bluuebunny/crossref_metadata_2025 huggingface dataset:
Stop the Brain Drain: Ways to Improve Recruitment and Retention to Scottish Consultant Posts
Authors: Wakeling J , McGregor JR , Bagnall G
Published: March 2011

Background and aims

NHS Scotland loses approximately one-third of Specialist Registrars (SpRs) it trains to consultant posts elsewhere. This has considerable resource and service implications and is the cause of intense political frustration. This study sought to gather data about the career intentions of SpRs and to discover what factors influence their career decisions.

Methods

All SpRs in Scotland due to gain their Certificate of Completion of Specialist Training (CCST) between April 2005 and March 2006 were approached to take part in an interview about their career aspirations. Interviews, using a structured interview schedule, took place in spring 2005.

Results

198 SpRs were interviewed - 75% of the target population. Almost threequarters would prefer to stay in Scotland if possible, but when asked to realistically predict where they would take up a consultant post, this proportion had dropped to 64%. Perceived barriers to working in Scotland included the large number of District General Hospital (DGH) posts (often with onerous on-call rotas). A further problem concerned poor information flow between NHS Boards and trainees, with trainees being lost to Scotland who might have stayed if a job had been advertised in time.

Conclusions

The majority of SpRs would prefer to stay in Scotland for their consultant career. There is a need to improve information flow between NHS Boards and trainees. NHS Boards need to know more about the career intentions of trainees and training committees and trainees need to be informed as to when and where posts will be advertised. Posts in DGHs might be made more appealing by having some sessions in larger teaching hospitals (although split-site working is not always popular). Flexibility and part-time options need to be promoted.
Audit of Literacy of Medical Patients in North Glasgow
Authors: Dani KA , Stobo DB , Capell HA , Madhok R
Published: March 2011

Aims

We aimed to assess the scale of the problem of illiteracy among our hospital's general medical in-patients and investigate any influence on literacy from gender, age, socioeconomic status, disease process and number of prescribed medications.

Methods

We employed a shortened version of the previously validated Rapid Estimate of Adult Literacy in Medicine (REALM) tool with medical inpatients at Glasgow Royal Infirmary. We also recorded gender, date of birth and clinical problem. Socioeconomic status was estimated from the patient's postcode using the Scottish Index of Multiple Deprivation (SIMD).

Results

60 patients were invited to participate, however six (10%) declined. We therefore gathered data for 54 patients (54% male) with a mean age of 67 years. The female group had a significantly higher mean age of 73 years versus 62 years in men. The mean SIMD quintile was 3.5 (1 least deprived, 5 most deprived) and the mean number of medications was 7. 55% of our patients had a mean score of<60 which represents low health literacy. There were no significant differences in literacy between men (median score 59) and women (median score 60). Reading ability was not found to be associated with socioeconomic group, diseased body system or number of medications on the drug chart (data not shown).

Conclusions

Low level health literacy is prevalent. Affected individuals may have difficulty understanding patient-orientated health literature, medication instructions, clinic appointment cards and hospital signage.
An Audit of the Value of Pre-Operative Electrocardiograms before Surgery (General Anaesthetic) in a Day Surgery Unit
Authors: Ho C
Published: March 2011

Background

As the population presenting for day-case surgery and anaesthesia increases, so does the challenge of adequate pre-operative assessment. The resting 12-lead electrocardiogram (ECG) is relatively insensitive and frequently normal even in the presence of severe coronary artery disease but it is quick, easy to perform and frequently requested, thus its value in day-case surgery remains unproven.

Aims

To assess whether patients at Day Surgery Unit, Gartnavel General Hospital who fit the ECG criteria get an immediate ECG and also to review whether abnormal ECG results leads to any change in the patient's management.

Methods

A prospective audit was performed on all patients coming in for noncardiac day-case surgery over a 3-week period between February 2006 and March 2006. Patient notes were reviewed before their surgery.

Results

60 patients presenting for day-case surgery over this period should have had an ECG done but only 24 were referred. A significant abnormality was noted in 12.5% of ECGs. None of these patients had their surgery postponed or management changed. No adverse events occurred in patients proceeding to surgery and there were no cases of peri-operative cardiovascular complications or admissions to hospital.

Conclusion

The finding of ECG abnormalities did not prevent the patient proceeding directly to anaesthesia and surgery. Furthermore, they did not predict intra-operative, postoperative complications or hospital admission following the procedure. The ECG is of limited value in the risk stratification of patients selected for day-case surgery.
Gallstone ileus - an unusual presentation in an underweight older women
Authors: Selwyn J K , Witham M D , Flatman K , Meldrum S , Mcmurdo M E T
Published: March 2011

Gallstone ileus is an uncommon and peculiar complication of cholelithiasis in an older population. Perioperative mortality rates are high as this condition is difficult to diagnose, often lead to delay in treatment and high percentage older patients have multiple co-morbidities. Atypical presentations are common in older patients, most of who present to medical rather than surgical units, further delaying definitive treatment. We discuss a 79 year old female patient who presented with severe dehydration due to gastrointestinal symptom with no typical clinical signs of intestinal obstruction.
Seeing Through The Problem: The Use Of 3-D CT Reconstruction In The Removal Of Multiple Foreign Bodies
Authors: Stormer Emma , Watt Andrew , Davis Carl
Published: March 2011

We report an unusual but invaluable use of three dimensional computed tomography (CT) reconstruction for the removal of multiple foreign bodies in a 7 year old boy following trauma. In a road traffic accident (RTA) a 7 year old boy sustained multiple facial lacerations from shattered glass. Facial CT scans were performed to exclude a mandible fracture requiring intervention, following which it was possible provide three dimensional reconstructions of the boy's face revealing thirteen pieces of glass. Using this reconstruction as a guide in theatre twelve of the thirteen pieces of glass were retrieved with a satisfactory cosmetic result.
The Introduction of a Chest Pain Nurse and Fast-Track Troponin Service Reduces the Length of Stay of Patients Presenting with Chest Pain.
Authors: Motherwell DW , Rogers J , Kellagher M , Craig D , O'Reilly DSJ , Cobbe SM
Published: March 2011

Background

Troponin I (TnI) measurement is important in decision making and management of patients who present with chest pain. Undetectable levels of TnI in these patients are associated with a low risk of death or myocardial infarction at 30 days, and may allow early discharge from hospital.

Methods

An audit was performed tracking patients who presented with chest pain and had a TnI blood test requested. Routine clinical service was audited for three months. A “fast-track” troponin service and chest pain specialist nurse was then introduced to assist in the management of patients. This was continued for three months to assess the impact on length of stay.

Results

446 patients were admitted during the first three month period and 511 patients admitted during the second monitoring period when the new measures were introduced. The time from chest pain onset until the TnI blood test was taken reduced from 23.0 hours to 20.3 hours. The percentage of patients admitted to hospital wards from the Acute Medical Receiving Unit (AMRU) fell from 62% to 53% (p<0.001). The new measures resulted in a reduction in admission time from 73.1 hours to 51.0 hours.

Conclusion

A fast-track troponin and specialist nurse achieved a reduction of nearly 24 hours in length of stay in patients presenting with chest pain. This would result in a saving of approximately 2000 bed-days per annum, releasing 5-6 acute beds per day.
Key Issues in the Management of Atrial Fibrillation - Protecting the Patient and Controlling the Arrhythmia
Authors: Jenkins S M M , Dunn F G
Published: March 2011

Atrial fibrillation (AF) is the most common sustained tachyarrhythmia and its prevalence is increasing. It is an independent risk factor for stroke and is associated with significant morbidity and mortality. AF currently accounts for 1% of NHS expenditure. The management of AF has a broad evidence base and both the American College of Cardiology/American Heart Association/European Society of Cardiology (ACC/AHA/ESC) and the National Institute for Clinical Excellence (NICE) have recently published guidelines. Some controversy persists regarding stroke risk stratification and appropriate anticoagulation regimes although a general consensus is now emerging. Rate and rhythm control strategies have been shown to be comparable in terms of clinical outcomes. Current anti-arrhythmic drugs have limited efficacy and significant side-effect profiles. Electrophysiological and surgical interventions have a role in both strategies. This article broadly reviews the evidence for different management strategies in AF and presents a practical approach to treatment in light of the recently published national and international guidelines.
Accidental Ingestion of Steradent Tablets in a Patient with Cognitive Impairment
Authors: Laidlaw S
Published: March 2011

Accidental ingestion of medicines and household goods can be a problem in people with cognitive impairment. There is significant associated morbidity and mortality. Here we present a case of an 87-year-old gentleman with vascular dementia who accidentally ingested two Steradent denture-cleaning tablets. He rapidly developed acute upper airway obstruction and extensive oesophageal ulceration. He required intubation and ventilation. This case reinforces the importance of minimising the risk of accidental ingestion.
Predicting Outcome in Patients with Acute Coronary Syndrome: Evaluation of B-Type Natriuretic Peptide and the Global Registry of Acute Coronary Events (GRACE) Risk Score
Authors: Sinclair H. , Paterson M , Walker S. , Beckett G , Fox K.A.A.
Published: March 2011

Background

Accurate risk stratification soon after admission for patients with acute coronary syndromes (ACS) is vital in guiding management. Clinical risk scores and B-type natriuretic peptide (BNP) can predict mortality and re-infarction in ACS, but it is unknown whether BNP provides prognostic information over and above that of the clinical risk scores.

Methods

142 unselected patients with ACS were prospectively studied. BNP was measured and patients were stratified according to BNP and Global Registry of Acute Coronary Events (GRACE) score. In-hospital and 30-day events were characterised.

Results

20.4% of ACS subjects had ST-elevation myocardial infarction (MI), 14.1%, non-ST elevation MI and 65.5% unstable angina. Elevated BNP predicted inhospital and 30-day heart failure (p<0.01), and the risk of in-hospital recurrent ACS (p<0.05). Increasing GRACE score predicted in-hospital recurrent ACS (p<0.05), heart failure (p<0.001), arrhythmias (p<0.05) and angioplasty (p<0.05). GRACE score also predicted 30-day heart failure (p<0.05). In contrast, the predictive accuracy of troponin elevation was less robust.

Conclusion

BNP and the GRACE score predict complementary outcomes from ACS, but both predicted heart failure. BNP is a powerful indicator of heart failure in patients with ACS and provides prognostic information above and beyond conventional biomarkers and risk scores.
Sir William Macewen (1848-1924): Surgeon and Clinical Photographer
Authors: Summerly P
Published: March 2011

The eminent surgeon Sir William Macewen (1848-1924), kept a series of Private Journals (PJs) of cases he encountered on the surgical wards of the Glasgow Royal Infirmary (GRI). From 1881 photographs featured in the PJs, soon afterwards Macewen began to duplicate images and mount them on boards, which formed the basis of his teaching collection. When he moved to the University of Glasgow and the Western Infirmary, Glasgow (WI) in 1892 Macewen continued to expand his collection of clinical photographs.
Otitis Externa - what a pain in the neck!
Authors: Suh Yaeeun , Ilyas Shahzad , Bejjanki Nithin K , Al-Nammari Shafic S
Published: March 2011

We report on the first case of pyogenic spondylodiscitis caused by otitis externa, which arose by haematogenous spread. Pyogenic spondylodiscitis is a serious condition and it is imperative to have a high index of suspicion for this condition in any patient that has back or neck pain, systemic upset and raised inflammatory markers.
Splenic infarction due to infectious mononucleosis
Authors: Ashawesh K , Abdulqawi R , Chandrappa BN , Srinivasan K.S.
Published: March 2011

Splenic infarction due to Infectious mononucleosis is very uncommon. We describe a rare case of acute Epstein-Barr virus infection in which the patient presented with acute abdominal pain secondary to splenic infarction.
Lateral cutaneous nerve of thigh injury following TEPP laparoscopic inguinal hernia repair
Authors: Simpkins C , Cota AM , Johnson N
Published: March 2011

A 40-year-old gentleman underwent a routine TEPP (trans-extraperitoneal) procedure without the use of staples to fix the mesh. He presented with symptoms of lateral cutaneous nerve of the thigh injury. We present this rare complication and its management.
The Management of Renal Failure in Patients with Liver Disease. Experiences from a District General Hospital.
Authors: Manning JJ , Hislop WS , Mcpeake JR
Published: March 2011

Aim

To compare the pre-existing management of patients with Hepatorenal Syndrome (HRS) in the gastroenterology unit of the Royal Alexandra Hospital, Renfrewshire, with the published evidence based studies.

Method

A retrospective, 6-month, case record review of patients diagnosed with HRS was performed. An evidence-based protocol for the diagnosis and management of HRS was introduced into the unit, to aid patient treatment prospectively. After 6 months, both compliance with the protocol, and patient outcomes were analysed.

Results

Eleven patients were identified in the first part of the audit cycle, all of whom died. Seven were identified in the second cycle. Two had their renal function successfully corrected and one was discharged from hospital. Renal impairment and staging of liver disease was equivalent in both groups. The second group received more appropriate and aggressive therapy. Alcohol was the causative aetiology of liver disease in all patients.

Conclusions

Targetted therapy in patients with severe liver disease and HRS can improve renal parameters. Previous studies have shown this to be linked with improved patient outcomes.
Langerhans cell histiocytosis of the cervical spine: A post traumatic presentation.
Authors: Aw J , Wheeler K , Cadoux-Hudson TAD , Jones A
Published: March 2011

Langerhans cell histiocytosis occurring at critical sites can cause both diagnostic difficulty and risk for morbidity. We present a case report of a 17 year old male who presented with neck pain following a sports injury. He was initially treated with analgesia but due to persistent pain he presented to the emergency department. A plain radiograph revealed a pathological fracture with osteolytic destruction of C4. Further investigations and surgical spinal stabilisation under orthopaedic care revealed a biopsy proven diagnosis of solitary histiocytosis of C4. He recovered completely with normal function. This case report contributes to the clinical experience of this rare entity and gives a review of the literature on this rare but highly significant disease.
Hydroceles: Disturbing Discoveries During Routine Repair
Authors: Ganai B , Seywright M , Hendry D
Published: March 2011

Hydroceles are a common presenting complaint to the urological surgeon. They are known to harbour malignancy in a small percentage of cases. We report a case of malignant mesothelioma of the tunica vaginalis and a case of isolated lymphoma of the spermatic cord, both presenting during routine hydrocele repair. These are both rare diagnoses with a handful of reported cases worldwide. The literature of both these pathological entities is reviewed.
Community acquired MRSA sub-acute osteomyelitis of the tibia in a child
Authors: Maceachern CF , Patton MS , Dougall TW
Published: March 2011

A previously fit and well child attended accident and emergency with increasing pain in his left lower leg after sustaining a laceration to the pre-tibial border of his left leg at a local swimming pool 2 months previously. X-rays at time of presentation showed the formation of a Brodie's abscess. Following incision, debridement and drainage, samples sent to the laboratory confirmed histological features consistent with sub-acute osteomyelitis. Microscopy and Cultures demonstrated Methacillin Resistant Staphylococcus aureus (MRSA) of a type seen in community acquired infection. Based on this report we would advocate MRSA being considered as a possible causative organism in acute or sub-acute osteomyelitis even in an otherwise healthy child with no prior hospital exposure.
Mitochondrial disorder overlapping with aorto-iliac occlusive disease (Leriche-syndrome)
Authors: Finsterer J
Published: March 2011

Objectives

Diagnosing mitochondrial disorder (MCD) is challenging if symptoms and signs of a second trouble overlap with those of the MCD.

Case report

A 54-yo male developed muscle pain in his proximal lower and distal upper limbs, easy fatigability and exercise intolerance, and myoglobinurea. Based upon the clinical presentation, recurrent creatine-kinase elevation, highly abnormal lactate stress testing, abnormal muscle biopsy, and a positive MRI spectroscopy, MCD was diagnosed. Based upon progressing pain of the lower limbs, the development of claudication, recurrent falls, nightly, muscle cramping, gait disturbance, erectile dysfunction, the inability to sit, and an angiography revealing stenosis of the distal aorta, occlusion of the right iliac and left internal iliac and stenosis of the left external iliac artery, Leriche-syndrome was diagnosed. He profited from stenting of the left external iliac artery. Manifestations of MCD remained stable throughout the period of observation.

Conclusion

If the history is misleading or if manifestations of a MCD overlap with those of a Leriche-syndrome, diagnosing either condition is challenging, Atherosclerosis may be a feature of mitochondrial disease
Description of a Chronic Heart Failure Service Model and Review of Pharmacotherapy in a District General Hospital in Comparison to Scottish Intercollegiate Guideline Network (SIGN) Guidelines.
Authors: Ogundipe OA , Cordina J , Norris CA
Published: March 2011

Background

The Scottish Intercollegiate Guidelines Network (SIGN) guideline 95 on the management of chronic heart failure (CHF) was published in February 2007, superseding SIGN guideline 35 of February 1999. The guideline promotes evidence based management of CHF.

Aims

To describe an existing service model and to review our level of concordance with SIGN guidelines.

Methods

We describe a model of a CHF service based in a district general hospital (DGH) in Scotland. We conducted a retrospective review on consecutive new referrals between August and November 2002, and a prospective review of new attendances between September 2005 and January 2006.

Results

In 2002 and 2005/6, 49 and 45 patients were reviewed respectively, with 26 and 28 patients showing left ventricular systolic dysfunction on echocardiography. Median ages of patients were 81 and 79 years respectively. Angiotensin Converting Enzyme Inhibitor (ACEI) or Angiotensin II Receptor Blocker (AIIRB) therapy was in use in 23 (88.5%) and 24 (85.7%) patients respectively. The use of β-blockers, digoxin and spironolactone was shown to have improved between both reviews.

Conclusions

We have been able to demonstrate an improving level of concordance with SIGN guidelines in a district general hospital (DGH) heart failure service model run by care of the elderly physicians and supported by specialist nurses.
Are Grampian General Practitioners Good Gatekeepers for Access to Emergency General Surgical Care?
Authors: Mitchell AI , Keenan RA
Published: March 2011

Background

Direct admission from primary care is the predominant emergency general surgical referral route in north-east Scotland. Recent primary and secondary care reconfiguration has increased resources necessary to support the current system, therefore alternative models are proposed. We seek to analyse frequency and accuracy of provisional diagnosis by general practitioners within our current admission system.

Method

Presence of referral letter, provisional diagnosis, discharge diagnosis and management were prospectively recorded for all emergency general surgical admissions to Aberdeen Royal Infirmary over three weeks.

Results

One hundred and sixty three primary care admissions: 69.3% from patient's own practice and 30.7% from the out-of-hours service. Of these patients 98.1% came with a referral letter, 86.1% including a provisional diagnosis, which was correct in 43.6% of cases. Fourteen patients (8.6%) were transferred to another ward for treatment.

Discussion

General practitioners provide written provisional diagnoses with most referrals, accurate in almost half of cases, with only a minority of patients requiring transfer for management of presenting problems. This is despite limited investigations, clinical isolation, restricted facilities for examination and limited time for assessment. We believe Grampian general practitioners are good gatekeepers to emergency general surgical care and support the current direct admission pathway.
Fatal Cerebral Toxoplasmosis in a Heavily Immune Suppressed Patient with Waldentrom's Disease
Authors: Maini R , Kv Patil , Mg Rainey , De Villiers F , Prj Ames
Published: March 2011

A 57 year-old gentleman with Waldenstrom's disease developed ecthyma gangrenosum, molluscum contagiosum and fatal cerebral toxoplasmosis. The emergence of these infections is discussed in the light of drug-induced immune-suppression.
How Accurate are Primary Care Referral Letters for Presumed Acute Stroke?
Authors: Mcneill A
Published: March 2011

The introduction of thrombolysis for the treatment of acute ischaemic stroke has increased the importance of prompt and accurate diagnosis. Research has shown a high rate of misdiagnosis of acute stroke in the community by paramedics and primary care doctors (PCDs). In this study, referral letters for presumed acute stroke or Transient Ischaemic Attack (TIA) were audited to assess the diagnostic accuracy of PCDs and the quality of the referral letters. In 30 % of cases, the diagnosis of stroke was correct. Important stroke mimics included sepsis, delirium and functional disorders. PCDs may benefit from a stroke recognition tool to increase diagnostic accuracy.
Vaccination Induced Immunity to the Hepatitis B Virus among High-Risk Groups in Glasgow 1993–2001: Evaluating the Effectiveness of the United Kingdom's Selective Immunisation Policy
Authors: Roy KM , Goldberg DJ , Wilson K , Cameron SO
Published: March 2011

Background and Aims

The United Kingdom has adopted a selective approach to the control of hepatitis B (HBV), vaccinating those at increased risk of infection through lifestyle, occupation or other factors such as close contact with a case or carrier. This paper sought to assess the effectiveness of the targeted HBV vaccination programme, by determining the level of immunity and exposure to HBV infection among three high risk groups (injecting drug users (IDUs), men who have sex with men (MSM) and heterosexuals attending genitourinary medicine clinics) at three time points between 1993–2001 in Glasgow, Scotland.

Methods

Residual sera from i) IDUs having a named HIV test and ii) MSM and heterosexual men and women attending GUM clinics and undergoing routine syphilis serology testing, were tested anonymously for HBV infection.

Results

The overall prevalence of HBV infection remained at a low level in all three risk groups. IDUs continue to be the group at greatest risk of infection.

Discussion

Despite the implementation of new initiatives targeting high-risk groups, vaccination levels remain low in the populations studied.
Basic Surgical Training in the Era of the European Working Time Directive: What are the Problems and Solutions?
Authors: Skipworth RJE , Terrace JD , Fulton LA , Anderson DN
Published: March 2011

Background and Aims

Imposed reductions in working hours will impact significantly on the ability of surgical trainees to achieve competency. The objective of this study was to obtain the opinions of Scottish surgical trainees concerning the training they receive, in order to inform and guide the development of future, high-standard training programmes.

Methods

An anonymous questionnaire was sent to basic surgical trainees on the Edinburgh, Aberdeen and Dundee Basic Surgical Rotations commencing after August 2002.

Results

Thirty six questionnaire responses were analysed. Very few of the returned comments were complimentary to the existing training structure; indeed, most comments demonstrated significant trainee disappointment. Despite “regular” exposure to operative sessions, training tutorials and named consultant trainers, the most common concern was a perceived lack of high-quality, structured, operative exposure and responsibility. Textbooks and journals remain the most frequently utilised learning tools, with high-tech systems such as teleconferencing, videos, CD-ROMS, and DVDs being poorly exploited.

Conclusions

Current surgical training is not meeting the expectation of the majority of its trainees. To solve this problem will require extensive revision of attitudes and current educational format. A greater emphasis on the integration of 21st century learning tools in the training programme may help bridge this gap.
The Effect of Catalytic Converter Legislation on Suicide Rates in Grampian and Scotland 1980–2003
Authors: Skilling GD , Sclare PD , Watt SJ , Fielding S
Published: March 2011

Objective

To examine the effect of catalytic converter legislation on suicide rates in Grampian and Scotland since its implementation in 1993.

Methods

1. Population study in Grampian and Scotland using national population and mortality statistics for 1980 to 2003. 2. Retrospective, controlled cohort study of individuals who had unsuccessfully attempted suicide by motor vehicle exhaust gassing to examine the theory of method substitution.

Results

There was a significant fall in suicides by motor vehicle exhaust gas inhalation in Scotland and Grampian following the introduction of compulsory catalytic converter legislation. However, in the same time period, there was a significant increase in numbers of suicides by hanging and total suicide rates in Scotland. There was a non-significant trend in a small sample of patients from a local hyperbaric unit for an increased rate of subsequent completed suicide between those who had previously attempted suicide by motor vehicle exhaust gas inhalation and controls.

Conclusions

Catalytic converter legislation has resulted in a decrease in the number of suicides by motor vehicle exhaust gas inhalation. Overall suicide rates have not decreased. There is evidence to suggest that those who would have previously committed suicide by motor vehicle exhaust gas inhalation find alternative methods of suicide, so called ‘method substitution’. Initiatives to reduce suicide rates should be directed at those means that are used by impulsive suicide attempters, as other, determined individuals, will commit suicide by another method.
Displaced Intracapuslar Hip Fractures in the Working Age Alcohol-Abusing Patient
Authors: Stearns AT , Jaberoo M-C , Ashraf R , Wheelwright EF , Maclean AD
Published: March 2011

Management of alcohol-abusing patients presenting with intracapsular hip fractures is controversial. The aim of this study was to compare the management and outcome of working-age alcohol-abusing patients with similar-aged controls.

Patients were identified from a prospectively collected database of trauma admissions. Full case notes were available for 78 patients under 65 of age presenting with a displaced intacapsular fracture at a teaching hospital between 1998 and 2002. Thirty seven patients had evidence of alcohol abuse.

Alcohol-abusing patients presented to hospital later (p=0.05), underwent surgery a median of 18 hours later (p=0.011) and required a longer post operative stay (p=0.003) compared to non-abusers. Despite this, the results of internal fixation were comparable. There was no significant difference between alcohol-abusers and nonabusers in rates of avascular necrosis (6.9% vs 9.7%; odds ratio 0.69, 0.11–4.47) or revision surgery (0.21 vs 0.10 procedures/ patient; odds ratio 1.49, 0.30–7.33).

The high rates of alcohol abuse in this low-velocity trauma population suggest such patients are at increased risk of osteoporosis. Routine screening for osteoporosis should be considered in working-age alcohol abusers. After subcapital fracture, reduction and internal fixation is an acceptable treatment in this sub-group of patients.
NICE Guidance in the Scottish Context
Authors: Kohli H , Tannahill A
Published: March 2011

The UK landscape of guidance for clinical practice and public health has become increasingly complicated in recent times, and it is easy to feel confused as to what is available for what purposes, what applies where, and who does what. Within this overall picture, there is potential for uncertainty as to the applicability, or otherwise, in Scotland of guidance produced by the National Institute for Health and Clinical Excellence (NICE) in England, including NICE technology appraisals, clinical guidelines, interventional procedures guidance, and public health programme and intervention guidance. This paper is offered as a map to help health professionals and others to find their way through the Scottish landscape, with particular reference to NICE's outputs and the respective roles of NHS Quality Improvement Scotland (NHS QIS) and NHS Health Scotland (HS).
An unusual cause of pericardial tamponade
Authors: Chatterji A
Published: March 2011

Pericardial effusion in hypothyroidism is common. But an effusion which causes cardiac tamponade is a rarity. Reported below is a case with myxedema and cardiac tamponade due to pericardial effusion.
Hyponatraemia associated with the use of a proton pump inhibitor
Authors: Ogundipe OA , Cross C
Published: March 2011

Hyponatraemia is a rare side-effect associated with the use of proton pump inhibitors. We report the case of a 98-year old patient with hyponatraemia that resolved soon after cessation of omeprazole therapy.
Carotid Endarterectomy: Are We Meeting the Two Week Target?
Authors: Guest RV , Richards JMJ , Fraser SCA , Chalmers RTA
Published: March 2011

Objective

It has been recommended that carotid endarterectomy should be carried out within fourteen days of the index event if maximum stroke prevention benefit is to be achieved. The aim of this study was to see whether this target was being met in our region and where in the pathway delays occurred.

Methods

This was a retrospective review of all patients (n=75) undergoing carotid endarterectomy in 2006 in a regional vascular unit. Eleven patients were excluded as the timing of onset of symptoms was unclear, leaving 64 patients for further analysis.

Results

The median time-interval from onset of symptoms to surgery was 47 days (interquartile range 32-65 days). Five of 64 patients (4.5%) had a carotid endarterectomy within 14 days. Median time from onset of symptoms to presentation to health services was one day (IQR 0-7 days), from presentation to health services to neurovascular clinic was 16 days (IQR 10-23 days), from neurovascular clinic to vascular surgery clinic was 13 days (IQR 9-24 days), and from vascular surgery clinic to operation was 13 days (IQR 8-22 days). Fifteen of the 51 patients (29%) attending a neurovascular clinic and five of the 57 patients (9%) attending a vascular surgery clinic were seen within 14 days.

Conclusion

The fourteen-day target is difficult to achieve due to the number of steps in the referral pathway. This delay may be jeopardising outcome. Reduction in the delay to surgery would require a multi-disciplinary approach and should involve education of the general public.
Patient Preferences for Single Rooms or Shared Accommodation in a District General Hospital
Authors: Florey L , Flynn R , Isles C
Published: March 2011

Objectives

To determine whether patients who have used a Scottish district general hospital would prefer single or shared accommodation on a future admission.

Methods

We surveyed 80 in-patients in January 2008 in order to obtain 20 medical and 20 surgical patients in single rooms and the same number in shared accommodation. Each patient received a seven point questionnaire that had been validated in another centre.

Results

Forty four men and 36 women, median 64 years, who had been in hospital for a median of 4.5 days (range 1 to 53 days) participated in the survey. Seventy per cent of patients in shared and 40% of patients in single rooms said they would prefer shared accommodation during a future hospital admission. Those expressing a preference for shared accommodation were older (median age 68 versus 58 years) and had been in hospital for longer (median 5.5 versus 3.5 days) than those who said they would prefer a single room.

Conclusions

It is likely that the desire for company among older people who have to spend a week or more in hospital is driving the responses we obtained. Our findings do not support claims that the argument in favour of 100% single rooms is ‘overwhelming’.
Ascending paralysis as a prime clinical manifestation of hyperkalemia
Authors: Teixeira F C S , Lebre A , Cunha-Ramos S A , Silva M Costa e , Kawano E , Domingues-Ferreira M
Published: March 2011

Hyperkalemia paralysis is a very rare disorder that can be easily managed by the adjustment of serum potassium levels. It is characterised by an ascending flaccid motor weakness and differential diagnosis, mainly Guillan-Barré syndrome, should be considered. We describe a case of ascending flaccid paralysis in a patient admitted to an emergency unit in Sao Paulo, Brazil. The patient had previously received Spironolactone and examination revealed hyperkalemia and chronic renal failure due to a polycystic kidney disease. With the improvement in his potassium levels, the paralysis disappeared until complete remission occurred. This report indicates another important and poorly recognised manifestation of hyperkalemia.
Giant retroperitoneal liposarcoma extending into the scrotum: a case report
Authors: Genç V , Çakmak A , Akyol C , Baskan S , Hazinedaroglu SM
Published: March 2011

Liposarcomas are the most common soft-tissue sarcomas in adults. Soft tissue sarcomas can be seen almost every localisation in the body, 10-15% of these are located in the retroperitoneum. Due to their slow growth and lack of specific anatomical compartments, retroperitoneal liposarcomas frequently reach an enormous size long before diagnosis. We describe a case of giant retroperitoneal liposarcoma successfully treated by surgical resection. The interest of our report is that the dimension alone should not be considered a contraindication for surgery and to remind the effectiveness of the first operation is the most important part of the therapy.
Hennekam Syndrome Presentıng Wıth Abdomınal Mass
Authors: Akyildiz Bn , Urganci N , Kayserili H , Rosi Ro
Published: March 2011

We report a patient presenting with an abdominal distention and irritiability, who was found to have Hennekam syndrome. A physical examination revealed left sided hemihypertrophy and a mass with undefined margins around the umblical region. Ultrasonography and contrast enhanced computerised tomography revealed a solid heterogeneous mass extending from the parapancreatic region into the mesenteric root and, diagnostic laparotomy was performed. The intestinal walls and the mesentery were found to be diffusely thickened. Histopathological analysis revealed fibrosis along with cystic enlargement of the lymphatic vessels. The patient had left periorbital edema and facial dysmorphism. Non-pitting edema of the abdomen, left arm, left leg, and left labia majora was noted. Laboratory tests showed hypoproteinemia, hypoalbuminemia, and high faecal α-1 anti trypsin. Endoscopic examination revealed milky fluid oozing from the mucosa into the duodenal lumen. Histopathological analysis revealed total villus atrophy and cryptic hyperplasia. We postulate that an enlargement in the intestinal wall could be mistaken for an abdominal mass, and, we present this case of an abdominal mass as a new manifestation of Hennekam syndrome.
Thoracoscopic Splanchnectomy: A new treatment for Disorders of Motility: A Case Report
Authors: Steven M , Brindley N , Currie J , Carachi R
Published: March 2011

The case of a 15 year old female born with multiple anomalies, who subsequently developed severe gastro-intestinal dysmotility is discussed. Motility disorders are often seen in neurologically impaired children, those with a history of gastro-oesophageal reflux disease (GORD), and congenital malformations of the gut. It is characterized by abdominal pain, vomiting and failure to thrive. Once this condition develops, it is difficult to treat. This girl failed to improve with conventional treatment including repeated fundoplication. We hypothesised that her symptoms maybe due to antral dysmotility and sympathetic over-activity. She underwent celiac plexus blockade which was immediately curative but temporary and therefore underwent minimally invasive thoracic splanchnectomy. She continues to be asymptomatic. We discuss the relevant anatomy and management protocol which should be considered in such difficult cases.
The Development and Performance of a Rapid-Access Neurovascular (TIA) Assessment Clinic in a Rural Hospital Setting
Authors: Ahmad M , Selwyn J , Gillanders I , Cox G , Patterson L
Published: March 2011

Introduction

Following the withdrawal of acute medical services from rural Angus, a rapid-access Neurovascular (TIA) Clinic was established at Stracathro Hospital in December 2003. Referral protocols were agreed with Angus Primary Care. We measured the performance of this clinic over its first two years against national standards outlined by Quality Improvement Scotland (2005).

Methods

In a retrospective study between 1st December 2003 and 30th November 2005, patient demographics, waiting times, investigation results, diagnoses, and secondary prevention issues were analysed. Challenges presented by a rural setting were also examined.

Results

By November 2005, from a total of 355 patients, 79% were seen within 7 days and 98% within 14 days of clinic referral. Pre-clinic bloods were increasingly done in general practice. All patients had CT head and carotid NIVA scans performed on the day of clinic attendance. A high positive diagnostic yield from CT scanning was obtained in the first year of the clinic, and a significant proportion of patients had new secondary drug prevention treatment recommended. Organisational and transport difficulties were addressed and overcome.

Discussion

Developing a rapid-access neurovascular clinic in a rural setting is achievable, and waiting times approaching national standard targets are possible. A TIA clinic can identify rapidly those with cerebrovascular disease, allowing commencement of appropriate secondary prevention therapy.
Voltage-gated Potassium Channel-associated Limbic Encephalitis in the West of Scotland: Case Reports and Literature Review
Authors: Reid JM , Foley P , Willison HJ
Published: March 2011

Background and Aims

The syndrome of limbic encephalitis (LE) associated with antibodies against voltage-gated potassium channels (VGKC-LE) has recently been described. The number of published cases is however small. We therefore aimed to review all cases seen at our centre and compare with published cases.

Methods

Retrospective cases of VGKC-LE were identified using a questionnaire to Neurologists at the Southern General hospital, Glasgow, and by reviewing patients with a positive VGKC antibody test (2002-2007). Case-note review of identified cases and a literature review of all published cases of VGKC-LE were performed.

Results

Seven cases were identified (four female, age range 51- 81). Patients presented sub-acutely with seizures and anterograde memory loss. Five patients had medial temporal lobe change on cranial imaging. No paraneoplastic cases were identified. 5/7 patients made some improvement with immunotherapy. In 2006, 3/18 (17%) patients with a coded discharge of encephalitis were diagnosed with VGKC-LE. The literature review revealed 40 patients with VGKC-LE. Age, gender or VGKC level did not predict likelihood for a significant recovery. Patients treated ≤5 months of symptom onset with immunotherapy were more likely to make a significant recovery (83% vs. 45%, p=0.04).

Conclusion

VGKC-LE is being increasingly diagnosed and is best identified early and treated with immunotherapy to offer the greatest chance of recovery. This series and literature review expands the current published evidence in VGKC-LE.
Melkerson Rosenthal Syndrome – A Case Report
Authors: Sattur Atul , Patil Pallavi , Naikmasur Venkatesh G
Published: March 2011

Melkersson-Rosenthal Syndrome (MRS) is a rare syndrome consisting of a triad of persistent/ relapsing facial palsy, recurrent orofacial edema and fissured tongue. The syndrome does not manifest in complete triad at all times and diagnosis is often difficult. We present a case of a 40-year-old male with a complete triad of all the manifestation of this syndrome. This case highlights the need to consider MRS as one of the differential diagnosis of recurrent facial palsy and also stressing the importance of a thorough intraoral examination when patients presents with relapsing facial palsy.
An unusual differential diagnosis of suspected deep vein thrombosis
Authors: Hoyle G , Smeed Z
Published: March 2011

Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) is an acquired neuropathy with a wide range of clinical presentations and a variable clinical course. We describe a case of CIDP presenting initially as unilateral thigh pain. This case highlights the difficulties in diagnosis of CIDP, and the differentiation between CIDP and Acute Inflammatory Demyelinating Polyneuropathy (Guillian-Barré Syndrome).
Paediatric Referral and Attendance Rates for the Clinical Genetics Service in South-East Scotland - a Comparison of a Regional Clinic with Satellite Clinics
Authors: Holloway Sm , Lampe Ak , Lam Wwk
Published: March 2011

Background and Aims

In some studies the establishment of specialist satellite clinics nearer to the homes of patients has resulted in increased referral and attendance rates, particularly amongst populations in lower socio-economic groups. We investigated the effect on these rates of establishing satellite genetic counselling clinics for families with paediatric conditions in South East Scotland.

Methods and Results

Families offered appointments at a clinic at the regional paediatric hospital were compared with those offered appointments at a satellite clinic at a local district general hospital. Both groups of families were more socially deprived than the general population (regional clinic p < 0.001, satellite clinics p<0.05), and in both groups attendance rate at first appointment was 88% and inversely related to social deprivation. There was no evidence of greater attendance amongst more deprived patients at the satellite clinics compared to the regional clinic.

Conclusion

Our study found no evidence that the establishment of satellite clinics for genetic counselling in South East Scotland increases attendance by families with paediatric conditions in lower socio-economic groups. This suggests that factors other than clinic location determine referral and attendance rates, and these may include understanding of the reason for referral and the advantage of attendance.
Lack of Impact of Semen Quality on Fertilization in Assisted Conception
Authors: Kini S , Morrell D , Thong Kj , Kopakaki A , Hillier S , Irvine Ds
Published: March 2011

Background

Defective semen quality is one of the commonest causes of infertility. The diagnosis of male fertility depends upon a descriptive evaluation of human semen, however a normal semen analysis does not necessarily indicate satisfactory fertility potential.

Aims

(i) to examine the semen quality of patients undergoing treatment by assisted conception, (ii) to explore relationships between semen quality and treatment outcomes, and (iii) to look at inter-laboratory variation in the assessment of semen quality.

Methods

Semen quality in patients undergoing assisted conception treatment between 2001 and 2004 was reviewed. Data on female age, egg numbers and fertilization outcomes was obtained by case note review.

Results

The thresholds used to direct patients towards IVF or ICSI treatment were comparable with the normal values promulgated by WHO, with the exception of morphology. Semen quality was not predictive of fertilization rates. When the results of independent measurements of the same sample were compared, there was diagnostic disagreement in between 10% - 29% of samples.

Conclusions

The conventional criteria of semen quality are used to determine treatment strategy for couples undergoing assisted conception but are not reflected in fertilization rates, emphasising the limited utility of the conventional criteria of semen quality in the assessment of sperm function. There remains significant inter-laboratory variation in the results of semen analysis.
Safety and Effectiveness of Telemedicine for Neurology Outpatients
Authors: Duncan C , Dorrian C , Crowley P , Coleman R , Patterson V
Published: March 2011

Background and Aims

Patients often wait many months to see a neurologist for the first time. With the introduction of targets for maximum waiting times there is a need for novel approaches. Real time telemedicine by videolink (VL) is one such method and we aimed to replicate this in Aberdeen.

Methods

Patients were seen by VL by two Irish-based neurologists, one experienced in telemedicine, the other not. A senior trainee neurologist present with some of the patients validated the telemedicine diagnosis and management with his own face-to-face (FF) assessment. Satisfaction was assessed by questionnaires. Numbers requiring investigations and review were recorded as were representations to neurology over six months.

Results

Forty-four patients were seen. Satisfaction was higher and review rates were similar to previous cohorts seen by FF and VL. There was no difference between the two neurologists. There was complete diagnostic agreement between the VL and FF neurologists. There was a diagnostic change in a single patient after six months follow-up.

Conclusion

Neurology consultation using VL is safe and effective as well as acceptable, and the necessary skills were acquired rapidly by a telemedicine-naive neurologist. Telemedicine using VL can contribute to waiting list reduction, and is likely to be most useful in rural areas.
The Pituitary and Prostate: An Endocrine Connection
Authors: Taylor P , Perry P , Ibrahim B , Swaminathan K
Published: March 2011

A 61 year old gentleman presented with polyuria and polydipsia in the absence of diabetes mellitus. This case presentation highlights the diagnostic challenges and surprises in the evaluation of polyuria and polydipsia.