bluuebunny/crossref_metadata_2025 huggingface dataset:
Angry (or Disgusted), but Adjusting? The Effect of Specific Emotions on Adjustment From Self-Generated Anchors
Authors: Inbar Yoel , Gilovich Thomas
Published: March 2011

Many numerical judgments are made by adjusting from a salient anchor value. This research examines the effect of high-certainty emotions—emotions associated with feelings of confidence about what is happening, what will happen, and how to respond—on the adjustment process. The authors examined whether such emotions would induce people to engage in adjustment more confidently and thoroughly, leading to greater adjustment. In two studies, the authors found that people feeling anger (Study 1) and disgust (Study 2)—emotions associated with appraisals of certainty—adjusted more from self-generated anchors than did people feeling fear (Study 1) and sadness (Study 2)—emotions associated with appraisals of uncertainty. Study 2 found that this effect does not occur for experimenter-provided anchors, from which adjustment tends to be less consistently observed.
Hyperproliferation, cancer, and inflammation in mice expressing a Δ133p53-like isoform
Authors: Slatter Tania L. , Hung Noelyn , Campbell Hamish , Rubio Carina , Mehta Reena , Renshaw Prudence , Williams Gail , Wilson Michelle , Engelmann Afra , Jeffs Aaron , Royds Janice A. , Baird Margaret A. , Braithwaite Antony W.
Published: March 2011

The p53 protein is a pivotal tumor suppressor that is frequently mutated in many human cancers, although precisely how p53 prevents tumors is still unclear. To add to its complexity, several isoforms of human p53 have now been reported. The Δ133p53 isoform is generated from an alternative transcription initiation site in intron 4 of the p53 gene (Tp53) and lacks the N-terminus. Elevated levels of Δ133p53 have been observed in a variety of tumors. To explore the functions of Δ133p53, we created a mouse expressing an N-terminal deletion mutant of p53 (Δ122p53) that corresponds to Δ133p53. Δ122p53 mice show decreased survival and a different and more aggressive tumor spectrum compared with p53 null mice, implying that Δ122p53 is a dominant oncogene. Consistent with this, Δ122p53 also confers a marked proliferative advantage on cells and reduced apoptosis. In addition to tumor development, Δ122p53 mice show a profound proinflammatory phenotype having increased serum concentrations of interleukin-6 and other proinflammatory cytokines and lymphocyte aggregates in the lung and liver as well as other pathologies. Based on these observations, we propose that human Δ133p53 also functions to promote cell proliferation and inflammation, one or both of which contribute to tumor development.
Neonatal NK-cell repertoires are functionally, but not structurally, biased toward recognition of self HLA class I
Authors: Schönberg Kathrin , Fischer Johannes C. , Kögler Gesine , Uhrberg Markus
Published: March 2011

Human natural killer (NK)–cell repertoires are biased toward more frequent expression of inhibitory killer cell Ig-like receptor (KIR) receptors for self-human leukocyte antigen (HLA) class I. Moreover, only those NK cells that express cognate receptors for self are fully functional in terms of cytotoxicity and cytokine production. It is so far unknown whether functional education and structural adaptation to HLA class I are implemented during NK-cell development and whether both processes are mechanistically connected. Here we show that NK-cell repertoires in cord blood are not yet shaped toward increased clonal frequencies of KIR for self-HLA class I as determined for the 3 major KIR ligands C1, C2, and Bw4. Nonetheless, neonatal NK cells expressing cognate KIR exhibited enhanced effector function on the level of degranulation and cytokine production. The study suggests that functional education of cognate KIR by self-HLA class I precedes structural adaptation of KIR repertoires and that both processes are not directly linked to each other.
Antibiotic prescribing for discoloured sputum in acute cough/lower respiratory tract infection
Authors: Butler C.C. , Kelly M.J. , Hood K. , Schaberg T. , Melbye H. , Serra-Prat M. , Blasi F. , Little P. , Verheij T. , Mölstad S. , Godycki-Cwirko M. , Edwards P. , Almirall J. , Torres A. , Rautakorpi U-M. , Nuttall J. , Goossens H. , Coenen S.
Published: March 2011

We investigated whether discoloured sputum and feeling unwell were associated with antibiotic prescription and benefit from antibiotic treatment for acute cough/lower respiratory tract infection (LTRI) in a prospective study of 3,402 adults in 13 countries.

A two-level model investigated the association between producing discoloured sputum or feeling generally unwell and an antibiotic prescription. A three-level model investigated the association between an antibiotic prescription and symptom resolution.

Patients producing discoloured sputum were prescribed antibiotics more frequently than those not producing sputum (OR 3.2, 95% CI 2.1–5.0), unlike those producing clear/white sputum (OR 0.95, 95% CI 0.61–1.48). Antibiotic prescription was not associated with a greater rate or magnitude of symptom score resolution (as measured by a 13-item questionnaire completed by patients each day) among those who: produced yellow (coefficient 0.00; p = 0.68) or green (coefficient -0.01; p = 0.11) sputum; reported any of three categories of feeling unwell; or produced discoloured sputum and felt generally unwell (coefficient -0.01; p = 0.19).

Adults with acute cough/LRTI presenting in primary care settings with discoloured sputum were prescribed antibiotics more often compared to those not producing sputum. Sputum colour, alone or together with feeling generally unwell, was not associated with recovery or benefit from antibiotic treatment.
Association between overweight, obesity and self-perceived job insecurity in German employees
Authors: Muenster Eva , Rueger Heiko , Ochsmann Elke , Letzel Stephan , Toschke André M
Published: March 2011

Background

Recent studies have shown an association between job insecurity and morbidity as well as mortality, however until now, knowledge about a potential association between job insecurity and overweight or obesity has been lacking.

Methods

In order to identify a possible association between job insecurity and overweight or obesity, we analysed data from the German Socioeconomic Panel (GSOEP) 2004/2005, a longitudinal study of private households in Germany. In this representative cohort of the German adult population, living and working conditions were observed. Data on Body Mass Index (BMI) and self-perceived probability of job loss within the next 2 years were available for 10,747 adults either employed or attending training programs.

Results

We identified 5,216 (49%) individuals as being overweight (BMI > 25 kg/m2) and 1,358(13%) individuals as being obese (BMI > 30 kg/m2). A total of 5,941 (55%) participants reported having concerns regarding job insecurity. In the multivariate analysis - after adjustment for relevant confounders - a statistically significant association between obesity and job insecurity (100% probability for losing the job in the following two years) could be observed with an adjusted odds ratio of 2.55 (95% confidence interval: 1.09-5.96).

Conclusions

Because of these results, we were able to conclude that overweight and obese persons perceive job insecurity more often than their normal weight counterparts in Germany and that the concurrence of obesity and job insecurity might lead employees into a vicious cycle. Further research with an emphasis on the occupational setting might be necessary in order to establish useful preventive programmes at the workplace.
Case report of rapidly progressive proliferative verrucous leukoplakia and a proposal for aetiology in mainland China
Authors: Ge Lin , Wu Yun , Wu Lan-yan , Zhang Lin , Xie Bing , Zeng Xin , Lin Mei , Zhou Hong-mei
Published: March 2011

Proliferative verrucous leukoplakia (PVL) is a rare oral leukoplakia and has four features such as chronic proliferation, multiple occurrences, refractoriness to treatment and high rate of malignant transformation. As mentioned above, most PVL cases processed to malignancy over many years, sometimes 20 years. However, this report described a case of rapid progress, which had malignant transformation in a short period. Additionally, the aetiology of PVL was discussed and immunity was proposed as the possible cause.
Multiscale investigation of graphene layers on 6H-SiC(000-1)
Authors: Tiberj Antoine , Huntzinger Jean-Roch , Camassel Jean , Hiebel Fanny , Mahmood Ather , Mallet Pierre , Naud Cecile , Veuillen Jean-Yves
Published: March 2011

In this article, a multiscale investigation of few graphene layers grown on 6H-SiC(000-1) under ultrahigh vacuum (UHV) conditions is presented. At 100-μm scale, the authors show that the UHV growth yields few layer graphene (FLG) with an average thickness given by Auger spectroscopy between 1 and 2 graphene planes. At the same scale, electron diffraction reveals a significant rotational disorder between the first graphene layer and the SiC surface, although well-defined preferred orientations exist. This is confirmed at the nanometer scale by scanning tunneling microscopy (STM). Finally, STM (at the nm scale) and Raman spectroscopy (at the μm scale) show that the FLG stacking is turbostratic, and that the domain size of the crystallites ranges from 10 to 100 nm. The most striking result is that the FLGs experience a strong compressive stress that is seldom observed for graphene grown on the C face of SiC substrates.
Synthesis, structure, and opto-electronic properties of organic-based nanoscale heterojunctions
Authors: Rezek Bohuslav , Čermák Jan , Kromka Alexander , Ledinský Martin , Hubík Pavel , Mareš Jiří J , Purkrt Adam , Cimrová Vĕra , Fejfar Antonín , Kočka Jan
Published: March 2011

Enormous research effort has been put into optimizing organic-based opto-electronic systems for efficient generation of free charge carriers. This optimization is mainly due to typically high dissociation energy (0.1-1 eV) and short diffusion length (10 nm) of excitons in organic materials. Inherently, interplay of microscopic structural, chemical, and opto-electronic properties plays crucial role. We show that employing and combining advanced scanning probe techniques can provide us significant insight into the correlation of these properties. By adjusting parameters of contact- and tapping-mode atomic force microscopy (AFM), we perform morphologic and mechanical characterizations (nanoshaving) of organic layers, measure their electrical conductivity by current-sensing AFM, and deduce work functions and surface photovoltage (SPV) effects by Kelvin force microscopy using high spatial resolution. These data are further correlated with local material composition detected using micro-Raman spectroscopy and with other electronic transport data. We demonstrate benefits of this multi-dimensional characterizations on (i) bulk heterojunction of fully organic composite films, indicating differences in blend quality and component segregation leading to local shunts of photovoltaic cell, and (ii) thin-film heterojunction of polypyrrole (PPy) electropolymerized on hydrogen-terminated diamond, indicating covalent bonding and transfer of charge carriers from PPy to diamond.
Recent pattern of Co-infection amongst HIV seropositive individuals in tertiary care hospital, kolkata
Authors: Saha Kallol , Firdaus Rushna , Santra Poonam , Pal Jyotirmoy , Roy Arnab , Bhattacharya Mihir K , Chakrabarti Sekhar , Sadhukhan Provash C
Published: March 2011

Background

Opportunistic Infections (OIs) and co-infections are the major cause of deaths amongst HIV infected individuals and this mostly depends upon the risk factors, type of exposure and geographic region. The commonest types of infections reported are tuberculosis, chronic diarrhoea, oral candidiasis, herpes simplex virus-2, cytomegalovirus, hepatitis B virus and hepatitis C virus. Due to the scarcity of OIs data available from this region, we had designed a study to determine the frequency of different OIs amongst HIV seropositive patients.

Methods

Analysis of the different spectrum of OIs/Co-infections were carried out with 204 HIV sero-positive patients (142 males and 62 females) who visited the HIV/AIDS Apex Clinic in a tertiary care hospital from March 2006 to March 2009. The CD4+ count was estimated using FACS Calibur, the routine smear test, serology, nested RT-PCR and DNA sequencing were carried out to determine the different OIs.

Results

In this study, HIV seropositive patients were mostly from middle age group (31-40 yrs) with CD4+ counts in majority of symptomatic AIDS patients below 200 cells/mm3. The common co-infections/opportunistic infections were OC (53.43%), CD (47.05%), HSV-2 (36.76%), TB (35.29%), CMV (26.96%), HBV (15.19%) and HCV (7.35%). Dual infections, like HSV-2 & CMV (15.38%), HSV-2 & TB (14.61%), HSV-2 & oral candidiasis (24.61%) and CMV & oral candidiasis (14.61%) were significant in follow-up patients. Triple infections were also common e.g., TB, CD, OC infection occurring frequently in about 14.21% of the study population. Multiple infections like OC, TB, CD amongst the viral co-infected patients with HSV-2, HCV, CMV and HBV are also reported in this study. The genotyping analysis of the HCV co-infected HIV individuals shows that two belonged to HCV genotype 1 and 8 belonged to genotype 3.

Conclusions

A wide spectrum of OIs were observed amongst HIV-infected patients in the HIV/AIDS Apex Clinic. Oral candidiasis, CD, CMV and HSV-2, were the common OIs in those patients. This study aims to provide a clearer picture regarding infections occurring amongst HIV seropositive individuals so that the scientific findings could be translated into sustainable prevention programmes and improved public health policies.

Trial registration

None
The medium-term sustainability of organisational innovations in the national health service
Authors: Martin Graham P , Currie Graeme , Finn Rachael , McDonald Ruth
Published: March 2011

Background

There is a growing recognition of the importance of introducing new ways of working into the UK's National Health Service (NHS) and other health systems, in order to ensure that patient care is provided as effectively and efficiently as possible. Researchers have examined the challenges of introducing new ways of working--'organisational innovations'--into complex organisations such as the NHS, and this has given rise to a much better understanding of how this takes place--and why seemingly good ideas do not always result in changes in practice. However, there has been less research on the medium- and longer-term outcomes for organisational innovations and on the question of how new ways of working, introduced by frontline clinicians and managers, are sustained and become established in day-to-day practice. Clearly, this question of sustainability is crucial if the gains in patient care that derive from organisational innovations are to be maintained, rather than lost to what the NHS Institute has called the 'improvement-evaporation effect'.

Methods

The study will involve research in four case-study sites around England, each of which was successful in sustaining its new model of service provision beyond an initial period of pilot funding for new genetics services provided by the Department of Health. Building on findings relating to the introduction and sustainability of these services already gained from an earlier study, the research will use qualitative methods--in-depth interviews, observation of key meetings, and analysis of relevant documents--to understand the longer-term challenges involved in each case and how these were surmounted. The research will provide lessons for those seeking to sustain their own organisational innovations in wide-ranging clinical areas and for those designing the systems and organisations that make up the NHS, to make them more receptive contexts for the sustainment of innovation.

Discussion

Through comparison and contrast across four sites, each involving different organisational innovations, different forms of leadership, and different organisational contexts to contend with, the findings of the study will have wide relevance. The research will produce outputs that are useful for managers and clinicians responsible for organisational innovation, policy makers and senior managers, and academics.
Development of melanopsin-based irradiance detecting circuitry
Authors: McNeill David S , Sheely Catherine J , Ecker Jennifer L , Badea, Tudor C , Morhardt Duncan , Guido William , Hattar Samer
Published: March 2011

Background

Most retinal ganglion cells (RGCs) convey contrast and motion information to visual brain centers. Approximately 2% of RGCs are intrinsically photosensitive (ipRGCs), express melanopsin and are necessary for light to modulate specific physiological processes in mice. The ipRGCs directly target the suprachiasmatic nucleus (SCN) to photoentrain circadian rhythms, and the olivary pretectal nucleus (OPN) to mediate the pupillary light response. How and when this ipRGC circuitry develops is unknown.

Results

Here, we show that some ipRGCs follow a delayed developmental time course relative to other image-forming RGCs. Specifically, ipRGC neurogenesis extends beyond that of other RGCs, and ipRGCs begin innervating the SCN at postnatal ages, unlike most RGCs, which innervate their image-forming targets embryonically. Moreover, the appearance of ipRGC axons in the OPN coincides precisely with the onset of the pupillary light response.

Conclusions

Some ipRGCs differ not only functionally but also developmentally from RGCs that mediate pattern-forming vision.
Persistent hypomagnesaemia associated with pulmonary tuberculosis despite resolution of hypokalaemia
Authors: Medford AR , France AJ
Published: March 2011

We report a case of persistent hypomagnesaemia in a twenty-year-old girl with pulmonary tuberculosis (TB) despite continuous intravenous magnesium supplementation following nutritional replacement and correction of all other relevant electrolyte deficiencies. Untreated hypomagnesaemia can have serious clinical consequences. Previous associations with TB relate to a combination of the disease itself, TB drugs, malnutrition or alcoholism. It may persist despite treatment of TB, electrolyte abnormalities, removal of offending drugs, and nutritional repletion. In such circumstances, even in the normokalaemic TB patient, it is important to retain a high index of suspicion as it may require ongoing treatment.
Hypoglycaemia with Septicaemia: 2 case reports and a review of the literature
Authors: Mcgeough Elizabeth C. , Walker James D
Published: March 2011

Hypoglycaemia can be associated with a number of clinical conditions in patients without diabetes. It can be associated with severe sepsis and hypoglycaemia complicating septicaemia may not always be recognised. We report two cases of spontaneous hypoglycaemia complicating severe sepsis and summarise the literature.
Endogenous Pulmonary Antibiotics
Authors: Gibbons M A , Bowdish D M , Davidson D J , Sallenave J M , Simpson A J
Published: March 2011

The human lung produces a variety of peptides and proteins which have intrinsic antimicrobial activity. In general these molecules have broad spectra of antimicrobial activity, kill micro-organisms rapidly, and evade resistance generated by pathogens. In recent years it has become increasingly apparent that the antimicrobial peptides (AMPs) simultaneously possess immunomodulatory functions, suggesting complex roles for these molecules in regulating the clearance of, and immune response to, invading pathogens. These collective properties have stimulated considerable interest in the potential clinical application of endogenous AMPs.

This article outlines the biology of AMPs, their pattern of expression in the lung, and their functions, with reference to both antimicrobial and immunomodulatory activity. We then consider the biological importance of AMPs, before concentrating on the potential to use AMPs to therapeutic effect. The principles discussed in the article apply to innate immune defence throughout the body, but particular emphasis is placed on AMPs in the lung and the potential application to pulmonary infection.
The Contribution of Medical Physicists and Doctors in Aberdeen to the Evolution of Modern Medical Imaging - SPECT, PET and MRI, 1965-1992
Authors: Mallard John R
Published: March 2011

From the beginnings of medical imaging with radioactivity, an account is given of the development in Aberdeen of Computed Tomography (CT) scanners in Nuclear Medicine, and their clinical value, leading to present-day gamma-cameras. The introduction and clinical use of the cyclotron and Positron Emission Tomography (PET) imager in Aberdeen, has led to a national programme for the cancer patients in Scotland. Early animal work with electron magnetic resonance, which developed into a programme towards nuclear magnetic resonance of water, and then to a quest to build the first clinically-useful whole-body MRI, is described. Successful diagnostic images obtained with it have led to the present-day worldwide use of the MRI technique.
Alexithymia in Diabetes Mellitus
Authors: Topsever P , Filiz Tm , Salman S , Sengul A , Sarac E , Topalli R , Gorpelioglu S , Yilmaz T
Published: March 2011

Background

Diabetes mellitus is a chronic, progressive disease with complex therapy protocols requiring major coping efforts from patients to achieve and maintain glycaemic control in order to reduce risk of diabetic complications. Disease coping strategies including good knowledge of diabetes and high ability of self-care have been reported to be impaired by alexithymic features. Alexithymia is a psychological construct characterised by inability to express emotions verbally, poor imagination and operational thinking, leading to failure in psychological self-regulation.

Objective

To compare prevalence of alexithymia and mean Toronto Alexithymia Scale-26 (TAS-26) scores in diabetic patients with non-diabetic controls; to investigate the association of alexithymia with glycemic control in diabetes.

Method

In this cross- sectional study, TAS-26 scores of 193 diabetic patients and 49 non-diabetic controls were compared. Disease related factors were obtained from patient records. Alexithymia was used as a continuous (mean TAS-26 scores) and semi-quantitative (dichotomised into non-alexithymic 11>TAS-26 scores>11 and alexithymic individuals) variable. Descriptive data are presented as mean±SD, median (range) or %. Differences in means were compared via Independent-Samples T Test and One-Way ANOVA. Proportions were analysed with chi-square test and odds ratios (OR) were calculated via cross tabulation with a confidence interval (CI) of 95%. P<0.05 was considered statistically significant.

Results

The control group was similar with respect to age, gender and education with the diabetic group. In the diabetic study population (n=193, male/female: 42/58%, age 54.2±14.0 years, median diabetes duration 7 years (1-32 years), postprandial blood glucose (PBG) 243±110 mg/dl, HbA1c 7.3±3.6%) prevalence of alexithymia was significantly higher than in the control group (65 % in diabetics vs. 45 % in controls, p=0.011; mean TAS-26 score 12.3±3.7 vs. 10.6±3.6, p=0.004, respectively). Poor postprandial glycaemic control (p=0.002), female gender (p=0.026), combination therapy (p=0.037) and poor educational level (p=0.005) were positively associated with TAS-26 scores in diabetic individuals. Alexithymic diabetic patients were less educated (OR=1.2, p=0.046) and under worse glycaemic control (OR=2.4, p=0.005) compared to their non-alexithymic counterparts.
Flexible Trainees in Scotland
Authors: Macewen CJ , Olson S , Rea C , Needham G , Taylor J , Montgomery J , Chambers M
Published: March 2011

Introduction

Demand for flexible training is increasing. The contribution of such trainees to the trained medical workforce is not clear.

Methods

All full time and flexible trainees in Scotland were ‘tracked’ at the completion of training.

Results

80% of flexible trainees took up a consultant post of which 93% were in Scotland. 82% of full time trainees took up a consultant post of which 80% were in Scotland.

Discussion

Flexible trainees become consultants at the same rate as their full time counterparts. They are commonly geographically tied and are therefore more likely to remain in Scotland and contribute to retention of doctors in this country.
Co-occurrence of Cardiac and Cerebral Hydatid Cysts: A Case Report
Authors: Itumur K , Tamam Y , Karabulut A , Guzel A , Kilic N
Published: March 2011

Cardiac and cerebral hydatid cysts are rarely encountered. In this case, we report a male patient admitted to our hospital with hemiparesis, headache and dysphasia which occurred as a result of complications of both 3,1x3,5 cm single hydatid cyst in the left cardiac ventricle and multiple cerebral hydatid cysts (approximately 18 particles, the largest being 3× 2,2cm). He had undergone surgery 17 month earlier due to a multiple brain hydatid cysts. Although he had been treated with albendazole, multiple cerebral hydatid cysts re-appeared 17 months after operation. This was a rare case in which left ventricular intracavitary hydatid cyst occurred together with brain multiple cysts at the same time. Physicians should be alert about the probability of cardiac involvement when a cerebral hydatid cyst is diagnosed and appropriate investigations should always be conducted.
Management of COPD in Primary Care in North-East Scotland
Authors: Cleland J , Mackenzie M , Small I , Douglas G , Gentles I
Published: March 2011

Introduction

We wished to obtain a snapshot of current service provision and how this could best be developed approximately one year on from the introduction of the National Institute for Clinical Excellence (NICE) guidelines for the management of chronic obstructive pulmonary disease (COPD) and the inclusion of COPD care in the New GMS Contract Quality and Outcomes Framework (QOF).

Methodology

A questionnaire-based survey sent to every general practice (n = 84) in Grampian.

Results

Responses were received from 75 of 84 practices (89%). Questionnaires were returned by both general practitioners (GPs) and practice nurses in 45 practices (54%). All responding practices reported that they had COPD registers. 60/75 (80%) of practices reported having a dedicated COPD clinic; 70/75 (93%) had a spirometer. Areas identified for service development were: quality assuring training in COPD care and spirometry; expanding pulmonary rehabilitation provision (86%), delivering this service locally (54%) and in primary care (75%); standardising referral, assessment and communication about provision of home oxygen; training in pulse oximetry (71%).

Conclusion

This data has important implications for the validity of the quality indicators (QOF) under the new GMS contract. Our respondents identified areas where the new GMS contract QOF could be improved, as well as providing useful suggestions for service development. Respondents recognised that not all clinical services can be effectively delivered by general practice with data supporting the development of intermediate care services for people with COPD.
Urgent In-Patient Coronary Angiography: A Comparison of Centres With and Without Cardiac Catheter Facilities
Authors: Leslie Sj , Henriksen Pa , Timlin H , Stanton T , Spratt Jc , Denvir Ma
Published: March 2011

Objectives

To review the referral of patients to a tertiary centre for urgent angiography and to determine if there are differences in invasive treatment strategies for patients with acute coronary syndrome (ACS).

Methods

There were 2 parts to the study, a retrospective part over 3.5 years from a computerised cardiac laboratory booking data base and a prospective part over 3 months.

Results

There were 1190 urgent in-patient angiograms performed with 499 (42%) admitted initially to the tertiary centre while the remaining 691 (58%) were admitted to district general hospitals (DGH), with no on-site access to a cardiac laboratory, and subsequently transferred to the tertiary centre. Once referred, DGH patients waited longer for their angiogram (2.7 ± 3.2 vs 2.0 ± 2.8 days, p <0.0001). Interestingly, DGH patients appear to spend an average of 4 days in hospital prior to referral for angiography. DGH patients were more likely to have a higher Thrombosis in Myocardial Infarction (TIMI) risk score at presentation and following angiography were more likely to have coronary artery bypass graft (CABG) or percutaneous coronary intervention (PCI) and less likely to have angiographically normal arteries.

Conclusions

Our findings are consistent with previous studies demonstrating that access to coronary angiography varies considerably between hospitals. However, we have demonstrated that patients in DGHs wait on average 4 days before referral for coronary angiography suggesting that there may be triage based on initial responses to medical therapy. Further research is needed to determine whether this has a direct effect on outcomes.
Are Medical Students Adequately Trained to Prescribe at the Point of Graduation? Views of First Year Foundation Doctors
Authors: Han Wh , Maxwell Srj
Published: March 2011

Background

Drugs are the major therapeutic intervention provided by most doctors throughout their careers. The General Medical Council expects all medical students to be competent to prescribe at the point of graduation.

Aims

The aim of this study was to assess the views of Foundation Year 1 (FY1) doctors who had recently graduated from the University of Edinburgh about their training and competence in relation to the use of drugs based on their early clinical experience.

Method

A questionnaire was constructed based on Tomorrow's Doctors 2002 and distributed to FY1 doctors who graduated in August 2005.

Results

Responses were received from 100 (39.8%) of the doctors who graduated in 2005. Only 32% respondents considered themselves ‘competent to prescribe’ at the point of graduation. Less than 50% of respondents felt comfortable in providing information about possible treatments to allow patients to make informed decisions about their care. The majority of respondents complained about a lack of formal teaching and practice at basic clinical skills relating to drug therapy.

Conclusion

Many graduates feel under-prepared to take on prescribing responsibilities after graduation. These findings emphasise the need to ensure that all medical curricula are able to provide sufficient learning opportunities and robust assessment in this important area of clinical practice.
Multiple Aneurysms
Authors: Cornell R. L. , Murie J. A.
Published: March 2011

Idiopathic aneurysms, occurring at multiple sites throughout the arterial tree, are rare. This report describes a case of multiple asymptomatic arterial aneurysms of uncertain origin, involving the aorta and lower limb vasculature, in a 70 year old man. The clinical presentation, vascular reconstruction and a brief review of the literature are described.
Ventricular Aneurysm as a cause for post traumatic tachycardia – a case report
Authors: Beastall J E , Hadden W A , Pandit S
Published: March 2011

The purpose of this case is to illustrate an interesting cause of a common symptom. It is designed to make the reader aware of the possibility of post traumatic ventricular aneurysm. It also illustrates the difficulty involved in making an unusual diagnosis in the Intensive Care setting.
It's Getting Better: Progress in Medical Senior House Officer Training in Scotland
Authors: Roberts M , McHardy K , Wakeling J , Dalgetty E , Cadzow A , Bagnall G
Published: March 2011

Objectives

To identify factors which influence the quality of education and training for medical senior house officers (SHOs) in Scotland compared to a study in 1995.

Design

Postal questionnaire to collect both qualitative and quantitative data.

Participants

All 640 SHOs in hospital general medicine and medical specialty posts were identified; 395 (62%) responded.

Main outcome measures

Working patterns, experience of education and training, career choice, and an “attitudes to work” scale.

Results

Sixty seven percent of SHOs had been in post for 2 years or less. Seventy three percent work some form of shift pattern compared to 28% in 1995. There were improvements in on the job feedback (92% v 27%), and awareness of educational supervisors (96% v 48%). SHO specific teaching was only available to 49% and was rarely bleep-free. Sixty eight percent had made career decisions. There was a statistically significant improvement in 20/25 components of an attitudes to work scale.

Conclusions

Overall medical SHOs have more positive attitudes to their work in 2003 than in 1995, mirroring educational improvements in the work place and changes in working patterns. There remain challenges particularly in provision of formal educational activities.
Nineteenth Century Medical Education for Tomorrow's Doctors
Authors: Waterston SW , Laing MR , Hutchison JD
Published: March 2011

Many of the ideas contained within the GMC's ‘Tomorrow's Doctors’ could be considered as old ideas reworked for modern medical education. Sir John Struthers, a pioneer in the field of medical education, touched on many of the issues in ‘Tomorrow's Doctors’ in his writings published over one hundred years ago. The study of the history of medicine, often neglected by members of our profession in the search for new ideas, is not only of interest, but is valuable to current and future medical education. History illustrates the mistakes of the past, but also helps highlight the successes and insights that remain applicable and relevant today.
Acute renal failure precipitated by Diclofenac in a volume depleted child
Authors: Athavale D , Sivapunniam SK , Beattie TJ
Published: March 2011

Anti-pyretic and analgesic usage of non-steroidal anti-inflammatory drugs (NSAIDs) is commonplace in paediatric practice. The nephrotoxic effects of Non-steroidal anti-inflammatory drugs (NSAIDs) are well documented and increasingly cases of Acute Renal Failure (ARF) precipitated in volume-depleted states in children following NSAIDs usage is being recognised. We report a significant case of ARF in a volume depleted child precipitated by a single dose of Diclofenac, highlighting an important clinical message – adequate hydration is essential, prior to administration of any NSAID, in order to prevent acute renal failure.
A Survey of the Training Needs of the National Panel of Specialists
Authors: Tochel C , Williams B
Published: March 2011

Background

A survey of National Panellists (NPs) in Scotland was undertaken to establish their current skill base and what training would be required to enable them to carry out appointment committee responsibilities effectively.

Methods

A questionnaire was sent to all NPs in November 2005 requesting their views on the importance of a range of issues covering the appointment process for Specialist Registrars (SpRs) and Consultants.

Results

Three quarters of NPs responded. Half (51%) had not undertaken training in the appointments process. Many (46%) of those who considered that employment legislation was important, rated their knowledge as ‘none’ or ‘poor’. Of those who considered that knowledge of equal opportunities legislation was important, 15% rated their knowledge as none or poor.

Conclusion

NHS Education for Scotland (NES) has been encouraged to bring forward training courses to prepare NPs with respect to employment and equal opportunities legislation relevant to the appointment of Consultants and SpRs. A resource package of information about professional/regulatory body guidance, and other pertinent information should also be made available for NPs.
Scotland, Malawi and Medicine: Livingstone's Legacy, I Presume? An Historical Perspective.
Authors: Lwanda John
Published: March 2011

In this personal short historical perspective I reflect on aspects of the medical history of Malawi, formerly Nyasaland, highlighting the role of Scotland and its people in the development of the Malawi medical services in both the colonial as well as the postcolonial period which began in 1964. The paper, after discussing the history of medical training in Malawi and current constraints and challenges, goes on to make some suggestions - based on historical lessons - about future role of Scottish involvement in Malawi's medical development. It would be unfortunate if, in a rush to ‘help or do something’ the mistakes of the past are repeated.
Small bowel obstruction: an unusual cause.
Authors: Steven MJ , Jabaar A
Published: March 2011

A bezoar is a tightly packed collection of partially digested or undigested material. When this material is vegetable matter it is known as a phytobezoar, when it is hair it is a trichobezoar and when it is medication a pharmacobezoar. Phytobezoars are a known cause of small bowel obstruction in patients who have had previous gastric surgery. Two cases of small bowel obstruction caused by phytobezoars are discussed in patients with no risk factors. The cause, clinical features and management of phytobezoars is reviewed in an attempt to increase awareness of this unusual cause of small bowel obstruction.
Lymphoepithelial cyst of the pancreas. A case report
Authors: Fraser L , Komolafe OO , Anderson JR
Published: March 2011

We present the case of a 63 year-old male who presented with a cystic lesion of the distal pancreas. Excision and histology showed this to be a lymphoepithelial cyst. Cystic lesions of the pancreas represent a diagnostic challenge, especially when pseudocyst secondary to pancreatitis is excluded. These lesions can be broadly classified into benign, pre-malignant and malignant. Widely used imaging modalities such as CT and MRI are not able to categorically differentiate between these. More invasive procedures such as endoscopic US and FNA again do not give a cast-iron diagnosis. Our patient had a symptomatic cystic lesion in his pancreas which was excised after cross-specialty discussion. We advocate that this is the ideal way to treat patients with cystic lesions of the pancreas, with each case considered on its own merits as all current diagnostic investigations have their limitations.
Complete Heart Block caused by a Cardiac Metastasis: A Rare Presentation of Lung Cancer.
Authors: Pettit Stephen J , Roditi Giles , Davidson Scott
Published: March 2011

We report the case of a 73 year old female who presented with recurrent short-lived episodes of loss of consciousness. She had complete heart block due to a cardiac metastasis within the interventricular septum from a probable primary carcinoma of the lung. This metastasis was not detected on echocardiography but was identified on computed tomography imaging. Cardiac metastases are an uncommon clinical problem, but are present at post mortem examination in up to 25% of patients who die of malignant disease. Detailed assessment of cardiac anatomy should be considered when individuals present with complete heart block and possible malignant disease.
Should We Prescribe Heroin? A Current Scottish Debate.
Authors: Gallagher J , McKeganey N
Published: March 2011

There have been recent calls from within both Scotland and England for the wider prescription of heroin to heroin addicts as a way of coping with our burgeoning drug problem and as a route to reducing drug related criminality. But how feasible is heroin prescribing in this context? This paper considers some of the existing research evidence relating to heroin prescribing and looks also at the ethics and practicalities of prescribing heroin to heroin addicts in Scotland. We conclude that whilst the evidence on the benefits of heroin prescribing is far from clear cut there is a case for mounting a Scottish trial of heroin prescribing. Such a trial would need to be tightly controlled and rigorously evaluated. It would need to show that heroin prescribing was associated not only with a comparable level of harm reduction, as methadone prescribing, but that it was also an effective route towards drug users' eventual recovery and drug cessation.
Sequelae From Working Under Pressure: Dysbaric Osteonecrosis.
Authors: Irvine David , Leach Mike
Published: March 2011

We describe a 73-year-old gentleman who was referred to haematology for management of myeloma following the discovery of a small plasmacytoma of the tonsil and an osteolytic lesion in the head of his left humerus. Investigation for myeloma was negative and the lytic lesions were explained by dysbaric osteonecrosis rather than myelomatous bone involvement. He had worked on the construction of the Clyde tunnel between 1958 and 1963 and had been subjected to repeat compression/decompression cycles. He was diagnosed with a solitary extramedullary plasmacytoma of the nasopharynx, which responded well to local radiotherapy.
Neuro-ophthalmic complications after coronary angiography
Authors: Muqit MMK , Weir CR , Ballantyne J , Dunn FG , Goodfield NER
Published: March 2011

Diplopia and gaze palsies are extremely disabling and distressing problems, especially in patients with significant cardiac co-morbidity. A case of Parinaud syndrome and oculomotor nerve palsy following coronary angiography (CA) is reported. These neuro-ophthalmic complications are not previously documented in the literature in association with CA. The case raises awareness of potential ocular motility deficits that may occur following CA. Potential risk factors during CA are analysed and the mechanisms of the embolic pathway are discussed.
Paroxysmal cold haemoglobinuria leading to acute renal failure: A case report
Authors: Das K , Hughes D
Published: March 2011

Paroxysmal cold haemoglobinuria (PCH) is a form of autoimmune haemolytic anaemia (AIHA) characterised by sudden onset of haemoglobinuria either spontaneously or following exposure to cold. It was previously believed to be a rare form of AIHA, but is now thought to be responsible for up to 40% of cases of acute transient haemolytic anaemia in children1 following viral infections. Although the anaemia can be severe, illness is characteristically of short duration and does not recur. Published reports of PCH in children leading to renal impairment are rare, with supportive management only being used in affected cases.2, 3 We describe the case of a 2-year-old boy who developed acute renal failure (ARF) secondary to PCH, requiring peritoneal dialysis, where the early institution of plasma exchange was associated with rapid recovery of renal function.
Hepatic abscess secondary to gallbladder perforation: Case report and literature review
Authors: Masood Mr , Ali M , Burgaul R , Smith A
Published: March 2011

Pyogenic hepatic abscess is an uncommon disease, and hepatic abscess secondary to gallbladder perforation is even rarer. We present a case of hepatic abscess secondary to gallbladder perforation, who presented with nonspecific clinical features. The diagnosis was made by radiological imaging and it was treated by percutaneous drainage followed by drainage of hepatic abscess and cholecystectomy. There are very few reported cases of hepatic abscess secondary to gallbladder perforation, we report one such case and also review the literature for similar cases.
Postoperative hypercapnic respiratory failure in patients with obstructive sleep apnoea: treatment with non-invasive ventilation
Authors: Dorkova Z , Somos A , Orolin M , Farah J , Joppa P , Tkacova R
Published: March 2011

Acute hypercapnic respiratory failure is a rare but life-threatening complication in grossly obese patients with severe obstructive sleep apnoea (OSA). Facial trauma or upper airway surgery, respiratory tract infections, bronchospasm, use of pain medication and concomitant obstructive or restrictive pulmonary impairment predispose to the development of respiratory failure in such patients. We present a case of a morbidly obese male patient in whom moderately severe OSA (the apnoea-hypoponea index, AHI of 37/hour) was treated with uvulapalatopharyngoplasty (UPPP) because he declined treatment with non-invasive ventilation. The early postoperative period was complicated by severe hypercapnic respiratory failure in association with worsening of OSA: arterial PO2 was 4.14 kPa, PCO2 9.7 kPa, AHI increased to 93.8/hour, minimal nocturnal arterial oxygen saturation was 46%. Therapy with non-invasive ventilation using bi-level positive airway pressure (BiPAP) was initiated immediately, and resulted in marked improvements in the patient's clinical condition, in association with the improvements in arterial blood gases. Before the discharge, nocturnal continuous positive airway pressure (CPAP) therapy to treat OSA on the long-term basis was initiated. Two months after the release, the patient's blood gases were within the normal range, and he reported marked improvements in his clinical condition including alleviation of daytime sleepiness and increased physical endurance. Our case demonstrates that in the presence of severe OSA, life-threatening hypoxaemia and hypercapnia were successfully alleviated using BiPAP in the postoperative period after UPPP.
Somatostatinoma: a rare cause of diabetic ketosis
Authors: AK Viswanath , JM Seymour , JAH Wass , JS Bevan
Published: March 2011

Somatostatinomas are rare gut neuroendocrine tumours. The classical ‘somatostatinoma syndrome’, secondary to the inhibitory action of somatostatin, comprises mild diabetes mellitus, gall bladder disease and diarrhoea with steatorrhoea. The diabetes is usually mild and not associated with major ketosis.

We describe a 72 year-old man who presented with severe metabolic upset (hyperglycaemia, ketonuria and acute renal failure). He had lost significant amount of weight and was found to have extensive liver metastases. Biopsy confirmed a carcinoid tumour and somatostatin levels were markedly elevated in keeping with a diagnosis of metastatic somatostatinoma (probably of pancreatic origin). Paradoxically, a somatostatin analogue (octreotide, Sandostatin LAR) effectively controlled his symptoms and although insulin-dependent his daily requirement was never higher than 16 units.

We speculate that his tumour secreted a spectrum of somatostatin-related peptides with a relatively greater inhibitory effect on the pancreatic secretion of insulin, compared to glucagon, and that this was responsible for the severe metabolic derangement at first presentation. Glycaemic status should always be assessed in patients with newly presenting carcinoid tumours.
Acute Paediatric Neck Abscesses
Authors: Wynne DM , Borg HK , Botma M , Macgregor F
Published: March 2011

Acute neck swellings in a paediatric setting are often treated with antibiotics, proceeding to incision and drainage if an abscess is suspected. A variety of investigations are available and the causative organism can vary. A five-year retrospective study analysing trends in microbiology, antibiotic sensitivity, clinical evaluation and management of children presenting with an acute cervical abscess of four weeks duration or less was performed.

The case notes of 175 children admitted between January 1996 and December 2000 to the acute surgical admission unit at the Royal Hospital of Sick Children, Glasgow were studied.

During this period there were 90 males and 85 females with a mean age of three years (range: one month to 13 years). One hundred and twenty three (70%) children underwent surgery with pus being confirmed in 114 (93%) of cases. Ultrasound was performed in 70 (40%) patients with 48 proceeding to surgery. Positive culture of pus from abscess cavities revealed Staphylococcus aureus in 46% (85% sensitive to both flucloxacillin and erythromycin) and Streptococcus pyogenes in 15% (80% sensitive to penicillin and 75% to erythromycin).

The role of investigations and the available treatment options are discussed.