Journal round up
Authors: James Hutton
Journal: Journal of the Royal Society of Medicine (2012)

Are nurse and pharmacist independent prescribers making clinically appropriate prescribing decisions?

Latter S, Smith A, Blenkinsopp A, Nicholls P, Little P, Chapman S

Journal of Health Services Research & Policy 2012;17:149–156

Legislation and health policy enabling nurses and pharmacists to prescribe a comprehensive range of medicines has been in place in the UK since 2006. While it is clear that patients are generally satisfied with their experiences, particularly the increased access this policy affords, concerns about the appropriateness of prescriptions is unknown. Using 100 audio-records of consultations in which a nurse or pharmacist prescribed a medicine, a group of doctors, nurses and pharmacists assessed the appropriateness of the decisions against 10 criteria. Prescribing was deemed appropriate in over 90% of cases for eight criteria. The exceptions were ‘giving correct directions for use’ (80%) and ‘use of least expensive option’ (70%). Given that a similar set of consultations with doctors were not studied, it is difficult to know how nurses and pharmacists compare! However, generally the policy to extend prescribing to these groups appears thoroughly justified.

***

Social and practical implications of fetal sex determination using ultrasound

Edwards H, Thomson N

Ultrasound 2012;20:49–53

Following recent debate on prenatal sex selection, the Council of Europe has resolved to encourage national ethics bodies to develop and introduce guidelines for medical staff discouraging prenatal sex selection by whatever means unless justified for the prevention of serious sex-linked genetic diseases. Ultrasound is the most common method for determining sex prenatally and is used for medical and social reasons. In some countries where male offspring are more desirable, fetal sexing during ultrasound examinations has been outlawed due to growing concern that large numbers of female fetuses are being terminated. Although Council of Europe decisions are not binding on the UK, it is timely to examine the use of ultrasound for the determination of fetal sex in the UK and to discuss some of the reasons behind why ultrasound cannot always get it right. We describe sex-linked conditions where sex identification is especially important, and conditions and circumstances which make sexing difficult, including ambiguous genitalia. The social aspects of determining the sex of the fetus during an ultrasound examination are also explored as there is no doubt that many women want to know either from curiosity or to help plan for the new arrival. We recommend that ultrasound practitioners remain aware of the accuracy and limitations of ultrasound for the determination of fetal sex and should therefore exercise due caution when imparting sex information to parents.

***

Renal transplant ultrasound: a pictorial review

Belfield JC, Griffin CP, Powell S

Ultrasound 2012;20:82–91

Renal transplantation is considered the optimal treatment in patients with end-stage renal disease. Ultrasound is usually the first choice imaging modality for evaluating renal transplant anatomy and perfusion. It is important to be aware of how to image a renal transplant, the normal sonographic appearances and relevant pathological processes. Renal transplant ultrasound imaging includes duplex vascular evaluation and the operator must have a sound knowledge of both normal and abnormal Doppler waveforms. Complications following renal transplantation are usually assessed with ultrasound. The time-frame in which complications can occur stretches from the immediate postoperative period to months or years following transplantation. A knowledge of the anticipated complications relative to that timescale helps to focus the examination. This pictorial review aims to demonstrate the appearances of the normal renal transplant as well as potential complications. These include vascular (renal vein thrombosis, renal artery stenosis, pseudoaneurysm and arteriovenous fistulae), parenchymal (acute rejection, acute tubular necrosis and malignancy) and urological (ureteric stricture and renal calculi) complications.

***

Tele-electroencephalograms in the UK: a report of over 1000 patients

Coates S, Clarke A, Davison G, Patterson V

Journal of Telemedicine and Telecare 2012;18:243–246

Clinical neurophysiology is the medical specialty in the UK responsible for training doctors in the interpretation of electroencephalograms (EEGs). At present it is difficult to recruit doctors to train in clinical neurophysiology which causes difficulty in delivering services. A tele-EEG service was set up to record and report on EEGs at a National Health Service (NHS) hospital which was unable to attract a resident clinical neurophysiologist. The EEGs were recorded in digital format and placed on a web server to be read by a clinical neurophysiologist in another part of the UK. Where possible this was done using NHS web servers and email, but a back-up system was established using other systems with suitable encryption. A total of 1007 EEGs were reported in 13 months from patients of all ages, epilepsy being the commonest reason for referral. All cases were reported within 24 hours of recording. The back-up system was used in 60 cases. Tele-EEG is a feasible, secure, timely and effective method of providing an EEG service to hospitals which cannot recruit a resident clinical neurophysiologist.

***

Human-animal anthrax outbreak in the Luangwa valley of Zambia in 2011

Hang'ombe MB, Mwansa JCL, Muwowo S et al.

Tropical Doctor 2012;42:136–139

Between 8 August and 25 October 2011, 521 cases of suspected human anthrax were seen in the Luangwa valley in Zambia, five of whom died. A few weeks earlier, local fishermen had reported seeing many dead and dying hippopotami along the river and, in total, 85 dead hippos were identified. Fifty-six samples were taken from patients, dead hippos and soil from the surrounding area and 17 of these were culture positive for Bacillus anthracis. Most of the human cases occurred among men who had butchered hippo carcasses. Two samples of dried, smoked hippo meat confiscated in the surrounding villages were also found to be positive for B. anthracis. No other animal species were found to be affected and, after 25 October, no more cases were seen.