotherapy session with an experience practitioner. RESULTS: Thirty-eight (48%) of practitioners responded to our practitioner survey and 242 client questionnaires were returned. One third of practitioners reported a previous clinical background and 32 (83%) were single-handed practitioners. The average time in practice was six years and with an average age of the hydrotherapists being 50 years (22-78 years). Estimated number of sessions conducted were 3200 (range 140-10 000). Average annual income before expenses per practitioner was estimated at pound 45 675. The clients' ages ranged was 18 and 82 years of age (mean 44 years) and had undergone an average of 35 hydrotherapy treatments (range 1-2500). Clients had lower SF-36 scores than the UK norm. CONCLUSION: Colonic hydrotherapy is practised widely in the UK with an estimated 5600 procedures carried out by ACH practitioners monthly. It is not known how much activity is carried out by non-ACH members. ACH practitioners appear to be well trained and a proportion have medical backgrounds. Clients, who are often unhappy with orthodox medicine seem satisfied enough with the experience of colonic hydrotherapy to undergo regular purgings. No serious side-effects have been reported to us. Economic factors could be a driving force for the continuation of the practice as the monies earnt are not inconsiderable.

Adolescent↗
PubMed2001

Motion analysis.

BACKGROUND: The ability to make an objective evaluation of a surgeon's operative ability remains an elusive goal. In this study, we used motion analysis as a measure of dexterity in the performance of a simulated operation. METHODS: Fifteen surgeons performed a total of 45 laboratory-based laparoscopic cholecystectomies on a cadaveric porcine liver model. Subjects were assigned to one of three groups according to their level of experience in human laparoscopic cholecystectomy. Electromagnetic tracking devices were used to analyze the surgeon's hand movements as they performed the procedure. Movement data (time, distance, number of movements, and speed of movement) were then compared. RESULTS: Analysis of variance (ANOVA) movement scores across the three groups showed significantly better performance among the experienced laparoscopic surgeons than the novices. Learning curves across repetitions of procedures were plotted. Novices made more improvement than experts. CONCLUSIONS: Motion analysis provides useful data for the assessment of laparoscopic dexterity, and the porcine liver model is a valid simulation of the real procedure.

Animals↗
PubMed1999

Rigid videosigmoidoscopy vs conventional sigmoidoscopy. A randomized controlled study.

BACKGROUND: Not only is rigid sigmoidoscopy uncomfortable for patients, but visualisation of the rectosigmoid junction and sigmoid colon is successful in only 40-70% of examinations. A novel fine-bore rigid videosigmoidoscope is described and then compared with a rigid conventional sigmoidoscope for patient discomfort and length of insertion. METHOD: A total of 58 patients were examined with both sigmoidoscopes in a random order. Discomfort was scored on a visual analogue scale; length of insertion was scored by the surgeon. Patients were blinded to which sigmoidoscope was being used. The images from the video examination were transmitted in real time for a second opinion in a different hospital. RESULTS: The mean (SD) insertion distance of the videosigmoidoscope was 23.2 (5.9) cm, which was significantly further than with the conventional sigmoidosocpe 16.5 (3.8) cm (p < 0.01). The discomfort on a visual analogue score for the videosigmoidoscope was 3.0 (1.8), which was significantly less than for the conventional sigmoidoscope 5.5 (2.7) (p < 0.01). The five users of the equipment (four surgeons and one colorectal nurse practitioner) preferred the videosigmoidoscope for image quality and ease of examination. CONCLUSIONS: A thinner, longer, rigid videosigmoidoscope is a more effective means of looking at the proximal sigmoid colon. Despite being inserted further, it caused less discomfort than the conventional sigmoidoscope. High-quality video images can be recorded or transmitted for real-time teleconsultation.

Humans↗
PubMed1999

Sigmoidoscopy in a nurse-practitioner community clinic using telemedicine.

We evaluated the feasibility of remote endoscopy in a community setting. Realtime teleconsultation and telesigmoidoscopy were carried out by a nurse practitioner at a community clinic while a colorectal specialist was present at the main hospital. Rigid video-sigmoidoscopes were used and the images were transmitted via ISDN lines at 384 kbit/s. Over three months, 32 patients (mean age 35 years; 19 men and 13 women) with bleeding per rectum took part in the study. Evaluation was carried out using satisfaction questionnaires for the patients, the nurse practitioner and the clinicians. The mean grade for clarity of intraluminal views was 3.5 (1 poor, 4 excellent). Only two cases had views graded less than 3, due to the presence of excessive faecal residue. All the patients were satisfied with the teleconsultation and video-endoscopy and would return for a similar visit. User satisfaction was also high on the part of the nurse practitioner and the clinician.

Adult↗
PubMed1997

Bacterial contamination of pneumoperitoneum gas in peritonitis and controls: a prospective laparoscopic study.

There is a theoretical risk that the pneumoperitoneum gas could carry bacteria in aerosol form and spread infection throughout the peritoneal cavity during laparoscopy for infective conditions such as appendicitis. The aim of this study was to attempt to culture bacteria from the pneumoperitoneum gas during laparoscopy for potentially infected cases and a group of controls. A total of 53 consecutive laparoscopies were studied, of which 21 were potentially infected and 32 served as controls. A lavage of the operative site was positive for pathogenic bacteria in almost 30% of the potentially infected group and only 3% of the control group. The pneumoperitoneum gas was bubbled through blood culture medium at the beginning and the end of the procedure, but only one of the 106 bottles grew any bacteria, and the specimen was a likely contaminant. In conclusion, we were unable to grow any significant bacteria from any of our cases despite using a sensitive method and demonstrating pathogenic bacteria in the peritoneal lavages. The pneumoperitoneum itself is unlikely to disperse bacteria.

Case-Control Studies↗
PubMed1996

Audit of 149 consecutive carotid endarterectomies performed by a single surgeon in a district general hospital over a 12-year period.

Carotid endarterectomy has been established by two large randomised controlled trials (European Carotid Surgery Trial (ECST) and North American Symptomatic Carotid Endarterectomy Trial (NASCET)) as an important surgical procedure for the prevention of ischaemic strokes in patients presenting with transient cerebral ischaemia or non-disabling strokes attributable to severe ipsilateral carotid artery stenosis. The operation carries significant risk of death and stroke and it has been advocated by some that carotid endarterectomy should only be performed in a small number of designated regional centres in order to achieve good surgical results. It is doubtful that the regional centres alone can cope with the increasing numbers of patients requiring carotid endarterectomy and there is therefore a requirement for the procedure to be carried out by vascular surgeons in district general hospitals. It is important that surgical results are audited to ensure that comparable outcomes are achieved. We present an audit of our experience of carotid endarterectomy since 1981. A total of 149 consecutive carotid endarterectomies were performed by a single surgeon with a special interest in carotid surgery. The results are comparable to ECST with a 30-day mortality of 0% and an overall 30-day stroke rate of 5.7% (major strokes) for patients with severe, ie 70-99%, ipsilateral carotid artery stenoses. We have shown that carotid endarterectomy is an operation that can be performed safely and with good results by suitably trained surgeons in district general hospitals.

Adult↗