bluuebunny/crossref_metadata_2025_split huggingface dataset:
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

Abstract

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

Abstract

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.
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.
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.
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.
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.
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.
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.
Cancer Waiting Times: What is the Value of a Lymphoma Waiting Time?
Authors: Savage Sah , Wotherspoon HA , Pentland D , Fitzsimons EJ 
Published: March 2011

Background and Aim Waiting times for patients with lymphoma have been reported across the United Kingdom since 2005. Lymphoma however, is not a single disease but a wide spectrum of lymphoid tumours that range from the most malignant to the most indolent, from highly curable to incurable. We now question the value of the current system that reports lymphoma waiting time on a quarterly basis and makes no allowance for the different types of lymphoma. Method Four hundred and sixty nine cases of lymphoma were registered in the west of Scotland in 2004. Complete datasets were available on 428. Patient demographic data, subtypes of lymphoma, biopsy site and referral urgency data were linked to the waiting times analysis for 2004 for the three major lymphoma subtypes, Hodgkin Lymphoma (HL), Diffuse Large B Cell (DLBC) and follicular Non Hodgkin Lymphoma (NHL). Results Patients with HL were younger, more likely to receive urgent referral and have a diagnosis made from neck node biopsy than the other two groups. Patients with DLBC NHL however had the shortest interval between presentation and the start of treatment and were subsequently more likely to receive treatment within 62 days than patients with either follicular NHL (p<0.001) or HL (p<0.05). Conclusion Lymphoma subtype is a major factor determining the rate of progress from presentation to the start of treatment, hence the waiting time.
Hormone Replacement Therapy (HRT) or Etidronate for Osteoporosis in Postmenopausal Asthmatics on Glucocorticoids: a Randomised Factorial Trial
Authors: Campbell IA , Douglas JG , Francis RM , Prescott RJ , Reid DM 
Published: March 2011

Introduction The study was designed to establish the effects of HRT on osteoporosis and fractures over five years in postmenopausal women with asthma receiving regular glucocorticoids and to compare with etidronate. Methods Postmenopausal patients receiving inhaled and/or oral glucocorticoids were randomly assigned to HRT, cyclical etidronate, HRT plus cyclical etidronate or no treatment for five years. The trial was multi-centre and aimed to recruit 750 patients. Outcomes were fractures and changes in bone mineral density (BMD). Results For reasons detailed in the discussion section of the text, only 50 patients were entered. Three did not fulfil the eligibility criteria and were excluded from the analysis. Among the remaining 47 patients, three (6%) experienced new, symptomatic fractures, one on etidronate and two in the no treatment group. New or worsening morphometric fractures of the thoracolumbar spine occurred in 50% of the 22 patients with spinal radiographs on entry and at five years (one HRT, three etidronate, two HRT plus etidronate and five on no treatment). BMD improved by approximately 1% per annum in those receiving HRT and/or etidronate; comparisons of HRT vs no HRT tended to favour HRT but were only statistically significant at proximal femur. The same trends emerged in the etidronate vs no etidronate comparison, but none reached the 5% level of statistical significance. Discussion For postmenopausal patients receiving glucocorticoids for asthma, HRT appears as effective as etidronate in preventing loss of BMD over five years and may have a similar effect on fracture prevention.
Weight Changes Following Lower Limb Arthroplasty: a Prospective Observational Study
Authors: Abu-Rajab RB , Findlay H , Young D , Jones B , Ingram R 
Published: March 2011

The aim of this study was to assess patterns of weight loss/gain following total hip or knee joint replacement. Four hundred and fifty primary lower limb arthroplasty patients, where the current surgery was the last limiting factor to improved mobility, were selected. Over a one year period 212 gained weight (mean 5.03kg), 92 remained static, and 146 lost weight. The median change was a weight gain of 0.50Kg (p=0.002). All patients had a significant improvement in Oxford outcome scores. Hip arthroplasty patients were statistically more likely to gain weight than knee arthroplasty patients. A successful arthroplasty, restoring a patient's mobility, does not necessarily lead to subsequent weight loss. The majority of patients put on weight with an overall net weight gain. No adverse effect on functional outcome was noted.