bluuebunny/crossref_metadata_2025_split huggingface dataset:
The Prevalence of Alcohol Misuse Among Acute Admissions: Current Experience and Historical Comparisons
Authors: Cameron A , Morris Jm , Forrest Eh 
Published: March 2011

Background Over the last 25 years there has been a large increase in alcohol related deaths in Scotland. Medical patients who misuse alcohol may have overt alcohol related disease, but may also present with other unrelated illness. Aim We examined alcohol misuse amongst acute medical admissions to compare this with other similar studies at the same hospital since 1974. Patients and Methods 850 consecutive admissions to the medical receiving unit of Victoria Infirmary were assessed. They were assessed using the modified Michigan Alcohol Screening Test (MAST) and also by a medical consultant. 414 patients also had their blood ethanol levels measured on admission. Results 18.6% admissions had a MAST greater than 5 and were considered to misuse alcohol (24.8% male and 12.2% female; p<0.0001). Patients from socio-economic group V and patients presenting with gastro-intestinal haemorrhage or self-poisoning were more likely to misuse alcohol. The sensitivity and specificity of consultant opinion regarding alcohol misuse were 0.55 and 0.97 compared with the MAST. There was an increase in the alcohol misuse amongst women admitted (12.2%) compared to 1977 (5.5%; p=0.0026) and 1981/2 (6.3%; p=0.004). Conclusion Alcohol misuse is common amongst acute medical admissions. Since 1979, there has been a particular increase in female medical admissions who misuse alcohol. Medical opinion regarding alcohol misuse lacks sensitivity in identifying at risk individuals compared with a validated questionnaire.
Rate of Referral of Breech Infants for Hip Ultrasound: An Audit Cycle
Authors: Dryden C , White Mp 
Published: March 2011

Background Infants with risk factors for developmental dysplasia of the hip (DDH) should have hip ultrasounds performed shortly after birth to detect and treat the condition at an early stage. Breech presentation is associated with increased risk of DDH. We embarked on an audit cycle to assess and improve our rate of referral of breech infants for hip ultrasound. Methods Two retrospective audits (phases I & II) were carried out before, and after, the introduction of a new pro-forma which encouraged recognition of breech presentation at the time of the routine neonatal examination. Breech infants were identified from labour ward records. Multiple births and infants < 35 weeks gestation were excluded. Infants were considered to have been referred for ultrasound if the computer system at our affiliated children's hospital held a record of an ultrasound appointment. Results and Conclusions In phase I 56% of breech infants born in our hospital had been referred for hip ultrasound. In phase II the referral rate had risen to 76% (p = 0.034). We conclude that the change in practice was effective. Further improvement might be achieved by increasing staff awareness of risk factors for DDH and by enlisting the help of advanced neonatal nurse practitioners (ANNPs) in routine neonatal examinations.
Lack of Knowledge of Osteoporosis: A Multi-Centre, Observational Study
Authors: Spencer SJ 
Published: March 2011

Background and Aim Osteoporosis poses a significant health problem. As the population ages, its incidence increases. Effective prevention requires good awareness of the disease among the general public. The aim of this study was to assess the level and source of osteoporosis knowledge in a group of patients attending for Dual Emission X-ray Absorpitometry (DEXA) scanning. Methods A questionnaire was devised to assess knowledge of the osteoporosis risk factors, risk-reducing measures and signs/symptoms. Questionnaires were completed by 176 patients in two centres; Glasgow Royal Infirmary, UK (120 patients), and Christchurch Public Hosp, New Zealand (56 patients). Results Overall knowledge of osteoporosis was poor. In terms of risk factors 31.8% (n=56/176) knew no risk factors at all, 19.3% (n=34/176) knew no risk reducing measures and 39.2% (n=69/176) knew no signs or symptoms of osteoporosis. Conclusion Knowledge of osteoporosis, despite this cohort being a group of patients attending for DEXA scanning, was poor. There is a need for the public to to be made more aware of osteoporosis, thereby enabling them to be more actively involved in preventive measures. National campaigns are required to increase awareness. Furthermore, increasing health professionals' awareness of the considerable limitations which exist in public knowledge of the disease, leading to a new realisation of the need for them to discuss osteoporosis with their patients, could provide a highly effective means of increasing awareness of the disease.
Epidemiological Aspects of Referral to TIA Clinics in Glasgow
Authors: Murray S , Bashir K , Lees KR , Muir K , MacAlpine C , Roberts M , Langhorne P 
Published: March 2011

A retrospective cohort study was carried out of new referrals to transient ischaemic attack (TIA) clinics in Glasgow. The aims of the study were to describe the profile of referrals and to assess the odds ratios for TIA, minor stroke or amaurosis fugax of both cardiovascular risk factors and clinical features. In total, data were collected for 813 new referrals in a period of six months. Thirteen point eight percent of referrals were from other Health Boards. The overall referral rate among residents of Greater Glasgow NHS Board was 165.6 per 100,000 per year. About 20% of referrals were made by clinicians in secondary care. The specialties from which referrals were most commonly made were accident and emergency, general medicine, ophthalmology and geriatric assessment. The most common risk factors in patients referred were hypertension (52.9%), smoking (31.7%), ischaemic heart disease (22.7%) and former smokers (22.4%). The most common clinical features were hemiparesis (13.3%), weakness of an upper limb (8.7%), vertigo (7.9%) and dysphasia (7.3%). In 48.7% of cases, a non-cerebrovascular diagnosis was made. Separate multivariate models were established for risk factors and clinical features. In the model for risk factors, five factors were significant for risk of TIA, stroke or amaurosis fugax. These were hyperlipidaemia, age over 64 years, hypertension, smoking and ex-smoking. In the model for clinical features, five factors were also significant. These were visual field defect, speech defact, facial weakness and hemiparesis.
Multiple pulmonary emboli despite the presence of a caval filter – a literature review
Authors: McGuire BB , Kelly C 
Published: March 2011

Introduction Acute pulmonary embolism is a serious life-threatening phenomenon. When anticoagulation is contraindicated, treatment poses a challenge. Background We describe the case of a young girl with recurrent pulmonary emboli despite the presence of a caval filter and explore the different treatment options available in this situation. The placement of an intra-caval filter often provides a feeling of protection against further pulmonary emboli, however the incidence of filter thrombosis is surprisingly quite high. Subsequent pulmonary embolus can occur in up to a third of these patients which is potentially life threatening. Conclusion We examine the different filters that are commercially available, and the incidence of thrombosis and embolism associated with them. Following this, we look at the treatment options available in managing filter thrombosis and the safety of such intervention.
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.
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.
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.
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.
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.
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.