bluuebunny/crossref_metadata_2025_split huggingface dataset:
Let's Get Physical! A Study of General Practitioner's Referral Letters to General Adult Psychiatry — Are Physical Examination and Investigation Results Included?
Authors: Culshaw D , Clafferty R , Brown K 
Published: March 2011

Background/Aim The authors previously conducted a survey of psychiatrists’ attitudes to physical examination and investigations of out-patients. The most common reason for not performing such investigations was the expectation that they had already been undertaken by the general practitioner (GP). We decided to test this theory. Method A series of GP out-patient referral letters to general psychiatry was examined to establish whether findings from physical examination and investigations had been included. Results One hundred and three letters were examined. None of the letters contained information relating to a physical examination. Only one in twenty had information on investigations despite 4 out of 10 patients in the sample presenting to the GP with somatic symptoms. Conclusion Details of physical examination and blood tests are not routinely included in referral letters to general psychiatry. This may lead to missed diagnoses of primary or secondary physical illness in psychiatric presentations. Unless it is clearly stated in the GP referral letter, it is unwise to assume that necessary investigations to exclude physical causes of presenting symptoms have been performed. Suggestions are made to improve communication between GPs and psychiatrists.
Encouraging Attendance at Outpatient Appointments: Can We Do More?
Authors: Henderson R 
Published: March 2011

Background and Aims Non-attendance at new outpatient appointments is a challenge for health services. Patients with treatable morbidity may fail to receive care from which they would benefit, and scarce resources are wasted. Therefore, a literature review was undertaken to assess the effectiveness of appointment reminders as a means of increasing attendance and reducing ‘Did not Attend’ rates at new outpatient appointments. Methods Electronic databases were interrogated using a combination of MeSH terms and truncated keywords. In addition, the reference lists of papers were studied to identify additional relevant material. Results Telephone and postal reminders appear effective, particularly if received within a day of scheduled appointments. Postal reminders offering a reward for attendance, threatening sanctions for non-attendance, and providing information about the clinic appear more effective than standard reminders. No studies assessing the impact of measures including e-mail or text messaging were identified. Many studies were conducted in psychiatric settings outwith the United Kingdom raising issues of generalisability. In addition, no assessment of how initiatives impact on inequalities in service access were found. Conclusions There is scope to increase attendance and reduce non-attendance at outpatient appointments but initiatives should be piloted in conjunction with robust evaluative frameworks.
Knowledge about the Scottish Mental Health Act in a General Hospital Setting
Authors: Baig BJ , Walker J , Crowe ES , MacHale SM , Aditya H , Potts SG 
Published: March 2011

Background Clinical experience suggests that non-psychiatrists' knowledge of mental health legislation in relation to emergency detention is inadequate. However, most nonpsychiatrists will use this legislation at some point in their career. Methodology A questionnaire about emergency detention legislation was circulated to non-psychiatric medical staff to test their knowledge of the provisions relevant to the general hospital. Results Two hundred and seventy four medical staff replied (a response rate of 82%). Results showed that an understanding of detention procedures and applicability were markedly deficient, irrespective of grade, specialty or experience. Conclusion The results indicate a need for increased education and awareness about emergency detention legislation especially in view of the implementation of the Mental Health (Scotland) Act (2003).
Early Neurologic Complications Following Coronary Bypass Surgery
Authors: Jabbour R , Salamoun M , Atweh SF , Sawaya RA 
Published: March 2011

Background Coronary artery bypass surgery is associated with central and peripheral nervous system complications in the period following surgery. Recognising these complications may help in their prevention or early treatment. Methods We reviewed medical records of all the patients who underwent coronary artery bypass surgery at our institution over a period of two years. We studied their risk factors, reasons for surgery, operative variables, and post operative neurologic complications. Results Of the 587 coronary artery bypass surgeries performed at our centre over a two year period. We found that 2.04% of these patients developed neurologic complication in the two weeks following the surgery. Fifty percent of these patients suffered from cerebrovascular insults and 50% suffered from cognitive decline. No patients in this group developed seizures or peripheral nerve lesions. Patients with renal failure, carotid stenosis, history of cerebral strokes, and redo coronary bypass surgery were more predisposed to develop neurologic complications after bypass surgery. Furthermore, a longer stay in the coronary care unit and the development of arrhythmias predisposed patients to neurologic complications. Mortality for patients who developed neurologic complications post bypass surgery ranged between 16.7% and 33.4%. Conclusions Around 2% of patients who undergo coronary artery bypass surgery develop neurologic complications in the period directly after the surgery. Patients with previous history of cerebral, coronary, or carotid disease are more predisposed for such complications, as well as patients who spend more time in the intensive units after the surgery.
Early Discharge Following Liver Resection for Colorectal Metastases
Authors: MacKay G , O'Dwyer PJ 
Published: March 2011

Objective Liver resection is currently the recognised treatment for localised colorectal liver metastases. Hospital stay in recently published series is between seven and 12 days for open surgery and five and eight days for laparoscopic resection. Recently there has been interest in the use of ‘fast-track’ recovery protocols following major abdominal surgery. Our aim was to measure the effect of such a protocol on hospital stay following liver resection. Methods Data was collected prospectively from 12 consecutive patients undergoing open liver resection between August 2003 and September 2004. All patients had a large subcostal incision with full mobilisation of the liver. A ‘fasttrack’ protocol was employed consisting of intra venous fluid restriction, patient controlled analgesia and early diet and mobilisation. Data on postoperative complications and hospital stay was recorded. Results Twelve patients with a median age of 60 (range 43-74) years underwent liver resection. Resection consisted of one hepatic lobectomy, two trisegmentectomies, three bisegmentectomies and six segmentectomies. Median hospital stay was four (range two to seven) days. One epileptic patient developed carbamazepine toxicity delaying their discharge. A further patient developed a collection requiring no intervention. Conclusion Early discharge following major liver resection using a ‘fast-track’ recovery protocol is both safe and achievable.
The Burden of Atrial Fibrillation in Unselected Acute Medical Admissions
Authors: Cameron AC , Jenkins SMM , Dunn FG 
Published: March 2011

Background Atrial fibrillation (AF) is the most common cardiac arrhythmia and is of increasing prevalence. The presence of AF complicates the management of patients presenting as medical emergencies. Objective To assess the prevalence of AF and current investigation and management strategies in unselected acute medical admissions. Design Prospective survey of all acute medical admissions over 22 days. Setting Stobhill Hospital – district general hospital in north Glasgow. Subjects Consecutive acute medical admissions. Results Of the 507 patients, 47 (9.3%) had AF. AF was a new diagnosis in five patients (11.0%). The most common presenting features were dyspnoea and chest pain. The principal underlying medical conditions were hypertension and ischaemic heart disease. AF was the primary reason for admission in six patients (12.8%) and a documented reason for admission in 11 patients (23.4%). Thyroid function tests were or had previously been performed in 45 patients (95.7%). Twenty-four patients (51.1%) underwent echocardiography or had done so previously. Twenty-two patients (46.8%) received anticoagulation with warfarin. Ten patients (21.3%) should have received warfarin by standard guidelines but did not. No patient received warfarin inappropriately. Rate control was used in 40 patients (85.1%). Rhythm control was attempted in four patients (8.5%). Conclusion AF is common amongst emergency admissions to district general hospitals and has significant resource implications. Improvements are needed both in the use of echocardiography and in the administration of anticoagulant therapy.
History of Dyspepsia in Scotland
Authors: Baron JH , Sonnenberg A 
Published: March 2011

Introduction The aim of the study was to assess whether the rise in the occurrence of dyspepsia in Scotland during the eighteenth century was a true epidemiologic phenomenon or just an increase in medical awareness. Methods Admissions for dyspepsia to the Edinburgh Royal Infirmary from 1729 until 1830 were analysed by consecutive five-year time periods. The titles of MD theses on dyspepsia from 1726 to 1823 were extracted from the Edinburgh University index. Monographs and articles on dyspepsia from Britain during the same time period were sought in the Catalogues of the US Surgeon-General's Library. Results During the eighteenth century, the annual number of dyspepsia patients admitted to the Edinburgh Royal Infirmary showed an extraordinary increase from none in 1730 to 900 per million population in 1760. About 4000 MD theses were presented to the Edinburgh University between 1726 and 1823. There were none on dyspepsia or gastritis between 1726 and 1749, after when it gradually started to rise. British publications on dyspepsia similarly appeared only in the 1790s and then rapidly increased. Discussion We suggest that the rise in MD theses and publications on dyspepsia were responses to a real increase in dyspepsia during the mid eighteenth century.
Concurrent Ipsilateral Acute And Chronic Ectopic Pregnancies
Authors: Alsammoua S , Kennedy J.H , Tolhurst J , Liptak P , Alexander-Sefre F 
Published: March 2011

Introduction This report describes a unique case of concurrent chronic and acute ectopic pregnancies in an ipsilateral tube. Case History A 33-year-old woman presented with symptoms suggestive of miscarriage that resolved on conservative management, resulting to normal βhCG level. However, she was readmitted 5 weeks later with vaginal spotting, right iliac fossa pain and slightly elevated βHCG. A diagnosis of pregnancy of unknown location was made and she was managed conservatively. Four weeks later the patient presented once again with vaginal bleeding and a positive pregnancy test. Her serum βhCG level was elevated and her pelvic ultrasound scan showed an adnexal mass. The patient therefore underwent laparoscopic salpingectomy. Histopathological examination showed two ectopic pregnancies within the same tube; an older (chronic) ectopic positioned within proximal end of the tube and a more recent one at the distal end. Conclusion This case highlights the difficulty in diagnosing chronic ectopic pregnancy and the increased risk of recurrence after conservative management.
Renal Power Doppler Ultrasound Does Not Predict Renal Scarring after Urinary Tract Infection
Authors: Narchi H , Donovan R 
Published: March 2011

Objective Young children may develop renal scarring following a urinary tract infection (UTI) especially after pyelonephritis which is difficult to diagnose. Permanent renal scars are diagnosed by dimercapto-succinic acid (DMSA) scan several months later. To decrease unnecessary exposure to radiation, we investigate the role of renal power Doppler (RPD) in predicting those who may not require a late DMSA scan. Methods Children under four years of age with a first UTI underwent an RPD study soon after diagnosis, and a DMSA scintigraphy six months later. The predictive values of the early RPD to detect DMSA renal scarring were calculated. Results Twenty three children (median age 30 months) were enrolled: 13 had a febrile presentation, two with bacteraemia. Permanent scarring occurred in three children (13%). In the 46 kidney units studied, initial RPD was abnormal in two and late DMSA abnormal in three units. Overall concordance between RPD and DMSA was 93.5%. The sensitivity of RPD for renal scar as per DMSA was 33.3%, specificity 97.7%; positive predictive value 50% and a negative predictive value of 95.4%. Conclusions RPD offered no advantage over ultrasound to predict renal scarring and cannot be recommended to predict renal scarring following UTI.
Direct to Consumer Advertising via the Internet, a Study of Hip Resurfacing
Authors: Ogunwale B , Clarke J , Young D , Mohammed A , Patil S , Meek RMD 
Published: March 2011

Background and Aims With increased use of the internet for health information and direct to consumer advertising from medical companies, there is concern about the quality of information available to patients. The aim of this study was to examine the quality of health information on the internet for hip resurfacing. Methods An assessment tool was designed to measure quality of information. Websites were measured on credibility of source; usability; currentness of the information; content relevance; content accuracy/completeness and disclosure/bias. Each website assessed was given a total score, based on number of scores achieved from the above categories websites were further analysed on author, geographical origin and possession of an independent credibility check. Results There was positive correlation between the overall score for the website and the score of each website in each assessment category. Websites by implant companies, doctors and hospitals scored poorly. Websites with an independent credibility check such as Health on the Net (HoN) scored twice the total scores of websites without. Conclusions Like other internet health websites, the quality of information on hip resurfacing websites is variable. This study highlights methods by which to assess the quality of health information on the internet and advocates that patients should look for a statement of an “independent credibility check” when searching for information on hip resurfacing.
Use of Radiology by General Practitioners Making Orthopaedic Referrals: a Cross-Sectional Study
Authors: Morley NCD , Robertson H , Millar J , Finlayson DF 
Published: March 2011

Background In orthopaedic clinics, patients can be x-rayed during their visit to the surgeon. Could radiographs carried out in primary care be more efficiently carried out when the patient meets the surgeon? Aims To quantify and describe use of radiological investigations by general practitioners (GPs), when referring to orthopaedics. Methods We made a retrospective examination of 294 referral letters for detail regarding x-ray investigation of the condition prompting the letter. We used referral letters assessed by the recipient as ‘routine’. We excluded those addressed to a particular surgeon because of subspecialty interest or prior care. Results Twenty one percent (62) of referrals described an investigation that did not contribute to management prior to the patient's clinic appointment. Conclusions A significant number of patients travelled specifically for an x-ray. In some of these cases the radiographs could be delayed until the clinic visit without compromising care. Discussion We suggest that GPs seeing patients with musculoskeletal problems should consider referral to an orthopaedic surgeon prior to requesting x-rays. X-ray investigation in the orthopaedic clinic may be more convenient for the patient and surgeon.
An Observational Study of the Impact of a Rehabilitation Admission on Readmission Data
Authors: Petrie RXA , Mountain DA 
Published: March 2011

Background and Aim Specialist psychiatric rehabilitation services are changing in response to overall redesign of psychiatric services. The assumed therapeutic gains of these services have not been established or quantified, and their role in contemporary practice has not been formally articulated. The aim of this observational study is to examine the impact of an admission to psychiatric rehabilitation wards at the Royal Edinburgh Hospital on readmission data post-discharge. Method Thirty-five admissions were included in the sample. Simple measures of outcome were used: the number of days spent in hospital; number of Mental Health Act uses; number of admissions. This information was obtained from case notes and from data collected routinely on the Patient Information Management System. These measures were examined in the two-year periods before and after a rehabilitation admission. Results In the two-year period following the index admission there was a significant reduction in all these measures compared to the two-year period before the index admission: mean number of bed days (p < 0.001); number of uses of the Mental Health Act (p < 0.001); number of readmissions (p < 0.01). Conclusion There was an improvement in patient outcome measures following a rehabilitation admission.
Epidemiology of Fungal Scalp Infections in the West of Scotland 2000 – 2006
Authors: Alexander CL , Brown L , Shankland GS 
Published: March 2011

Background Fungal infections of the scalp commonly affect the paediatric population and are caused by dermatophytes which have the ability to invade the keratinised structures of skin, hair and nails. This study analyses the changes in the epidemiology of fungal scalp infections in the West of Scotland during the period 2000 – 2006. Methods Skin and hair from scalp specimens sent by General Practitioners and Dermatologists throughout the West of Scotland were examined microscopically for the presence of fungal hyphae and/or spores and cultured to determine the identity of the fungi. Results The most common dermatophyte to be isolated from scalps during 2000–2006 was Trichophyton violaceum with 29 reported cases followed by 23 cases of Trichophyton tonsurans infection. During 2000-2002, over 90% of patients were British but during 2003–2006, greater than 50% of patients were of non-UK origin. The majority of T. violaceum and T. tonsurans infections during this study were from patients originating in either Africa or Pakistan and were from people known to be seeking asylum in the UK. Conclusions The overall increase and the change in pattern of reported fungal scalp infections in the West of Scotland may be explained by the migration of people to Scotland from Africa or Pakistan where T. violaceum and T. tonsurans are endemic. The increase in numbers of infections in the later period of this study reflects an increase in the awareness of General Practitioners and Dermatologists to send samples to Clinical Mycology.
Urban and Rural Risks of Lyme Disease in the Scottish Highlands
Authors: Mavin S , Hopkins PC , MacLennan A , Joss AWL , Ho-Yen DO 
Published: March 2011

Background This paper investigates the pattern of Lyme disease testing and infection within the Highland region of Scotland. Methods Data from all Highland samples tested during 2004-2006 were analysed according to result and patient's residence in relation to the eight fold Scottish Executive's urban/rural classification, and distance from woodland. Results In total, 1602 patients were tested for Lyme disease, 0.71% of the Highland population. From these, 104 (6.5%) were seropositive. There were more patients tested, and seropositive patients from rural than urban locations, 1113 vs 489, and 79 vs 25 respectively. There were also significantly more seropositive patients per patients tested from rural locations (χ2, p < 0.0001). The number of patients tested and seropositive patients increased as the rural areas become more remote. The likelihood of being tested for Lyme disease also increased as the distance between a patient's residence and woodland decreased. The relative risk of being tested elevated by 74% for those patients living within 200 metres of woodland. Conclusions Those living in the most rural areas of Highland and those living closest to woodland have an increased risk of being tested and having Lyme disease.
Impact of EUS-FNA in the Management of Patients with Oesophageal Cancer
Authors: Morris JM , Suzuki H , McKernan M , Stephen M , Stuart RC , Stanley AJ 
Published: March 2011

Background and Aim Endoscopic Ultrasound (EUS) has increased the staging accuracy of oesophageal cancer. The addition of EUS guided fine needle aspiration (EUS-FNA) appears superior to standard EUS for nodal staging. Our aim was to study the impact of EUS-FNA in the management of patients with oesophageal cancer. Methods We studied patients undergoing EUS for this indication between May 2003 and May 2006. EUS was performed in patients who were candidates for radical therapy following CT scanning. If suspicious non-peritumoural nodes were seen on EUS, EUS-FNA was undertaken. Further staging was performed as appropriate and all cases were discussed at our multidisciplinary meeting. Results and decisions were prospectively recorded. Results One hundred and ninety one patients underwent EUS for staging of oesophageal cancer during this period and 44 EUS-FNA were performed in 42 patients (mean age 62.2 years). Sixty two per cent of patients had adenocarcinoma and 48% sampled nodes were < 10mm diameter. Overall, 48% nodes were positive and two “suspicious” for malignancy. Following a positive EUS-FNA and MDM discussions, 15 patients had palliative and two neoadjuvant therapy. Eleven patients with a negative EUSFNA underwent radical therapy. Therefore, EUS-FNA appeared to alter management in 28 (67%) patients. Conclusion EUS-FNA appears to help direct patients towards appropriate treatment strategies.
The Prevalence of Chronic Kidney Disease in Rheumatology Outpatients
Authors: Hill AJ , Thomson RJ , Hunter JA , Traynor JP 
Published: March 2011

Background The introduction of routine reporting of estimated glomerular filtration rate coupled with a new definition of chronic kidney disease (CKD) has led to an unprecedented focus on kidney disease in many patient groups. In light of this, we performed an audit of patients attending the rheumatology clinics to assess the prevalence of CKD in this population. Methods Over a four week period, we reviewed the renal function of all patients attending the rheumatology clinics and day ward at our hospital (n=351). Renal function was assessed using the 4-variable MDRD formula. We then interviewed those patients with estimated glomerular filtration rate (eGFR) of 59 ml/min or lower. Results We found a prevalence rate of 18% for stage 3 CKD or lower in our audit population. Surprisingly, 60.3% of patients in this category were not aware of any problems with their kidneys (n=38). Conclusions The prevalence rate of 18% for stage 3 CKD or lower is significantly higher than the five per cent reported within the general population. As a result of this audit, we now plan to ensure that these patients undergo measurement of blood pressure, eGFR, and urinalysis on a six to twelve monthly basis.