Biomedical subjects

Sean Duffy

Publications and source records attributed to Sean Duffy.

16 recordsLinked to original sources

PubMed2006

Defining the role of aromatase inhibitors in the adjuvant endocrine treatment of early breast cancer.

BACKGROUND: Over the past few years, data have been published concerning the relative efficacy and safety profiles of tamoxifen and the aromatase inhibitors (AIs) in the adjuvant therapy setting for women with early hormone receptor-positive breast cancer. Recently, debate has centred around trials which have studied primary tamoxifen and AI therapy, switching and sequencing strategies and extended adjuvant therapy. METHODS: Here, a group of 24 breast cancer experts review efficacy and safety data from the recent major trials investigating tamoxifen and the third-generation AIs in postmenopausal women, which have challenged the perception of tamoxifen as optimum adjuvant endocrine therapy. Data from the Arimidex, Tamoxifen, Alone or in Combination (ATAC) trial, Breast International Group (BIG) 1-98 study, National Cancer Institute of Canada MA 17 trial, Intergroup Exemestane Study (IES), Italian Tamoxifen Anastrozole (ITA) trial, Austrian Breast and Colorectal Cancer Study Group (ABCSG) Trial 8 and Arimidex-Nolvadex (ARNO) 95 are considered to provide a rational interpretation of the impact of these data on current practice, and to highlight areas where further investigation is needed. CONCLUSION: We can be confident that AIs represent superior adjuvant endocrine treatment to tamoxifen in postmenopausal women, either as initial therapy or as an alternative for women who have started adjuvant therapy with tamoxifen. However, there remain issues regarding the best way to use AIs, such as the optimal length of AI treatment and how a sequence of tamoxifen followed by an AI compares with AI monotherapy; these will require further data to resolve.

Antineoplastic Agents, Hormonal↗

PubMed2005

Thermachoice endometrial ablation in the outpatient setting, without local anesthesia or intravenous sedation: a prospective cohort study.

OBJECTIVE: To determine whether Thermachoice endometrial ablation (EA) is a safe and acceptable procedure when performed in the outpatient (OP) setting without local anesthesia or IV sedation. DESIGN: Prospective cohort (double group) study. SETTING: Hysteroscopy clinic of large UK hospital. PATIENT(S): Twenty-seven women with menorrhagia. INTERVENTION(S): The first cohort of women underwent Thermachoice EA without elective analgesia. The second cohort underwent Thermachoice after taking ibuprofen. MAIN OUTCOME MEASURE(S): To map pain scores and the requirement of "rescue analgesia." To assess speed of recovery and time away from home. RESULT(S): Thermachoice EA was successfully performed in the OP setting on 89% (n = 24) of women. Four women in the first cohort required rescue analgesia compared to none in the second. During the procedure there was little difference between the groups visual analogue style pain scores-with the overall score being 3.6 (range = 0-10). Postoperatively there was a lower mean pain score in the second cohort, with fewer women experiencing nausea and vomiting. Mean time away from home was 2.6 hours and mean time to make a full recovery was 3.3 days. Women required analgesia for 2.6 days, on average, and returned to their normal activities at this time. CONCLUSION(S): Thermachoice EA without local analgesia or IV sedation can be safely and successfully performed in the OP setting and if ibuprofen is taken preoperatively few women require "rescue analgesia."

Adult↗

PubMed2005

Female sterilisation: a cohort controlled comparative study of ESSURE versus laparoscopic sterilisation.

OBJECTIVE: To compare patient satisfaction, discomfort, procedure time, success rate and adverse events of hysteroscopic (ESSURE, Conceptus Inc, San Carlos, USA) versus laparoscopic sterilisation. DESIGN: Cohort controlled comparative study. SETTING: The day surgery and outpatient unit of three large UK hospitals. POPULATION: Eighty-nine women requesting sterilisation were enrolled into the study. METHODS: A 2:1 ratio of ESSURE placement to laparoscopic sterilisation was undertaken. Laparoscopic sterilisation was carried out under general anaesthesia in the day surgery unit whereas all ESSURE procedures were carried out in a dedicated outpatient facility. All patients completed a self-assessment diary on days 7 and 90 post-operatively. Patient satisfaction, tolerance and discomfort were measured using an ordinal Likert style scale. Data were analysed using the chi(2) test for statistical significance. MAIN OUTCOME MEASURES: The primary outcome measure is patient satisfaction with ESSURE versus laparoscopic sterilisation. This included satisfaction with the decision to proceed with the relevant sterilisation method, recovery from the procedure and overall satisfaction following either ESSURE or laparoscopic sterilisation. Secondary outcome measures include successful completion of procedure, procedure time, tolerance, patient discomfort and post-operative adverse events. RESULTS: All women who underwent laparoscopic sterilisation had the procedure successfully completed whereas the overall bilateral device placement rate for ESSURE was 81%. Patient satisfaction with their decision to undergo either ESSURE or laparoscopic sterilisation was high with 94% of the ESSURE group being 'very' or 'somewhat' satisfied at 90 days post-procedure versus 80% in the laparoscopic sterilisation group. At 90 days post-procedure 100% of women in the ESSURE group were 'very satisfied' with their speed of recovery versus 80% in the laparoscopic sterilisation group. The procedure time (defined from the time of insertion of the hysteroscope or laparoscope to its removal) took significantly longer for ESSURE than laparoscopic sterilisation (mean = 13.2 vs 9.7 minutes, P= 0.045). However, the time required for insertion of a Verres needle and insufflation of the abdominal cavity is a necessary part of the laparoscopic sterilisation and had it been included would bring the procedures times more in line with each other. The mean time spent in hospital was significantly shorter for the ESSURE group than the laparoscopic group (188.7 vs 396.1 minutes, P < 0.005). Eighty-two percent of women in the ESSURE group described their tolerance of the procedure between 'good and excellent' compared with only 41% of the laparoscopic sterilisation group (P= 0.0002). Only 31% of the ESSURE group reported moderate or severe pain following the procedure compared with 63% of the laparoscopic sterilisation group (P= 0.08). Only 11% of patients had problems immediately post-operatively in the ESSURE group compared with 27% in the laparoscopy group. Finally, in the more medium term (three months post-operatively), patients still had an advantage in terms of post-procedure adverse events in the ESSURE group (21%vs 50%). CONCLUSIONS: This study provides evidence that ESSURE can be performed in the majority of women and, when successful, is associated with a greater overall patient satisfaction rate than laparoscopic sterilisation. Women also spend less time in hospital, have better tolerance of the procedure and describe less severe post-operative pain. However, the devices cannot be bilaterally placed in all cases and some women do not tolerate the procedure awake.

Adult↗

PubMed2004

The technique and overview of flexible hysteroscopy.

Flexible hysteroscopy is a safe, successful, and reliable method of investigation for abnormal uterine bleeding. When compared with rigid hysteroscopy flexible hysteroscopy is associated with less pain both at introduction of the hysteroscope and during the procedure itself especially when the diameter of the scope is reduced. This article provides evidence of the benefits of flexible hysteroscopy to the health service provider, clinician, and patient. Flexible hysteroscopy is acceptable to most women when performed in the outpatient setting without analgesia and offers a suitable alternative to rigid hysteroscopy.

Equipment Design↗

PubMed2004

The Yorkshire Modular Training Programme: a model for structured training and quality assurance in obstetrics and gynaecology.

Recent changes in postgraduate education have highlighted the need for structured training to ensure quality in training and optimize patient care. In Yorkshire, a "modular" approach to postgraduate education in obstetrics and gynaecology has been adopted through the Yorkshire Modular Training Programme (YMTP). The curriculum for trainees is divided into "modules" organized over five years. This provides a comprehensive educational package covering all aspects of obstetrics and gynaecology for trainees in the specialty. The YMTP provides a framework for region-wide integration and ownership of responsibility for teaching and training. It also provides quality assurance in education throughout the region and provides an "educational continuum" in which the different modules work together to meet the educational requirements of the trainees. It also aims to integrate "training" and "education" for the trainees. This paper describes the organization of the programme including its educational principles. It discusses its strengths and weaknesses. It provides a useful framework for postgraduate education that could be used by other regions.

Curriculum↗

PubMed2004

Delivering an effective outpatient service in gynaecology. A randomised controlled trial analysing the cost of outpatient versus daycase hysteroscopy.

OBJECTIVE: To examine the cost implications of outpatient versus daycase hysteroscopy to the National Health Service, the patient and their employer. DESIGN AND INTERVENTIONS: Randomised controlled trial. SETTING: The gynaecology clinic of a large teaching hospital. PARTICIPANTS: Ninety-seven women with abnormal uterine bleeding requiring investigation. METHODS: Women were randomly allocated to either outpatient or daycase hysteroscopy. They were asked to complete diaries recording expenses and time off work. The National Health Service costs were calculated for a standard outpatient and daycase hysteroscopy. MAIN OUTCOME MEASURES: Costs to the National Health Service, costs to the employer, loss of income, childcare costs and travel expenses. RESULTS: The outpatient group required significantly less time off work compared with the daycase group (0.8 days vs 3.3 days), P < 0.001. Of those women who lost income due to the hysteroscopy, the average loss of income was twice as much in the daycase group ( pound 20.40 in the outpatient group vs pound 50.60 in the daycase group). The average cost of childcare required to cover the time spent in hospital undergoing the hysteroscopy was similar in both groups, however, the number of women requiring childcare was small. Travel costs incurred by the women were 74% more in the daycase group compared with the outpatient group-with an average cost of pound 3.46 in the outpatient group and pound 6.02 in the daycase group. Daycase hysteroscopy costs the National Health Service approximately pound 53.88 more per patient, than performing an outpatient hysteroscopy. Purchasing the hysteroscopes necessary to perform an outpatient hysteroscopy is a more expensive outlay than those required for daycase hysteroscopy. However, there are so many other savings that only 38 patients need to undergo outpatient hysteroscopy (even with a 4% failure rate) rather than daycase hysteroscopy in order to recoup the extra money required to set up an outpatient hysteroscopy service. CONCLUSION: Outpatient hysteroscopy offers many benefits over its traditional counterpart including faster recovery, less time away from work and home and cost savings to the woman and her employer and the National Health Service. Resources need to be made available to rapidly develop this service across the UK in order to better serve both patient and taxpayer.

Ambulatory Care↗

PubMed2003

In-vitro and in-vivo histochemical and thermal studies using a thermal balloon endometrial ablation system for varying treatment times.

BACKGROUND: To assess the immediate zone of thermal necrosis (ZTN) using an enzyme histochemical staining technique and serosal temperatures for the Cavaterm endometrial balloon ablation system for different treatment times. METHODS: A thermal balloon ablation was performed initially post- (n = 6) and subsequently pre-hysterectomy (n = 15). Eight to 12 tissue blocks from each uterus were sectioned and stained using diaphorase respiratory enzyme techniques. Patients in the in-vivo group had temperature measurements taken from four serosal points, a myometrial gradient profile, the balloon surface and the endocervical canal. RESULTS: The serosal temperature sensors did not demonstrate any rise in temperature above 44.1 degrees C. The mean temperature at the anterior wall, posterior wall, fundus and cornual areas was 37.1 (SD 1.3), 36.8 (SD 1.0), 37.4 (SD 1.8) and 36.7 degrees C (SD 1.0), respectively. The immediate mean maximum ZTN was greatest for the 15-min treatment time (3.1 mm, SD 1.5) compared to the 10- and 7-min treatment times (3.0 mm, SD 1.4 and 2.2 mm, SD 0.7, respectively). The maximum ZTN recorded was 5.6 mm. No full thickness injuries were demonstrated either histochemically or suggested by the temperature studies. CONCLUSIONS: This study confirms that Cavaterm thermal balloon ablation produces a reproducible thermal injury without evidence of serosal heating. Results suggest that the treatment time could be reduced to 10-min with no detrimental effect on the clinical outcomes. This hypothesis is currently being evaluated by clinical trials.

Female↗

PubMed2003

Perceiving an object and its context in different cultures: a cultural look at new look.

In two studies, a newly devised test (framed-line test) was used to examine the hypothesis that individuals engaging in Asian cultures are more capable of incorporating contextual information and those engaging in North American cultures are more capable of ignoring contextual information. On each trial, participants were presented with a square frame, within which was printed a vertical line. Participants were then shown another square frame of the same or different size and asked to draw a line that was identical to the first line in either absolute length (absolute task) or proportion to the height of the surrounding frame (relative task). The results supported the hypothesis: Whereas Japanese were more accurate in the relative task, Americans were more accurate in the absolute task. Moreover, when engaging in another culture, individuals tended to show the cognitive characteristic common in the host culture.

Adolescent↗

PubMed2003

Web-based physician order entry: an open source solution with broad physician involvement.

Computerized physician order entry (CPOE) is a disruptive technology but holds great promise for reducing medical errors, improving workflow and in the long run, producing cost-savings. However, many studies have reported significant physician resistance to implementing CPOE. In this manuscript we present a two-prong strategy for quick implementation of CPOE: 1) a web-based deployment tool using an open source, secure environment that allows rapid development and deployment of content, and 2) the development of a large set of disease specific order sets and knowledge bases based on established vocabulary standards such as LOINC and SNOMED CT by teams of multidisciplinary content experts at the departmental level. The order sets can be viewed, edited and signed through a standard browser interface. This paper presents the conceptual framework and implementation requirements for such an endeavor.

Attitude of Health Personnel↗

PubMed2003

Rapid deployment of physician order entry using web-based, disease-specific order sets.

Computerized physician order entry (POE) is a disruptive technology that holds great promise to reduce medical errors and improve workflow. However, Studies have reported significant physician resistance. This presentation will describe a two-pronged strategy to build broad support for POE: To build a secure, open source, browser-based platform to support POE and create a large number of disease-specific order-sets for immediate use. This presentation will demonstrate the conceptual framework and implementation requirements for such an endeavor.

Attitude of Health Personnel↗

PubMed2002

Development of transferable skills during short special study modules: students' self-appraisal.

Special study modules (SSMs) were introduced into the Leeds undergraduate medical curriculum following recommendations by the General Medical Council (GMC). The main rationale behind such project work is to enable students to develop the skills and attitudes necessary for future self-directed learning along with the knowledge required to practise as competent doctors. At the University of Leeds, the students complete SSM monitoring forms for each SSM in the fourth year, aimed at allowing students to self-evaluate the SSMs. In addition, it provides useful feedback from the students on the themes of the projects as well as on the transferable skills developed by the students during their individual SSMs. The aim of the study was to identify the themes pursued in each project, look at the transferable skills developed and evaluate the differences or similarities between the type of project pursued and the themes and skills identified in the different specialities. A total of 181 monitoring forms of fourth-year students were analysed for the themes and the transferable skills identified. There were 55 students each in Obstetrics and Gynaecology and Paediatrics and 50 students each in Psychiatry and General Practice/Public Health. The results from the four specialities were compared for themes and skills identified. Overall, health and prevention was the commonest theme identified followed by communication skills (64.4% and 62.7% respectively). All transferable skills were well represented in the different specialities with information gathering and learning/organizational skills identified by most students as the major component. The feedback from the students is positive in terms of a wide range of transferable skills developed and most of the themes identified by the GMC are being pursued.

Clinical Competence↗

PubMed2002

'Ten golden rules' for designing software in medical education: results from a formative evaluation of DIALOG.

Evaluation of educational material has become very important in a climate where there is increasing concern with assessing and maintaining quality. DIALOG (acronym for Distance Interactive Learning in Obstetrics and Gynaecology) is an electronic program on CD-ROM for continuing education. A formative evaluation of DIALOG was carried out to determine whether DIALOG was achieving its educational objectives. The results of the evaluation helped to suggest '10 golden rules' for designing software for the purpose of CPD for medical practitioners. These 'rules' should help in designing future software in medical education. They highlight the importance of content, presentation, design, use of hypermedia and multimedia and reduced cost in order to facilitate appropriate use of such programmes.

CD-ROM↗

PubMed2002

Infants and toddlers discriminate amount: are they measuring?

Four experiments that show an early ability to encode and retain information about extent are presented. We found that infants discriminate between the heights of dowels in a habituation task. We also found that toddlers discriminate between heights on a choice task in which a target dowel is presented and removed and they then choose between the target and a foil. Until 4 years of age, however, discrimination occurs only in the presence of a perceptually salient standard. Adults do not require a perceptually present standard; they can assess extent across temporal or spatial gaps by imposing a standard (measure). The present findings indicate that infants and toddlers do not possess an adult ability to establish extent, but that they do possess a skill that provides a start point for this important intellectual achievement.

Analysis of Variance↗

PubMed2002

Evaluation of distance interactive learning in obstetrics and gynaecology (DIALOG).

OBJECTIVES: 1. To determine whether DIALOG, a multimedia interactive CD-ROM designed for postgraduate education, was achieving its educational aim; 2. to assess DIALOG as a computer-assisted learning tool by evaluating its design, presentation, usability, effective use of multimedia and interactions and availability; 3. to measure end user satisfaction and the impact of DIALOG in achieving an improvement in clinical practice as an index of educational value. METHODS: Postal questionnaires were sent out to 150 users of DIALOG. A combination of the CIPP model, the CRISIS criteria and Kirkpatrick's model was used to design the evaluation questionnaire. RESULTS: There was a 61.3% response rate to the questionnaire. Overall, 86.9% of respondents were happy with the use of DIALOG, 60.8% had a positive comment on the concept of distance learning using DIALOG and computer-assisted learning, 50% agreed that it had helped sharpen their analytic skills and 45.6% reported an improvement in clinical practice after using DIALOG. CONCLUSION: This assessment proved to be a useful formative assessment of DIALOG. It has provided feedback on the availability and use of DIALOG and has highlighted the potential areas of improvement for future issues.

Education, Distance↗

PubMed2002

A comparison of outpatient hysteroscopy with saline infusion hysterosonography.

OBJECTIVES: To establish the accuracy of saline infusion hysterosonography in diagnosing uterine pathology when compared with outpatient hysteroscopy. DESIGN: Prospective, parallel, blinded comparative study. SETTING: Outpatient hysteroscopy clinic in a large university teaching hospital. POPULATION: All women referred for outpatient hysteroscopy in a 15-month period. INTERVENTIONS: Women underwent saline infusion hysterosonography followed by flexible hysteroscopy. The ultrasonographer was blinded to the hysteroscopy result and the gynaecologist was blinded to the saline infusion hysterosonography result. MAIN OUTCOME MEASURES: The relative success rates and pain scores for each procedure. The validity of saline infusion hysterosonography as a diagnostic test. RESULTS: One hundred and seventeen women entered the study; 70 women were premenopausal and 47 postmenopausal. In 27 women, one or both procedures could not be performed. Saline infusion hysterosonography failed in 20 women, on one occasion hysteroscopy failed and both investigations failed in six women. Ninety cases remained for direct comparison, with 78 cases of agreement on the uterine findings in both investigations. Twelve cases disagreed; in one case, an adhesion was seen, two cases with polyps and five with fibroids seen on ultrasound but not seen on hysteroscopy. There were four cases where polyps were identified on hysteroscopy but not on saline infusion hysterosonography. The median pain scores were 1.6 for saline infusion hysterosonography and 3.2 for hysteroscopy. CONCLUSIONS: Both saline infusion hysterosonography and hysteroscopy are well tolerated by women. Saline infusion hysterosonography has a high failure rate but has a lower pain score than hysteroscopy.

Adult↗

PubMed2002

Distance learning to support postgraduate training in obstetrics and gynaecology.

A number of major distance learning programmes have been launched by the medical Royal Colleges for the purposes of training and/or continuing medical education. The most recent is 'StratOG', a modular programme published by the Royal College of Obstetricians and Gynaecologists (RCOG) and aimed primarily at candidates for the part 2 RCOG Membership examination.

Education, Distance↗