Scottish Medical Journal最新文献

{"title":"Relationship between Lp-PLA2 and in-stent restenosis after coronary stenting: a 3-year follow-up study.","authors":"Guohua Sheng,&nbsp;Juan Zhou,&nbsp;Chi Zhang,&nbsp;Caijuan Wu,&nbsp;Kairong Huang,&nbsp;Xiaotong Qin,&nbsp;Jie Wu","doi":"10.1177/00369330211034809","DOIUrl":"https://doi.org/10.1177/00369330211034809","url":null,"abstract":"<p><strong>Background and aims: </strong>Coronary in-stent restenosis (ISR) is an important complication of percutaneous coronary intervention (PCI). However, the relationship between lipoprotein associated phospholipase A2 (Lp-PLA2) level and ISR after PCI is rarely reported. This study aims to explore the relationship between Lp-PLA2 and the occurrence of ISR at post-PCI and its predictive value for ISR.</p><p><strong>Methods and results: </strong>Plasma Lp-PLA2 mass were measured in 847 patients planting 1262 stents and evaluated along with known risk indicators. One-year angiographic follow-up showed that baseline elevated Lp-PLA2 mass was strongly associated with early restenosis (95% CI = 1.062-3.050, P < 0.05). Beyond the first year, the occurrence of late restenosis (95% CI = 1.043-3.214, P < 0.05) was significantly larger in the elevated Lp-PLA2 group. Kaplan-Meier analysis after three-year clinical follow up suggested that Lp-PLA2 mass did add the positive effect on the occurrence of major adverse cardiovascular events (MACEs).</p><p><strong>Conclusion: </strong>In conclusion, increased baseline plasma Lp-PLA2 predicts increased risks of re-stenosis and MACEs, which may be a novel biomarker for predicting ISR and MACEs.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"66 4","pages":"178-185"},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/00369330211034809","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39226540","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial - Medical litigation in the 21st century.","authors":"Robyn Webber","doi":"10.1177/00369330211055810","DOIUrl":"https://doi.org/10.1177/00369330211055810","url":null,"abstract":"<p><p>The possibility of a medical negligence claim lies at the back of many doctors' minds. But which specialties see the greatest and fewest claims, and what are the potential costs to the NHS of a successful claim? In their article, Dr Lane et al. analyse 10 years' NHS litigation data, broken down by specialty, number of claims, and the attendant cost of those claims which were successful. Litigation in the 'post Montgomery' era is considered along with some of the common factors which may lead to a patient or their family taking legal action.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"66 4","pages":"166-167"},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39849686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medicolegal issues in healthcare: Corporatisation of healthcare.","authors":"Ghuam Nabi","doi":"10.1177/00369330211058808","DOIUrl":"https://doi.org/10.1177/00369330211058808","url":null,"abstract":"A career in Medicine is often rewarding and profession is regarded as one of the noble professions. In a professional relationship between patient and doctor, due care is rendered based on principles of sincerity, trust and mutual understanding that outcome may not be predictable in certain circumstances and things can and will go wrong. however, axiom such as “you learn from your mistakes” is not considered as learning opportunity anymore and law is brought in by the patients to decide level of negligence by the doctors, in cases where perceived errors are witnessed. The judges with no knowledge of medical science decide degree of negligence and compensation based on medical expert opinions. In Cambridge dictionary, negligence is defined as “the fact of not giving enough care or attention to someone or something”. The parameters to categorise degree of negligence are often subjective and varied between; lata culpa, gross neglect; levis culpa’ ordinary neglect and levissima culpa, slight neglect (1). The decision on the level of negligence is further dependant on the context, circumstances of individuals and systems. In a medical error, it is often assumed that things have gone wrong and somebody needs to be punished and medical practitioners are often held responsible without observing any cautions that matters are invariably complex. The decisions to pursue cases of medicolegal negligence are often based on notions that what the best practice should have been rather than exhibiting deeper understanding of real-life practices. No distinction is made between a case of occupational negligence and professional negligence. A case of negligence should not be made on the basis that better alternatives or more skilled approach was likely to adopted in a case than the one under consideration. Rather Bolam test should be applied to the matters of negligence (2). The Bolam test is “The test is the standard of the ordinary skilled man exercising and professing to have that special skill” A practitioner is not negligent as long as he has acted in accordance with practice approved by a body of other responsible doctors. There is a less recognised side effect of negligence cases pursued by litigants against doctors. The impact of “fear of failure” by medical practitioners on society need to be realised and this may be counterproductive with potential for more harm than good. A dangling fear in the mind of surgeon of failure and subsequent prosecution would prevent him from acting in the best interest of patient. Similarly, a seriously sick patient with 10% chances of survival may not get resuscitated as failure to achieve a satisfactory outcome may land a medical practitioner into a court case and the fear may prevent him from acting in the best interest of patient. In contrast to spending resources on pursuing matters of perceived negligence by society, we should be spending on prevention. Use of apology, clinical guidelines and proper documentation are some","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"66 4","pages":"165"},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39849692","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Investigation and management of papillary thyroid microcarcinoma - a Scottish regional case series and literature review.","authors":"Timothy Davies,&nbsp;William Royce,&nbsp;Robin Crosbie,&nbsp;Richard Townsley","doi":"10.1177/00369330211032352","DOIUrl":"https://doi.org/10.1177/00369330211032352","url":null,"abstract":"<p><strong>Background and aims: </strong>Papillary thyroid microcarcinoma is defined as papillary thyroid cancer with a diameter of ≤1 cm. Despite its prevalence, there is wide variation in practice in the investigation and management of patients with papillary thyroid microcarcinoma throughout the UK and internationally. The primary aim of this paper is to describe the experience of investigation and management in a Scottish health board over the past 10 years.</p><p><strong>Methods and results: </strong>Retrospective analysis of thyroidectomy and hemithyroidectomy resection samples from March 2009 to March 2020. 532 specimens were reviewed and 20 patients with PTMC were identified. 12 patients had an incidental finding of PTMC. Median U score- 3, Median Thy score- 2.5 for dominant or radiologically suspicious nodules. 8 specimens demonstrated aggressive histopathological features. 1 patient with positive nodal disease in the neck and 0 patients with positive nodal disease in the thorax on CT Neck and Chest.</p><p><strong>Conclusion: </strong>Here we report the first UK Cohort describing the radiological investigation and management of papillary thyroid microcarcinoma. The results of our study are in accordance with a recent meta-analysis which found 4% nodal disease and 0.025% distant metastasis at time of presentation in patients with PTMC.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"66 4","pages":"191-196"},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/00369330211032352","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39218736","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Image guided ablation.","authors":"Xinrui Zhang,&nbsp;Andreas Melzer","doi":"10.1177/0036933020973637","DOIUrl":"https://doi.org/10.1177/0036933020973637","url":null,"abstract":"Ablation refers to the local application of optical, acoustic or electrical energy and cold as to induce irreversible cell injury, apoptosis and coagulative necrosis of tissues. By contrast to surgical excision, ablation is a minimally invasive treatment option, whereby the scarified tissue remains in situ and is being absorbed over several months and transformed to a scar. Clinical use of ablation encompasses the treatment of various tumors, including liver, lung, kidney, pancreatic, head and neck cancer and bone metastasis. Additionally, neurological disorders, particularly essential tremor and Parkinson’s disease, can be treated by ablation of brain tissue or neuronal structures. Relatively novel is the use electrical energy in a certain pattern that induces cell apoptosis without coagulation, referred to irreversible electroporation (IRE), see Rui Chen et al. in this issue of SMJ. In order to decide which kind of local cell destruction is useful and can be applied safely a thorough understanding of the underlying principles is essential. In addition, it is required to use an appropriate imaging technology to monitor and control the process of tissue destruction. The process of energy-induced cell/tissue destruction consists of two phases through direct and indirect mechanisms. The direct damage of cells occurs rapidly after exposure of the target tissue to high temperature, alteration of the cell membrane, dysfunction of mitochondrial and inhibition of DNA replication. Changes of cell membrane fluidity and permeability are considered as the major cause of cell injury, leading to dysfunction of actin filaments and microtubules and impairment of facilitated diffusion across the cell membrane. Mitochondria are affected by high temperature, increasing leakage of protons through the inner mitochondrial membrane and changing the ultrastructure in minutes. Besides the changes in cellular level, heatinduced denaturation of key replication enzymes DNA polymerase a and b, which is responsible for semiconservative DNA replication and DNA repair synthesis respectively, thereby inhibiting DNA replication. Denaturation of polymerase substrate chromatin, abnormal condensation of non-histone nuclear matrix proteins, disruption of RNA synthesis and the release of lysosomal enzymes are believed the mechanisms of heat-mediated reproductive cell death. The indirect mechanism occurs via several mechanisms, including induction of apoptosis, the release of cytokines and stimulation of immune response. Apoptosis is increased in the peripheral zone of the central ablated lesion, which undergoes coagulative necrosis. Expression of essential apoptotic protein p53 was upregulated and bcl-2 was downregulated in human liver cancer tissues after ablation treatment. Release of pro-inflammatory cytokines such as interleukin-1b (IL-1b), IL-6, IL-8, IL-18 and tumor necrosis factor-a (TNF-a) increase in several hours to days after ablation maximize the anti-tumor response. Heat","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"66 4","pages":"175-177"},"PeriodicalIF":2.7,"publicationDate":"2021-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://ftp.ncbi.nlm.nih.gov/pub/pmc/oa_pdf/de/e3/10.1177_0036933020973637.PMC8573691.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39849690","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Chest x-ray scoring as a predictor of COVID-19 disease; correlation with comorbidities and in-hospital mortality.","authors":"Aparajita Singh,&nbsp;Yoke Hong Lim,&nbsp;Rajesh Annamalaisamy,&nbsp;Shyam Sunder Koteyar,&nbsp;Suresh Chandran,&nbsp;Avinash Kumar Kanodia,&nbsp;Navin Khanna","doi":"10.1177/00369330211027447","DOIUrl":"https://doi.org/10.1177/00369330211027447","url":null,"abstract":"<p><strong>Objectives: </strong>To devise a novel, simple chest x-ray (CXR) scoring system which would help in prognosticating the disease severity and ability to predict comorbidities and in-hospital mortality.</p><p><strong>Methods: </strong>We included a total of 343 consecutive hospitalised patients with COVID-19 in this study. The chest x-rays of these patients were scored retrospectively by three radiologists independently. We divided CXR in to six zones (right upper, mid & lower and left, upper mid & lower zones). We scored each zone as- 0, 1 or 2 as follows- if that zone was clear (0) Ground glass opacity (1) or Consolidation (2). A total of score from 0 to 12 could be obtained.</p><p><strong>Results: </strong>A CXR score cut off ≥3 independently predicted mortality. Along with a relatively higher NPV ≥80%, it reinforced the importance of CXR score is a screening tool to triage patients according to risk of mortality.</p><p><strong>Conclusions: </strong>We propose that Pennine score is a simple tool which can be adapted by various countries, experiencing a large surge in number of patients, to decide which patient would need a tertiary Hospital referral/admission as opposed to patients that can be managed locally or at basic/primary care hospitals.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"66 3","pages":"101-107"},"PeriodicalIF":2.7,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/00369330211027447","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39112404","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"One-year real life data of our patients with moderate-severe Crohn's disease who underwent ustekinumab therapy.","authors":"Ferhat Bacaksız,&nbsp;Derya Arı,&nbsp;Volkan Gökbulut,&nbsp;Ömer Öztürk,&nbsp;Ertuğrul Kayaçetin","doi":"10.1177/00369330211008587","DOIUrl":"https://doi.org/10.1177/00369330211008587","url":null,"abstract":"<p><strong>Aim: </strong>The aim of this study was to present one-year real-life data of our patients with CD who showed unresponsiveness and/or intolerance to biological agents and then received ustekinumab treatment through an early access program.</p><p><strong>Materials and methods: </strong>The retrospective study reviewed the 52-week clinical data of 10 patients with moderate or severe CD who underwent ustekinumab therapy.</p><p><strong>Results: </strong>The 10 patients comprised 7 (70%) men and 3 (30%) women with a mean age of 38 ± 11.3 years. Mean disease duration was 13.5 ± 8.5 years. Mean pretreatment CDAI score was 273.5 ± 92 and mean pretreatment HBI score was 11.6 ± 3.8. At the end of the 8-week intravenous induction treatment, 5 (55%) patients showed clinical remission according to the CDAI and HBI scores. Additionally, 62.5% of the patients were in clinical remission at the end of week 52 according to the CDAI and HBI scores. No drug-related side effects were observed in any patient throughout the treatment.</p><p><strong>Conclusion: </strong>Ustekinumab appears to be effective and safe in the treatment of moderate and severe CD, particularly in cases of unresponsiveness and intolerance to biological agents such as anti-TNF, and in the achievement of clinical remission.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"66 3","pages":"152-157"},"PeriodicalIF":2.7,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/00369330211008587","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"25582523","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Scottish Cardiac Society.","authors":"","doi":"10.1177/0036933020986069","DOIUrl":"https://doi.org/10.1177/0036933020986069","url":null,"abstract":"Scottish Cardiac Society Post myocardial infarction VSD closure: experience from Edinburgh Royal Infirmary Jack PM Andrews, David Northridge and Miles WH Behan Cardiology Registrar, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK Consultant Cardiologist, Edinburgh Heart Centre, Royal Infirmary of Edinburgh, Edinburgh, UK Abstract Introduction: Post myocardial infarction ventricular septal defect (PMIVSD) is a devastating complication with an in hospital mortality of 42%. Surgical and percutaneous repair are the current treatment options. Here, we describe our experience of post MI VSD repair in the Royal infirmary of Edinburgh from May 2015 to July 2019. Methods: Data was collected from electronic case records. Baseline demographics, mode of presentation, VSD location, size and occluder device type were recorded. Major comorbidity and mortality at one year were recorded where possible. Results: 13 post MI VSD repairs were performed within the timeframe. Mean age at presentation was 70 11 years. 4 were from NHS Lothian, 8 from elsewhere in Scotland and one overseas patient. 7 were female. 8 presented with acute inferior STEMI, 3 anterior STEMI and two without ST elevation on the ECG. VSD location was inferior in 10 and anterior in 3. 9 were initially treated with percutaneous closure, 2 of which went on to have surgical revision. Of the 4 initially repaired surgically, 2 went on to have further percutaneous closure. 10 patients survived to discharge with 3 in hospital deaths (23% in hospital mortality). One year survival was 46% (6/13). Conclusions: In the era of primary PCI, post-infarction VSD is now a rare complication. Our in-hospital mortality rate of 23% suggests that the outlook for these patients may have improved, slightly, compared to historical series. Initial treatment choice between surgical or percutaneous repair requires multi-disciplinary team discussion and is based on clinical stability, operative risk and VSD morphology, and a significant proportion of cases (4 out of 13 in our series) will require both approaches. ReferenceIntroduction: Post myocardial infarction ventricular septal defect (PMIVSD) is a devastating complication with an in hospital mortality of 42%. Surgical and percutaneous repair are the current treatment options. Here, we describe our experience of post MI VSD repair in the Royal infirmary of Edinburgh from May 2015 to July 2019. Methods: Data was collected from electronic case records. Baseline demographics, mode of presentation, VSD location, size and occluder device type were recorded. Major comorbidity and mortality at one year were recorded where possible. Results: 13 post MI VSD repairs were performed within the timeframe. Mean age at presentation was 70 11 years. 4 were from NHS Lothian, 8 from elsewhere in Scotland and one overseas patient. 7 were female. 8 presented with acute inferior STEMI, 3 anterior STEMI and two without ST elevation on the ECG. VSD location was inferior in 10 ","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"66 3","pages":"NP15-NP29"},"PeriodicalIF":2.7,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/0036933020986069","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39259211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optical coherence tomography measurements in patients with systemic hypertension.","authors":"Özlem Bursali,&nbsp;Özgül Altintaş,&nbsp;Ayşen Ağir,&nbsp;Nurşen Yüksel,&nbsp;Berna Özkan","doi":"10.1177/00369330211011175","DOIUrl":"https://doi.org/10.1177/00369330211011175","url":null,"abstract":"<p><strong>Aim: </strong>To evaluate the effect of systemic arterial hypertension (SAH) on retinal optical coherence tomography (OCT) parameters and investigate whether a correlation exists between ambulatory blood pressure monitoring (ABPM) and OCT measurements.Material-methods: 115 SAH patients (225 eyes) and 123 healthy control cases (234 eyes) were included. ABPM was performed on 89 of 115 SAH patients. All patients underwent detailed ophthalmologic examination including imaging with OCT. SAH patients were divided into two groups (dippers, non-dippers) according to their nocturnal blood pressure (BP) reduction, and OCT measurements were compared.</p><p><strong>Results: </strong>Average and superior retinal nerve fiber layer (RNFL) quadrants were significantly thin in hypertensive cases (p:0.002, p < 0.001, respectively). Cup area, cup/disk (c/d) area, and c/d horizontal ratios were wider; the rim area was smaller in hypertensive cases (respectively: p:0.024, p:0.017, p:0.003, p < 0.001). Total macular volume (TMV), the thicknesses in 1-3 and 1-6 mm of the macula were less in hypertensives (p < 0.001). There was no significant difference between dippers and non-dippers in RNFL thickness, macula and optic nerve head (ONH) parameters.</p><p><strong>Conclusion: </strong>There were statistically significant differences between healthy cases and patients with SAH in terms of RNFL, macula thicknesses and ONH parameters.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"66 3","pages":"115-121"},"PeriodicalIF":2.7,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/00369330211011175","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"38949326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Squamous-cell carcinoma due to mesh infection after umbilical hernia operation: third case of the literature.","authors":"Mehmet Esat Duymus,&nbsp;Ozlem Ipci","doi":"10.1177/00369330211027465","DOIUrl":"https://doi.org/10.1177/00369330211027465","url":null,"abstract":"<p><strong>Introduction: </strong>Polypropylene (PP) meshes are safe synthetic products used for hernia repairs and associated with minimal complication. Chronic inflammation is thought to play a pathophysiological role in the development of cancer.<b>Case presentation:</b> We present a 67-year-old female case of squamous cell-cancer (SCC) that developed due to mesh after umbilical hernia operation. The mass in the anterior abdominal wall was totally resected. Pathology was reported as T2N0, moderately differentiated acantholytic type SCC. No recurrence or complication was detected in the fourth-month follow-up.</p><p><strong>Conclusion: </strong>Cancer development after mesh is very rare and our case is the third case in the literature. Cancer development should be kept in mind in patients presenting with ulcerated masses if do not regress with infection treatment after mesh application.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"66 3","pages":"158-161"},"PeriodicalIF":2.7,"publicationDate":"2021-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1177/00369330211027465","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39101013","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}