bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of the Effect of Local Corticosteroid Injection and Anti-inflammatory Medication in Carpal Tunnel Syndrome
Authors: Gurcay E , Unlu E , Gurcay AG , Tuncay R , Cakci A 
Published: March 2011

Background and Aims To evaluate the effect of local corticosteroid injection versus non-steroidal anti-inflammatory drugs (NSAIDs) in the treatment of carpal tunnel syndrome (CTS), 32 patients were included in this study. Methods A prospective, randomised clinical trial, assessing functional findings by Functional Status Scale (FSS), Jebsen Taylor Test (JTT) and electrophysiologic examinations, analysed on initial visit and at the third month after treatment. Group A was treated with betamethasone injection and group B with NSAIDs, both with concomitant use of wrist splints. Results The mean age of the patients was 40.8±11.2 (range 21–64) years. There was a significant improvement in FSS in groups A and B at the third month. In JTT, ‘writing’, ‘picking up small common objects’ and ‘picking up large heavy objects’ activities were improved in group A; ‘writing’ and ‘stacking checkers’ activities were improved in group B. Statistically significant improvement was observed in peak sensory conduction velocity and distal motor latency in groups A and B. Mixed nerve conduction velocity and compound sensory action potential were improved in group A. Conclusions The results showed that neither of the groups demonstrated superior results. We conclude that local steroid injection and NSAIDs with concomitant use of wrist splints may offer patients with CTS variable and effective treatment options for the management of functional scores and nerve conduction parameters.
A Comparison of Rural and Urban Rheumatoid Arthritis Populations
Authors: Basu N , Steven M 
Published: March 2011

Introduction There is evidence to suggest that remote populations have poorer clinical outcomes in certain disease processes such as asthma and cancer. This study looks to identify any disparities in the management of patients with rheumatoid arthritis in the context of rurality. Methods A retrospective observational study was performed on all 1314 patients with a diagnosis of rheumatoid arthritis who have been under the care of the principal rheumatologist at Raigmore Hospital, Inverness, between the years 1994 and 2004 inclusive. Rurality was defined according to the Scottish Household Survey. Populations were assessed in terms of age; sex; duration of diagnosis; number of years of Disease Modifying Anti-Rheumatic Drugs (DMARD) therapy, prednisolone use and the number of musculoskeletal practical interventions undertaken (eg joint aspiration or replacement). Results Two thirds of patients were considered rural dwellers. No significant difference was established between the populations with regards to management. DMARD therapy had been prescribed in 77% of rural patients vs 70% of their city counterparts for a mean 5.4 and 4.0 years respectively. The proportion of patients exposed to prednisolone therapy and who underwent musculoskeletal procedures were equivalent. Conclusions Rural dwellers, with rheumatoid arthritis in the Highlands of Scotland, do not appear to be disadvantaged in regards to their disease management in comparison to the urban population.
CT Scanning in Stroke Patients: Meeting the Challenge in the Remote and Rural District General Hospital
Authors: Todd AW , Anderson EM 
Published: March 2011

Introduction National audit data allow crude comparison between centres and indicate that most Scottish hospitals fail to meet current guidelines for CT scanning of the brain in stroke patients. This study identifies some of the reasons for delay in performing CT scans in a largely rural population. Methods This audit study assesses the delays from onset of symptoms, time of admission and request received to CT scan in stroke patients for three different in-patient groups as well as those managed in the community. Results The reasons for delay in CT scanning varied between different patient groups but for one group of in-patients, changes in booking procedure and introduction of a second CT scanner increased the proportion scanned within 48 hours of request from 65% to 96%. Discussion Further developments including the introduction of Saturday and Sunday routine CT scanning, radiologist reporting from home and additional CT scanners placed in remote hospitals may be expected to improve these figures further. Target times of three hours from onset of symptoms to scan to allow thrombolysis may however be impossible to meet for all stroke patients in rural areas.
The Risk of Malignancy Index for Ovarian Tumours in Northeast Scotland – a Population Based Study
Authors: Harry VN , Narayansingh GV , Parkin DE 
Published: March 2011

Background and Aims The Scottish Intercollegiate Guidelines Network (SIGN) recommends the use of the Risk of Malignancy Index (RMI) for ovarian tumours, a scoring system based on ultrasound findings, menopausal status and CA 125 level, in the pre-operative evaluation of pelvic masses. The aim of this study was to investigate the accuracy of this as a predictive method of discriminating benign from malignant disease. Methods and Results All women who underwent oophorectomy in 2004 at Aberdeen Royal Infirmary for suspected primary ovarian pathology were evaluated. The RMI was calculated and these results were compared with the final histopathology. The sensitivity of the RMI for diagnosing malignant ovarian disease was 94% (32/34) while the specificity was 70% (76/108). Conclusions Compared to previous studies, the RMI score was highly sensitive in detecting malignant disease, although not as specific in excluding benign lesions, particularly cystadenomas and endometriomas. This can be improved by the refinement of imaging techniques as well as the use of laparoscopy in particular cases. The RMI score may also be especially valuable in directing referrals to a specialised centre.
Neonatal Head Injuries Revisited
Authors: King J , Haddock G 
Published: March 2011

Background Between 1999 and 2005, 51 neonates were admitted to the regional Neonatal Surgical Unit (NSU), Glasgow with a diagnosis of head injury. The aim of this retrospective study was to compare this cohort with those from an earlier review of similar cases. Methods and Results Cases were reviewed using a structured data collection proforma. Information obtained was then compared with the results of an identical review carried out in the same Unit between 1990 and 1996. In the present series, the majority of the injuries were caused by a fall (n=39 [78%]) and resulted in scalp haematomata (n=31 [62%]) and associated skull fractures (n=30 [60%]). Only one patient required significant intervention. Conclusion Comparing the two study periods, there has been a marked increase in the number of cases admitted with a diagnosis of head injury (n=51 v n=25). There has also been an increase in the number of intracranial haemorrhages reported, associated with an increase in the number of CT scans performed. Non-accidental injury remains uncommon in this patient group. Outcome was excellent for all patients.
Professional Opinions of the Use of Telemedicine in Child & Adolescent Psychiatry
Authors: Mitchell Sarah A , Maclaren Andrew T , Morton Michael , Carachi Robert 
Published: March 2011

The Telemedicine project at Yorkhill Hospital, Glasgow was set up in 2004 to aid in the rapid diagnosis of children at a distant location. The Child and Adolescent Mental Health Services (CAMHS) are now the largest users. CAMHS use this service for clinical work, service development and to aid research. Twenty four CAMHS professionals with experience of the telemedicine facility were asked to complete questionnaires outlining their opinions on the strengths and weaknesses of the facility; 19 responded. The results showed a wide variety of professionals use the facility and that clinical work makes up the majority of the use. An advantage to rural populations in Scotland was considered the most important benefit. Saving time and an improved method of communication were also highlighted as important. Failure of technology and problems with sound quality were highlighted as drawbacks. Seventy nine percent of subjects stated that they preferred Telemedicine to Telephone conferencing. The results show the Telemedicine facility is perceived as a positive addition to CAMHS in Scotland. Therefore, its use should be encouraged in other areas of medicine and surgery.
Body Mass Index and Weight Distribution
Authors: Pengelly Cdr , Morris J 
Published: March 2011

It has been accepted for many years that being overweight or obese, as indicated by a body mass index (BMI) of 25 or over for the former and 30 or over for the latter, is associated with impairment of long term health and prognosis. The World Health Organisation (WHO) has indicated that, in Caucasians, waist measurements of 94cm or more in men, and 80cm or more in women have similar adverse effects on health, with increased risks at 102 cm or more in men and 88 cm in women. The role of waist-hip ratio (W/H) and whether it represents a better index than waist (W) measurement alone is being debated; many papers favour waist measurement alone. But two papers in 2005 discussing 27,098 subjects, 12,461 of whom had myocardial infarction and 14,637 controls, come down firmly in favour of W/H and were followed by a Lancet Editorial entitled ‘Farewell to Body Mass Index?’ Life assurance companies at medical examination usually request height and weight measurements (and therefore BMI). Most ask for waist measurements and a few hip measurements in addition (and therefore W/H). The authors have reviewed the data in 816 consecutive subjects for life assurance examination in whom BMIs, Ws and W/Hs were all recorded. In these the evidence supports the use of W as the best indicator of risk in men (634 cases), but not in the relatively small number of women (182 cases) in whom H appeared better. We believe that BMI, W and W/H should be recorded in every subject at life assurance examination so that the insurance companies in the long term will be able to reach valid conclusions about their individual and collective value
Consultants in Scotland: Survey of Educational Qualifications, Experience and Needs of Scottish Consultants
Authors: Schofield Sj , Nathwani D , Anderson F , Monie R , Watson M , Davis Mh 
Published: March 2011

Aims To survey Scotland's NHS consultants regarding their teaching roles; educational qualifications/training; attitudes to educational qualifications; perceptions of health boards’ attitudes to educational activities; usefulness of various educational courses and preferred delivery methods Methods Postal questionnaire (n=3615) Results Sixty two percent response rate (n=2246). 98% had one or more roles in education/training. 54% spent more time in educational roles than job-plan allocations. 6% had educational qualifications. 30% rated educational qualifications valuable to their educational role; 21% to their career. 48% had not attended any educational training. 19% of respondents rated their health board as supportive of their educational activities. Respondents rated dealing with underperforming students (74%), dealing with challenging behaviour (63%), appraising students (63%), trainee assessment (61%) and feedback (58%) as the most useful topics Conclusions Scottish consultant involvement in educational activities is virtually universal but consultants perceive they need more time than allocated in job plans. Most consultants had no teaching qualifications. Nearly half had no formal training for educational activities. Educational qualifications were valued by a minority regarding both career development and educational activities. Increased access to staff development for teaching is required as NHS sources are not meeting the need for teacher training of consultant staff.
Evaluation of a General Practice Based Hepatitis C Virus Screening Intervention
Authors: Anderson Em , Mandeville Rp , Hutchinson Sj , Cameron So , Mills Pr , Fox R , Ahmed S , Taylor A , Spence E , Goldberg Dj 
Published: March 2011

Background In 2003 an estimated 37,500 of Scotland's population was chronically infected with HCV; 44% were undiagnosed former injecting drug users (IDU) - a priority group for antiviral therapy Aim To evaluate a hepatitis C virus (HCV) screening intervention Design Outcome measures among two similar General Practice populations in an area of high HCV and drug use prevalence, one of which was exposed to an HCV screening intervention, were compared Methods Thirty to fifty four year old attendees of the intervention practice were opportunistically offered testing and counselling, where clinically appropriate, (November 2003– April 2004) Outcomes: HCV test uptake, case detection, referral and treatment administration rates. Results Of 584 eligible attendees, 421 (72%) were offered and 117 (28%) accepted testing in the intervention practice; no testing was undertaken in the comparison practice Prevalences of HCV antibody were 13% (15/117), 75% (3/4) and 91% (10/11) among all tested persons, current IDUs and former IDUs respectively. For 4/15 (27%) evidence of binge drinking following the receipt of their positive result, was available. Of the 11 referred to specialist care because they were HCV RNA positive, nine attended at least one appointment. Two received treatment: one had achieved a sustained viral response as of February 2008. Conclusion While non targeted HCV screening in the general practice setting can detect infected former IDU, the low diagnostic yield among non IDUs limited the effectiveness of the intervention. A more targeted approach for identifying former IDUs is recommended. Additionally, the low uptake of treatment among chronically infected persons four years after diagnosis demonstrates the difficulties in clinically managing such individuals. Strategies, including support for those with a history of problem alcohol use, to improve treatment uptake are required.
The Use of CT Angiography in Acute Subarachnoid Haemorrhage in Eastern Scotland
Authors: White P , Macpherson R , Sellar R 
Published: March 2011

Introduction Early confirmation of aneurysmal cause for SAH can expedite patient management and thus minimise rebleed risk. CT Angiography is the first-line method for diagnosing the cause of SAH in most UK regions. We wanted to assess the use of CTA in this context in the East of Scotland and determine how imaging delays contribute to overall delay from ictus to aneurysm treatment. Methods A prospective audit of aneurysmal SAH admissions over a three month period to the Neurosciences Unit in Edinburgh was performed. The time from diagnosis of SAH to aneurysm imaging with CTA and/or DSA and time from aneurysm confirmation to definitive treatment was ascertained. Results Twenty nine patients with aneurysmal SAH were admitted during the audit. Four patients had CTA expeditiously after SAH was diagnosed; the remaining 25 patients had a substantially greater wait for aneurysm imaging, involving transfer to a neuroscience centre. Average excess delay was 17 hours for CTA (72 hours for DSA). Discussion CTA is a widely available and accurate method of determining the cause of SAH. Performing immediate CTA after SAH is confirmed could reduce delays to aneurysm treatment by up to 64%. By thus reducing rebleeds post SAH, immediate CTA could reduce poor outcomes in the East of Scotland.
A Mental Health Assessment and Support Team for Community Elders in Fife (EAST)
Authors: Stevenson G , Ewing H , Keith J 
Published: March 2011

Background The aging population combined with the increased recognition of the need to assess elderly patients with mental health difficulties in their own environment encouraged service redesign in Fife with the focus on community assessment of older people with mental health needs. Aims To establish and assess the functioning of a joint Health and Social Services enhanced assessment and support team (EAST) for community-dwelling elders with significant mental health needs living in a Scottish health region, and to determine the impact of this team on the requirement for acute psychogeriatric hospital services. Methods Prospective three-year data collection of service activity involving EAST and the local psychogeriatric acute inpatient and day hospital facilities. Results EAST assessed 111 patients during the study, 83% with a diagnosis of dementia. The mean duration of assessment was six weeks with 9% of patients receiving an overnight home assessment and 6% requiring hospital admission. Overall there was a substantial reduction in utilization of both acute psychogeriatric admission beds and day hospital placements. Conclusions Multi-agency community assessment of elders with mental health problems can be addressed effectively without recourse to hospital admission, which may allow resource release for further service developments.
Castleman's Disease of the Parotid Gland: A Case Report
Authors: Lee Yong Sang , Hong Soon Won , Lee Seung Chul , Nam Kee-Hyun , Chung Woong Youn , Chang Hang Seok , Park Cheong Soo 
Published: March 2011

Castleman's disease is a lymphoproliferative disorder of unknown etiology. Although it may occur at any site where lymph nodes are located, it has rarely been found in the salivary glands. We describe here a patient with intraparotid Castleman's disease. A 29-year-old woman presented with a history of right cheek swelling for 2 months. Physical examination and computed tomography showed a well-demarcated, round-shaped, homogeneous, enhancing mass in the right parotid gland that seemed to involve the superficial lobe. A right superficial parotidectomy was performed, during which the facial nerve was well preserved. Final pathological report demonstrated intraparotid lymph node showing hyperplasia with Castleman's disease. At 5-year follow up, the patient is free of disease.
Clinical Audit: Management of Acute Severe Asthma in West Glasgow
Authors: Bayes Hk , Oyeniran O , Shepherd M , Walters M 
Published: March 2011

Background The UK has 75,000 hospital admissions and over 1,500 deaths from asthma annually. The British Thoracic Society (BTS) guidelines represent the recognised standard for acute asthma management. We assessed the degree of conformity with these guidelines in an acute medical unit. Methodology Data from consecutive admissions were collected prospectively. Practice was audited in October -December 2005 and October 2006 - January 2007. Between cycles an educational programme was instigated. Results Fifty-eight patients were included. Clinical parameters were well recorded in both cycles. Peak expiratory flow was consistently under-recorded (72% at admission; 67% in monitoring). Severity assessment was documented at 55% and 66% in cycle one and two respectively. Of these, the assessment was incorrect in 33% in cycle one and 21% in cycle two. All misclassifications of severity were underestimates. All life-threatening attacks were not identified. No improvement occurred between cycles. Overall, 60% of patients were inappropriately treated according to BTS guidelines, 40% due to under-treatment. Under-treatment occurred more frequently in cycle two compared with cycle one (57% vs. 24%, p=0.007), predominantly due to inadequate treatment of life-threatening asthma. Conclusion Management of acute asthma in a large, urban teaching hospital is suboptimal. Educational intervention failed to improve care; more comprehensive strategies are required.
An overview of common lower extremity soft tissue injuries in athletes
Authors: Lakkol S , Singisetti K , Anand S 
Published: March 2011

Lower limb soft tissue injuries are commonly encountered in sports medicine especially in athletes and long distance runners. Dilemmas can exist in identifying the correct aetiology as it can frequently be multifactorial. Management of such injuries in lower limbs is evolving as more people perform physical exercise and play sport. This article is an overview of common lower limb soft tissue injuries seen in athletes. Lower extremity soft tissue injuries are common among athletes and non-athlete runners.1 Running injuries can be defined as pain or symptoms associated with running or starting within a specific time span from the beginning of a training programme, which forces the individual to stop training or decrease intensity.2 The knee is the commonest site involved comprising up to 44% of running injuries.2,3 This article outlines the natural history, pathophysiology, investigation and management of common conditions.
A review of the prevention of head, neck and facial injuries in ice hockey
Authors: Webb MSL , McLatchie G R 
Published: March 2011

Ice hockey is one of the fastest and most physical team sports. With projectiles (pucks) travelling at over 100mph and players travelling at up to 30mph wielding sticks and skating on razor sharp blades, there is potential for significant injury. In 1961, an insurance survey reported over 100 closed head injuries, with one death. This led to research into helmets and subsequent mandatory use. Facial protection was first developed in 1972 initially for goalkeepers. By 1976 all amateur players were required to wear full facial protection.
CT Guided Lung Biopsies: An Audit Cycle
Authors: Saraswat L , Azmat O , Shannon H. 
Published: March 2011

Aim To re-audit the practice of CT guided lung biopsies Standard British Thoracic Society guidelines Methods The present audit of CT guided lung biopsies has been undertaken to assess if changes in practice instituted following an initial audit in 2003/2004 has improved the diagnostic yield and impacted on the complication rate. Results 97 biopsies were carried out in 90 patients. The overall diagnostic rate was 85.6 % (66 true positive and 17 true negatives). There were 14 (14.4%) false negatives. 28 (28.9%) patients developed a pneumothorax and 6 patients (6.2%) required insertion of chest drain. Conclusion The overall diagnostic rate is within the BTS standard and is higher than the previous audit (85.6 % compared to 81 % in the previous audit). The number of biopsies performed has increased significantly. The complication rate for pneumothorax is higher than the BTS standard. The technique of biopsy has also changed with most biopsies now being core biopsies rather than fine needle aspiration (FNA).
Donor Cell–Derived Leukemias/Myelodysplastic Neoplasms in Allogeneic Hematopoietic Stem Cell Transplant Recipients
Authors: Wang Endi , Hutchinson Charles Blake , Huang Qin , Lu Chuanyi Mark , Crow Jennifer , Wang Frances F. , Sebastian Siby , Rehder Catherine , Lagoo Anand , Horwitz Mitchell , Rizzieri David , Yu Jingwei , Goodman Barbara , Datto Michael , Buckley Patrick 
Published: March 2011

Abstract
We report 10 cases of donor cell leukemia (DCL). All cases except the case of chronic lymphocytic leukemia had anemia, neutropenia, and/or thrombocytopenia when DCL was diagnosed. Eight cases with sex-mismatched hematopoietic stem cell transplant (HCT) showed donor gonosomal complements, suggesting DCL. Clonal cytogenetic abnormalities were detected in 8 cases: 6 were monosomy 7/del(7q). In all 10 cases, engraftment studies confirmed donor cell origin. Retrospective fluorescence in situ hybridization in archived donor cells in 4 cases showed a low level of abnormalities in 2. Of 7 patients with clinical follow-up of 5 months or more, 1 (with acute myeloid leukemia) died of disease; 6 are alive, including 1 with myelodysplastic syndrome with spontaneous remission. Similar to reported cases, we found disproportional sex-mismatched HCTs, suggesting probable underdetection of DCL in sex-matched HCTs. The latency between HCT and DCL ranged from 1 to 193 months (median, 24 months), in keeping with the literature. Analyzing our cases, pooled with reported cases, with survival models showed much shorter latency for malignancy as primary disease, for T-cell large granular lymphocyte leukemia as type of DCL, and for umbilical cord blood as stem cell source.