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Biomedical subjects

R Hawes

Publications and source records attributed to R Hawes.

8 recordsLinked to original sources
PubMed1987

Endoscopic laser palliation for advanced malignant dysphagia.

Palliative treatment of malignant dysphagia aims to optimise swallowing for the maximum time possible with the minimum of general distress to these seriously ill patients. Thirty four patients considered unsuitable for surgery because of advanced malignancy, other major pathology or in whom previous surgery had been unsuccessful were treated endoscopically with the Nd YAG laser. Significant improvement was achieved in 29 (85%). On a scale of 0-4 (0 = normal swallowing; 4 = dysphagia for all fluids), mean improvement was 1.7, with 25 patients (74%) able to swallow most, or all solids after treatment. With increasing experience, the average number of treatment sessions required for each patient became less; initial time in hospital became comparable to that needed for intubation. Failures were caused by inappropriate patient selection (3), or laser related perforation (2). The mean survival in the whole group was 19 weeks (range 2-44). Eighteen patients needed further treatment for recurrent dysphagia, a mean of six weeks (range 2-15) after initial therapy. Ten of these responded, but eight eventually required insertion of a prosthetic tube. The duration of good palliation was very variable after initial laser therapy.

Aged↗
PubMed1986

Endoscopic treatment of inoperable colorectal cancers with the Nd YAG laser.

Seventeen patients with cancers of the rectum or distal sigmoid and considered inoperable because of old age, severe concomitant disease or advanced stage of malignancy, were treated endoscopically with the Nd YAG laser. Symptoms included rectal bleeding, obstruction, diarrhoea and incontinence. Significant improvement was achieved in 15 (88 per cent) and there were no complications. The procedure was carried out with simple bowel preparation and minimal sedation and, for otherwise fit individuals, the mean total hospital stay was 6.8 days, with day case therapy sometimes possible. Three patients required further therapy for recurrent symptoms 6-8 weeks after treatment. Fourteen patients died 1-39 weeks after therapy (mean survival 15 weeks). Three are alive and free of bowel symptoms after 39-54 weeks. This technique is the only non-surgical therapy that can be used safely for lesions above the peritoneal reflection and provides palliation at least as good as electrocoagulation, cryotherapy and radiotherapy with minimal upset to these seriously ill patients.

Adenocarcinoma↗
PubMed1986

A study of optimal length of flexible fiberoptic sigmoidoscopes for initial endoscopic training.

Eighteen trainees with no prior fiberoptic endoscopic experience performed a total of 305 fiberoptic sigmoidoscopies using a colonoscope. Basic training, consisting of reading materials, lecture instructions, practice on a colon model, and observation of procedures, was completed prior to beginning patient examinations. Additional instruction was given between examinations. The performance of these examinations was an individual effort on the part of the trainee without verbal or mechanical assistance from the instructor after the initial ten examinations. All were performed with an instructor viewing through a teaching attachment. Total insertion distance was greater than or equal to 30, greater than or equal to 40, greater than or equal to 50, greater than or equal to 60 cm in 65, 60, 46, and 20 percent of examinations, respectively. Overall performance was better in those with prior rigid sigmoidoscopic experience (20 examinations). The mean examination time was 11.8 minutes. These data help to define the appropriate length of fiberoptic sigmoidoscope recommended for use by inexperienced endoscopists.

Education, Medical, Undergraduate↗
PubMed1986

Training resident physicians in fiberoptic sigmoidoscopy. How many supervised examinations are required to achieve competence?

Twenty-five resident physicians performed 495 fiberoptic sigmoidoscopic examinations that were graded for overall skill according to a six-point competence scale. In general, 24 to 30 examinations were required to become competent at fiberoptic sigmoidoscopy. Trainees with prior rigid sigmoidoscopy experience achieved competence more quickly than those with no prior rigid sigmoidoscopy experience. As experience increased, unassisted insertion distance and luminal visualization increased, insertion time and assisted time decreased, and management scores and percent correct diagnoses improved. Trainees detected 93 to 100 percent of polyps and cancers viewed by the experienced sigmoidoscopist once competence was achieved. These data indicate that programs for training primary care physicians in fiberoptic sigmoidoscopy are feasible, help define the number of examinations required to become competent, and indicate that such trainees should be effective in cancer screening.

Clinical Competence↗
PubMed1975

Reduction of fear-related dental management problems with use of filmed modeling.

In this study of the modification of anxiety-related disruptive behavior in dental treatment, matched groups of inner-city children attending a pedodontic clinic were shown a videotaped demonstration of a 4-year-old black child undergoing a dental restorative procedure or were given an unrelated drawing task before dental treatment. Children who viewed the videotape demonstration of a peer model coping with dental procedures showed significantly fewer fear-related disruptive behaviors during restoration of lesions. Observations of children's anxiety levels made by dentists and independent observers validated the effectiveness of viewing the videotaped demonstration. No significant correlation was found between the children's reports of their anxiety and their behavior during dental treatment.

Analysis of Variance↗