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Biomedical subjects

R C Feneley

Publications and source records attributed to R C Feneley.

At least 19 recordsLinked to original sources
PubMed2000

Early observations of the effect of extracorporeal shockwave lithotripsy on blood pressure: a prospective randomized control clinical trial.

OBJECTIVE: To determine, in a randomized controlled clinical trial, the effect of extracorporeal shock wave lithotripsy (ESWL) on blood pressure. PATIENTS AND METHODS: The trial included 228 patients with small (< 15 mm) asymptomatic calyceal stones who were randomised to undergo ESWL (113 patients) or to an untreated (observed) control group (115 patients). Blood pressure was recorded at randomization using a standardized protocol. Patients undergoing ESWL received a mean (SD) of 5281 (3462) shocks over a mean of 1.75 sessions on one of two lithotripters. Patients were then followed annually, assessing blood pressure and changes in medication. Data were analysed on an intention-to-treat basis. RESULTS: At randomization, 43% of patients in the control group and 53% in the ESWL group were hypertensive. Of the 228 randomized, 200 patients completed at least one annual follow-up, of whom 192 (93 in the control and 99 in the ESWL group) had their blood pressure recorded. The mean follow-up was 2.2 years; 35 (37%) patients in the control and 46 (46%) in the ESWL group were hypertensive (P = 0.19). Seven (7%) patients in the control group and 11 (11%) in the ESWL group were newly diagnosed to be hypertensive (P = 0.35). CONCLUSIONS: In this randomized controlled clinical trial there was no evidence that ESWL causes changes in blood pressure.

Aged↗
PubMed1999

Funding clinical research: the need for information and longer term strategies.

The Chief Medical Officer's Working Group on Specialist Medical Training recommended that training in research methodology should be a recognised component of all postgraduate training programmes and that further consideration be given by those responsible for postgraduate education, training and research to establishing how this might be achieved. Funding of the trainee in research is a crucial aspect of this directive, yet both trainers and trainees have described this as haphazard, invariably reliant on 'soft' money. The subject has raised wide discussion and debate. A questionnaire was sent to 205 consultant urologists in the UK, 154 (75%) replied and 130 (84%) had experience of research during their training. The first report examined their opinion about the contribution of research to their training; this report covers the questions directed towards funding, the source of their funding, whether sufficient funds, advice and information were available and where they might expect to obtain such details. The replies indicated a variety of sources of funding; knowledge about the financial support available for research was sparse and the majority considered there was insufficient advice and information available for trainees on the subject. Substantial funds are available for high quality scientific research programmes providing unprecedented opportunities for multidisciplinary collaboration that is essential for advancing clinical practice alongside technological developments. The process of obtaining support can be a time-consuming exercise, raising the need for an administrative infrastructure to select, prioritise and co-ordinate an appropriate research strategy for the future.

Education, Medical, Continuing↗
PubMed1998

Detrusor myectomy for detrusor overactivity: a minimum 1-year follow-up.

OBJECTIVE: To evaluate the clinical and urodynamic outcome of partial detrusor myectomy in patients with idiopathic detrusor instability and neuropathic hyper-reflexia. PATIENTS AND METHODS: Seventeen patients with idiopathic detrusor instability and 10 with hyper-reflexia and symptoms not responding to non-surgical treatment underwent partial detrusor myectomy. The clinical and urodynamic results before and after myectomy were compared and the patient's subjective assessment of the outcome documented. RESULTS: There was an overall improvement in 17 of 27 patients (63%) but the success rate was higher in those with idiopathic instability (12 of 17) than in those with neuropathy (five of 10). There was urodynamic evidence of reduced bladder contractility and an improvement in the storage characteristics of the bladder in most of the patients treated. CONCLUSIONS: Partial detrusor myectomy is relatively simple and is associated with minimum morbidity and an acceptable success rate. The procedure alters the urodynamic behaviour of the bladder and leads to symptomatic and objective improvement, giving better results with idiopathic than with neuropathic detrusor overactivity. Detrusor myectomy may be offered to patients with detrusor overactivity unresponsive to conventional management. The option of enterocystoplasty is still open to patients with an unsuccessful outcome. However, the long-term results and surgical variations of the technique should be evaluated further.

Follow-Up Studies↗
PubMed1998

The contribution of research to urological training in the United Kingdom.

OBJECTIVES: To report the findings of a questionnaire survey among consultant urologists in the United Kingdom (UK) designed to examine their personal experience of research and their opinion of its contribution in urological training. METHODS: A questionnaire was sent to 205 consultant urologists in the UK and 154 (75%) replied. Their replies were examined to ascertain the time spent in research, the production of publications, presentations and in gaining a higher university degree. Subsequent research activity was also related to the achievement of these endpoints. RESULTS: Among the 154 consultant urologists who replied. 130 (84%) had undertaken research during their training, for a period varying from 6 months to more than 2 years. Among the 130, 99 (76%) considered this to have been well spent; 76 (58%) obtained a higher degree, 86 (66%) achieved at least three publications in peer-reviewed journals and 90 (69%) had given at least five presentations to learned societies. Inadequate supervision in particular was cited as contributing to underachievement and motivation was also considered important to success. CONCLUSIONS: The contribution of research in urological training has been assessed traditionally by the presentation of a thesis to a university for a higher degree, but alternative methods of assessment should perhaps be sought for those wishing to spend less than 18 months in research.

Career Choice↗
PubMed1997

A modified semi-automated technique for in vitro assessment of encrustation of materials.

In vitro study of encrustation is an important part of assessment of materials as potential alloplasts or devices in the urinary tract. This modified semi-automated technique comprises a circular reaction chamber with an encrustation mixture, the level of which is controlled by a float switch which operates the exit peristaltic pump. The composition of the reactants used simulates infected urine with alkaline pH. Results of a preliminary study of the deposits by scanning electron micrography (SEM) and energy dispersive X-ray (EDX) microanalysis are consistent with struvite and hydroxyapatite, similar to the main minerals deposited on urinary catheters. It is a relatively simple, effective and inexpensive set-up for study of encrustation on materials.

Biocompatible Materials↗
PubMed1996

Long-term catheterization of the bladder: prevalence and morbidity.

OBJECTIVE: To estimate the prevalence and morbidity of long-term catheterization (LTC) of the urinary bladder. PATIENTS AND METHODS: A postal survey was conducted over two successive years from February 1989 to determine the incidence of LTC in three Bristol Health Districts with a total population of 827,595. During the first year the number of patients requiring emergency treatment for complications of LTC was also monitored over a 6-month period. In the second year, 54 patients were selected from the first survey and each was visited by one investigator every 2 weeks for 12 weeks to obtain information on catheter management, the incidence and type of complications, the attitudes of the patients or carers about the catheter and to assess the pH and microbiology of the patient's urine. RESULTS: The initial surveys identified 457 and 467 patients with long-term catheters during the 2 years, respectively; there were similar numbers of men and women in both years. The survey of catheter complications recorded 506 emergency referrals during the 6 months and the detailed study of 54 patients showed that 48% experienced catheter blockage, 37% reported urine by-passing the catheter and 30% noted haematuria. Patients found the catheter uncomfortable and depended on nursing support. Catheter blockage was associated with bladder stones, a high urinary pH and the presence of Proteus spp in the urine. CONCLUSION: The prevalence and high morbidity of LTC cause a considerable demand on the available District and Hospital nursing services; most patients with long-term catheters are elderly, disabled or debilitated and more nurses need to be trained in the technique of catheterization and the management of the catheterized patient. Further research is required to reduce the morbidity of LTC by investigating measures to reduce catheter blockage and encrustation at the urine/biomaterial interface.

Adolescent↗
PubMed1994

The Skyhook.

Explore the source record for details and available documents.

Equipment Design↗
PubMed1994

Long-term follow-up of transvaginal urethral closure and suprapubic cystostomy for urinary incontinence in women with multiple sclerosis.

OBJECTIVE: To assess the long-term success, in terms of continence and patient satisfaction, of transvaginal urethral closure and suprapubic cystostomy in women with multiple sclerosis and urinary incontinence. PATIENTS AND METHODS: The group under study comprised 50 severely disabled women with multiple sclerosis who were undergoing suprapubic cystostomy and transvaginal urethral closure to manage urinary incontinence refractory to conservative measures and urethral catheterization. Follow-up was by patient interview and Catheter Change Clinic records. RESULTS: An initial continence rate of 78% was achieved and secondary revision was attempted in 10%. Urinary diversion was performed in 4% and a return to urethral catheterization in 2%. Long-term follow-up (mean length 6.5 years) showed that 79% of patients remained completely dry and were managed by regular catheter change. Six per cent of women with continued leakage around the suprapubic site were managed by conservative local methods. The major complications of urethral closure and suprapubic cystostomy (recurrent calculi and encrustation blockage) related to the presence of the catheter. CONCLUSIONS: The lack of major complications associated with transvaginal urethral closure and suprapubic cystostomy, and the high rates of continence and patient satisfaction suggest that this technique could be more widely used. Particularly, it could be employed at an earlier stage in multiple sclerosis and thus offer patients a better quality of life for a longer period of time. Modifications in catheter design may overcome problems of calculi and encrustation blockage.

Cystostomy↗
PubMed1993

Choosing a powerful lithotriptor.

Clinicians have no yardstick to help them choose the most efficient lithotriptor. Their leading priority is a system allowing complete disintegration of the stone with the minimum number of shocks and a low re-treatment rate. One of the prerequisites of this system is a powerful shock wave generator. "Power" is as yet ill defined in lithotripsy. Therefore clinicians' choice depends upon other factors. Acoustic output measurements were recorded on 3 commercial lithotriptors representing the 3 main shock wave generating systems. These were the Dornier MPL 9000 (standard and X-155 electrodes), the Siemens (Lithostar, Lithostar Plus and System C) and the Wolf Piezolith 2300. The shock wave measurements were correlated to the capability of the lithotriptors to disintegrate standard stone models in vitro. Two factors were identified. The pulse intensity integral in the focus and the size of the focal zone proved to be the most important factors to assess and compare the efficacy or "power" of different lithotriptors. Together they can help clinicians to identify and choose the most efficient shock wave generating systems.

Acoustics↗
PubMed1992

Haemospermia.

Haemospermia is a frightening symptom. Many cases are of benign aetiology but 5 to 10% will have underlying malignancy. Many younger patients require only routine clinical examination, urine analysis and reassurance, but patients aged over 40 years, those with persistent haemospermia, or those with associated haematuria require urological investigation. Imaging of the prostate and seminal vesicles with transrectal ultrasound is of particular value in the investigation of these patients.

Blood↗