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Barnett S.F.,University College London | Alagar R.K.,University College London | Grocott M.P.W.,University College London | Grocott M.P.W.,University of Southampton | And 5 more authors.
Anesthesiology | Year: 2013

Patient satisfaction is an important measure of the quality of health care and is used as an outcome measure in interventional and quality improvement studies. Previous studies have found that there are few appropriately developed and validated questionnaires available. The authors conducted a systematic review to identify all tools used to measure patient satisfaction with anesthesia, which have undergone a psychometric development and validation process, appraised the quality of these processes, and made recommendations of tools that may be suitable for use in different clinical and academic settings. There are a number of robustly developed and subsequently validated instruments, however, there are still many studies using nonvalidated instruments or poorly developed tools, claiming to accurately assess satisfaction with anesthesia. This can lead to biased and inaccurate results. Researchers in this field should be encouraged to use available validated tools, to ensure that patient satisfaction is measured and reported fairly and accurately. Copyright © 2013, the American Society of Anesthesiologists, Inc. Lippincott Williams &Wilkins.

Eweiss A.Z.,Royal National Throat Nose and Ear Hospital | Eweiss A.Z.,Alexandria University | Lund V.J.,Alexandria University | Jay A.,University College Hospital | Rose G.,Moorfields Eye Hospital
Rhinology | Year: 2013

Background: Tumours of the lacrimal drainage apparatus (LDA) are very rare, but can be life-threatening. Seventy percent of lacrimal sac tumours are of epithelial origin, and transitional cell tumours represent an interesting sub-group of these epithelial tumours. Methods: A retrospective review of cases of LDA transitional cell tumours co-managed at the Royal National Throat Nose and Ear Hospital and Mocorfields Eye Hospital, London. Results: Twenty cases of transitional cell tumours of the LDA were identified, comprising 10 transitional cell papillomas (TCPs) and 10 transitional cell carcinomas (TCCs). All cases were resected through a modified lateral rhinotomy approach. Limited resection of orbital fat with preservation of orbital functions was required for 2 cases of TCC. Fractionated external beam radiotherapy was administered in 7 cases of TCC. The mean follow up was 80 months (range 11 months-16 years). Recurrences were detected in 4 cases, which were managed by further surgery. Two cases have been lost to follow-up, but the 18 other patients are currently alive and disease free. Conclusion: A favourable outcome can be achieved with transitional cell tumours of the LDA when an optimum management plan is followed.

Turnbull J.,University College Hospital | Patel A.,Royal National Throat
Trends in Anaesthesia and Critical Care | Year: 2015

Cricoid pressure was introduced in the 1960's to protect patients undergoing general anaesthesia against pulmonary aspiration. Evidence supporting its use was largely based on small cadaver studies, expert opinion and case studies. However, its uptake across the anaesthetic community was universal, perhaps due to the fear of aspiration, but also because it was thought to have little in the way of adverse effects. Recently, the role of CP has been reassessed, with many suggesting its use is no longer warranted, particularly in fully fasted patients. Evidence has shown that not only is CP ineffective in occluding the oesophageal lumen, but it may also interfere with crucial aspects of airway management. Moreover, the ability of medical and nursing staff to perform effective, consistent CP is questionable. However, at present, there is no valid alternative, and the use of CP is therefore likely to continue in selected patients. © 2015 .

News Article
Site: www.technologyreview.com

Working out how to zap a tumor with radiation is a laborious process for physicians. Google’s machine-learning division, DeepMind, thinks AI can help ease the burden. When medics apply radiotherapy to a cancer patient, they have to carefully determine which parts of the body should be exposed to radiation in order to kill the tumor while ensuring that as much healthy surrounding tissue as possible is preserved. The process, known as segmentation, requires the doctor to manually draw areas that can and can’t be treated onto a 3-D scan of the patient’s tumor site. The process is particularly complex for head and neck cancers, in which the tumor often sits immediately next to many important anatomical features. Now, though, DeepMind will work with University College Hospital in London to develop an artificial-intelligence system that can automate the process. DeepMind will analyze 700 anonymized scans from former patients who suffered from head and neck cancers. They hope to create an algorithm that can learn how physicians make decisions about this part of the treatment process, ultimately segmenting the scans automatically. “Clinicians will remain responsible for deciding radiotherapy treatment plans, but it is hoped that the segmentation process could be reduced from up to four hours to around an hour,” explains DeepMind. In time, the DeepMind team hopes, the same algorithm might find application in treating cancers elsewhere in the body. IBM’s Watson supercomputer has also been applying machine learning to personalized cancer treatment, though its approach is a little more bookish. It’s currently drawing on 600,000 medical evidence reports and 1.5 million patient records and clinical trials to help doctors develop better treatment plans for cancer patients. This isn’t DeepMind’s first foray into medical research, either—in fact, this is the third project that it’s announced in collaboration with the U.K.’s National Health Service. After coming under fire earlier in the year when an app project appeared to provide DeepMind with free access to 1.6 million patients’ records, the research outfit recently announced that it was helping to spot the early signs of visual degeneration by sifting through a million eye scans. Perhaps it’s working its way down the body.

Arumainayagam N.,University College Hospital | Kumaar S.,University College Hospital | Ahmed H.U.,University College Hospital | Moore C.M.,University College Hospital | And 5 more authors.
BJU International | Year: 2010

OBJECTIVE To assess the role of multiparametric magnetic resonance imaging (mp-MRI) of the prostate in evaluating local recurrence of prostate cancer, using transperineal template-guided 5 mm-spaced biopsies as a reference standard, in men treated with external beam radiotherapy (EBRT) for prostate cancer. PATIENTS AND METHODS The study included 13 patients with evidence of biochemical recurrence after EBRT who had undergone mp-MRI and prostate mapping. Each MRI scan (consisting of T1/T2 weighting, dynamic contrast enhancement and diffusion weighting) was reported by two expert uro-radiologists. Each prostate was divided into four regions of interest (ROI), generating 52 paired datasets for analysis. RESULTS The mean (range) age of the men was 65.5 (55-70) years, the mean prostate-specific antigen (PSA) level before EBRT was 36.6 (4.5-150) ng/mL, the mean time from EBRT to biochemical recurrence was 5.7 (3-10) years and the mean PSA level at the time of recurrence was 7.1 (0.83-27.9) ng/mL. Eleven men had histological evidence of recurrence, with 23 of 52 ROIs involved with cancer. Overall accuracy, as expressed by the area under a receiver-operator curve, was 0.77 and 0.89 for all cancer, with accuracies of 0.86 and 0.93 for those cancers with ≥3 mm biopsy core length. Inter-observer variability was measured by calculating K coefficients, which showed fair and moderate agreement between radiologists. CONCLUSIONS Interpretation of mpMRI of the prostate after previous EBRT is challenging. Our results show that the accuracy is good using an accurate reference standard. These results need verification in more patients, but have implications for determining presence or absence of local recurrence and subsequent local salvage therapy. © 2010 BJU INTERNATIONAL.

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