bluuebunny/crossref_metadata_2025_split huggingface dataset:
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.
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’.
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.
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.
Drugs and Sport
Authors: Pai S , McLatchie G R 
Published: March 2011

There has always been the temptation to take prohibited substances in the struggle for an athlete to gain the ‘higher ground’ above the rest of the competitors which allow goals to be attained easier than by the conventional training methods. The problem of drugs in sport has existed for a long time and is underestimated in its prevalence. This paper deals with the reasons of why athletes take such drugs, which drugs are available and the testing employed to detect their use. Among the issues discussed will be the future of drugs in sport and what measures can be taken to combat their use.
Equality of Access to “Fast-Track” Stroke Services in an Older, Socio-Economically Deprived Scottish Population
Authors: Quinn TJ , Dawson J , Walters MR 
Published: March 2011

Background and Aims Unequal access to specialist stroke services may contribute to the disproportionate stroke burden in certain populations. We evaluated the relationship between access to TIA services, deprivation and age. Methods We prospectively recorded referral pattern data on consecutive TIA service patients. Socio-economic deprivation was derived from postcode and census data. Associations were described using Kruskal-Wallis statistics. Results Of 3,462 patients assessed, there was no association between time to clinic referral or attendance and increasing deprivation or age. Conclusion Inequality of access to TIA services for older, deprived patients was not evident. However, delay to assessment and prevalence of risk factors was substantial for all patients.
Crohn's Disease Incidence in NHS Tayside
Authors: Steed H , Walsh S , Reynolds N 
Published: March 2011

Background & Aims The incidence of Crohn's disease (CD) in northeastern Scotland was last reported as rising in the 1980's, while in the rest of Europe it had reached steady state. This study reviewed the incidence of CD in NHS Tayside. Methods Data was collected retrospectively and analysed using age and sex standardization, socioeconomic factors and urban and rural postcodes. Results A point prevalence of 157 per 100,000 population in the Tayside region was found. The average incidence of CD was 9.56 per 100,000 per year between 2003 and 2007 and 7.16 per 100,000 per year between 1998 and 2001. There was no link to urbanization and no difference in incidence between the sexes. Incidence was not related to affluence in this population and peak age of onset occurred in the third decade of life only. 12.7% of patients had a family history of inflammatory bowel disease and 25% of patients were current smokers. Conclusions The incidence of CD appears to have arrived at a steady state in Tayside, while recent evidence suggests that it is on the rise in Scandinavia again. The results of the genetic studies to come from the east of Scotland are eagerly awaited to help shed light on the aetiology of this complex disorder.
Obstetric Care of New European Migrants in Scotland: an audit of antenatal care, obstetric outcomes and communication
Authors: Bray JK , Gorman DR , Dundas K , Sim J 
Published: March 2011

Background and Aims There has been a twelve-fold increase in the number of New European migrants giving birth in Lothian between 2004 and 2007. The objective of this study was to audit obstetric care standards in Lothian for new migrants and recommend service improvements. Methods A retrospective audit of 114/136 (84%) obstetric case records of new European migrants giving birth in Lothian hospitals in 2006 was conducted. Assessment was against care standards for antenatal booking, antenatal attendance and interpretation. Obstetric outcomes were audited against the general population. Results Eighty percent were primiparous. Fifty five percent had booked by the end of week 14. Mean birth weights and lengths of stay were similar to the general population. Intervention rates were 23% for Caesarean Sections (C/S) and 17% for instrumental deliveries (versus 27% and 19% respectively in the general population). Epidural or spinal anaesthesia was used for 57% compared to 50% of the general population. The interpretation services (ITS) were used infrequently. Conclusions Full compliance with antenatal and interpretation standards was not achieved for this population. ITS was most commonly used to meet the needs of healthcare professionals, rather than as a routine. While there were no significant differences in maternity outcomes, poor communication did affect care.
Scottish Survey of Public Place Defibrillators
Authors: Ashimi AO , Cobbe SM , Pell JP 
Published: March 2011

Background Public place defibrillators can reduce delays to defibrillation but their cost-effectiveness has not been evaluated in randomised trials. In Scotland, unlike England, no health sector funding has been provided. Nonetheless, anecdotal evidence suggests they are increasing in number. Methods A cross-sectional survey was conducted of all airports, shopping malls, leisure centres, and major train and bus stations to determine whether defibrillators had been purchased and by whom, the training and maintenance arrangements, and whether they had been discharged. Results Of the 183 eligible sites, 153 (84%) participated. 33 (22%) had at least one defibrillator. Those in airports and shopping malls were purchased privately. Those in leisure centres were bought by charities or local authorities. The majority (97%) provided training to existing staff, but 6 (18%) provided no training to new staff. Only 6 (18%) had a maintenance agreement and 8 (24%) a replacement policy. Only one site permitted public access. Defibrillators had been discharged in 10 (30%) sites. Of the 32 people shocked, 23 (72%) survived until the ambulance arrived. Conclusions Despite absence of health sector funding, defibrillators are located in 22% of high footfall public places. Those purchasing defibrillators need to ensure adequate maintenance, replacement and training arrangements.
Degos Disease
Authors: Magro Cynthia M. , Poe Jonathan C. , Kim Connie , Shapiro Lee , Nuovo Gerard , Crow Mary K. , Crow Yanick J. 
Published: March 2011

Abstract
Degos disease is a lethal small vessel angiopathy targeting the skin, gastrointestinal tract, and central nervous system, potentially developing in the setting of known autoimmune disease, although forme fruste primary variants exist. Its pathogenetic basis is unknown.
Four cases of Degos disease were encountered in archival material, representing 2 men, ages 38 and 43 years, and 2 females, ages 48 and 2 years; 3 patients died of disease. All had characteristic skin lesions with gastrointestinal involvement; other affected organs included brain in one and pericardium and pleura in another. Skin biopsies showed pauci-inflammatory thrombogenic microangiopathy with endothelial cell injury. Extracutaneous organs demonstrated fibromucinous occlusive arteriopathy. Prominent vascular C5b-9 was seen in the skin, gastrointestinal tract, and brain. All cases had evidence of high expression of interferon-α (based on tissue expression of MXA, a type I interferon-inducible protein), endothelial tubuloreticular inclusions, and an interferon gene signature in peripheral blood mononuclear cells. The MXA expression paralleled the pattern of C5b-9 deposition.
Degos disease is a distinct vascular injury syndrome whereby a dysregulated interferon-α response in concert with membranolytic attack complex deposition may contribute to the unique vascular changes. Understanding the pathophysiology of the disease process could lead to more directed therapies, including terminal complement inhibition with agents such as eculizumab.