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Biomedical subjects

R Feneley

Publications and source records attributed to R Feneley.

7 recordsLinked to original sources
PubMed2001

Preliminary results of a randomized controlled trial of prophylactic shock wave lithotripsy for small asymptomatic renal calyceal stones.

OBJECTIVE: To report a prospective, randomized study to determine whether prophylactic extracorporeal shockwave lithotripsy (ESWL) is justified as a treatment for small, asymptomatic calyceal stones. PATIENTS AND METHODS: The study included 228 patients with small (< 15 mm total diameter) asymptomatic calyceal stones; 113 patients were randomized to undergo ESWL and 115 to the control group who were kept under observation. Outcome measurements included the stone-free rate, requirement for additional treatment, symptoms, quality of life and renal function. RESULTS: In all, 200 patients had at least one annual follow-up; all outcome measurements reported were those at the most recent follow-up (mean 2.2 years, range 1-5). In the ESWL group 28 patients (28%) were stone-free, compared with 16 (17%) in the observation group (odds ratio 1.95, 95% confidence interval, CI, 0.97-3.89, P = 0.06). Additional treatment in the form of analgesics, antibiotics, ESWL, stent insertion and ureteroscopy, was required in 21 (21%) patients in the observation group and 15 (15%) in the ESWL group (odds ratio 0.66, 95% CI 0.32-1.37, P = 0.27). Ten patients in the observation group required invasive procedures, vs none in the ESWL group. There was no evidence of differences in the symptoms, quality of life or renal function tests between the arms of the trial at the final follow-up. CONCLUSIONS: Prophylactic ESWL for small asymptomatic renal calyceal stones does not appear to offer any advantage to patients in terms of stone-free rate, quality of life, renal function, symptoms or hospital admissions. However, a policy of observation is associated with a greater risk of requiring more invasive procedures. A longer follow-up is required to assess the validity of these preliminary findings.

Adult↗
PubMed2000

The costs of long-term catheterization in the community.

The prevalence of long-term catheterization in the adult population is of the order of 0.03-0.07%, rising to 0.5% in those over 75 years and 2% in those over 85 years old. Studies have shown that the prevalence of urinary incontinence increases with age and is higher in females. Little is known about the costs of long-term catheterization, which have consequences for care decisions. A pilot study was conducted to test (a) the applicability in the UK of a methodology developed in the USA for measuring the cost of long-term catheterization in community-based patients, and (b) the feasibility of using it in larger-scale community-based studies. The study made use of the method developed in the USA by Wagner and Hu (1998) to assess the true costs in the population. Patients were selected in order to represent as broad as possible a range of underlying disease processes and social circumstances. Eight patients were selected, drawn from 3 distinct groups of patients. The pilot study demonstrated wide variation in direct costs for 7 patients living in the community over a 3-month period, ranging from pound 118.80 to pound 2585.26. Since staffing is - for the most part - the most significant cost element, this indicates significant variation in levels of need. Resources deployed for one nursing procedure clearly impact on opportunities to undertake other procedures. An understanding of the costs of any procedure is necessary in order to make best use of the limited resources available.

Community Health Nursing↗
PubMed2000

A study of current nursing management of long-term suprapubic catheters.

Problems associated with long-term catheters can place increased demands on nurses' time and resources. This article reports a study which investigated the nursing management of 113 patients with long-term suprapubic catheters. The study identified that 52% of catheters were changed routinely, 30% of catheters were changed only when they became blocked and 30% of nurses experienced problems when changing catheters. A total of 42% of patients received either a bladder 'washout' or instillation and 60% required a dressing around their suprapubic site. This study also examined the reasons for applying dressings, the type of dressing used and the frequency of dressing changes, which has long been a neglected area of research. Recommendations for future practice are discussed.

Bandages↗
PubMed1992

Organising a continence advisory service.

Modern surgical techniques have greatly improved the treatment of incontinence, but there remains a large number of patients for whom conservative management will be necessary. This paper reports the appointment of a continence adviser 10 years ago, and describes the subsequent development of a District Continence Advisory Service. Experience has shown that this appointment is essential, not only in terms of facilitating the service, but also as a means of ensuring cost efficiency.

Community Health Nursing↗