Scottish Medical Journal最新文献

{"title":"Radiation safety awareness and practices amongst orthopaedic surgeons in Scotland","authors":"Gordon T Snowden, M. Jabbal, A. Akhtar","doi":"10.1177/00369330221099620","DOIUrl":"https://doi.org/10.1177/00369330221099620","url":null,"abstract":"As orthopaedic surgeons we use x-rays every day; not only when diagnosing pathology but often to assist in operative management of said pathology or ensure satisfactory outcomes for our patients in clinic. An awareness of the correct use of ionising radiation in the form of fluoroscopic imaging is therefore of great importance to reduce intraoperative exposure and has led to the development of the As Little As Reasonably Achievable (ALARA) principle. The primary aim of this study is to determine the knowledge and practises of radiation safety amongst orthopaedic surgeons in Scotland. Secondary aim is to assess the prevalence of back pain and relation to lead gowns. A google forms survey containing 20 questions about both an individual's radiation practises, and knowledge and departmental practises were distributed to all 4 deaneries in Scotland. In total 72 responses were received from 20 hospitals across all 4 Scottish deaneries. This included 28 Consultants, 23 Senior trainees and 21 Junior trainees. We found that the level of radiation training and knowledge varied considerably across seniority and the nation. Of those surveyed 100% reported always wear lead aprons/gowns however only 46.2% (n = 34) frequently or always wear thyroid protection when using X-rays. Only 55% (n = 40) of those surveyed had completed a radiation safety course with this being far less likely amongst junior trainees (29%, n = 6) than amongst Consultants (82%, n = 23) and senior trainees (48%, n = 11) (p < 0.0001). To our knowledge this is the most extensive survey into the radiation practises of Orthopaedic Surgeons in the literature and shows the need for increased education and awareness of radiation safety practises, particularly amongst junior trainees.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"103 - 108"},"PeriodicalIF":2.7,"publicationDate":"2022-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48565073","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":"Management of stage II seminoma: a contemporary UK perspective","authors":"C. Alifrangis, D. Nicol, J. Shamash, P. Rajan","doi":"10.1177/00369330221099619","DOIUrl":"https://doi.org/10.1177/00369330221099619","url":null,"abstract":"Background and Aims Testicular Germ Cell Tumours (TGCTs) are the commonest young adult male cancer, with excellent survival outcomes even with metastatic disease. Chemotherapy, radiotherapy, and surgery are international guideline-dictated standard of care (SOC) treatments for International Germ Cell Cancer Collaborative Group (IGCCCG) “good risk” TGCT, but are associated with significant toxicities. Therapy de-escalation aims to reduce treatment morbidity whilst preserving cure rates, and has been adopted by some centres for stage IIA/B seminoma. Here, we report on the contemporary UK treatment landscape for stage IIA/B seminoma. Methods A questionnaire-based survey of NHS England-designated specialist cancer centres hosting supra-regional specialist multi-disciplinary team (sMDT) services (n = 13) as well those within NHS Scotland, NHS Wales and Health and Social Care Northern Ireland. Respondents were asked to order preferences of SOC and therapy de-escalation treatments for stage IIA/B seminoma. Results We identified significant geographical heterogeneity in treatment preferences. Whilst up to a third of centres have adopted a treatment de-escalation regimen, the majority deliver combination chemotherapy or radiotherapy. Conclusion A wider recognition of UK treatment heterogeneity and consideration of therapy de-escalation strategies at supra-regional sMDTs will increase stage IIA/B seminoma treatment options as part of clinical trials with oncological and quality of life endpoints.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"126 - 128"},"PeriodicalIF":2.7,"publicationDate":"2022-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47785319","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":"The Relationship Between Urinary Symptom Severity And Functional Status İn Patients With Stroke.","authors":"Fatma Özcan,&nbsp;Zuhal Özişler","doi":"10.1177/00369330211072247","DOIUrl":"https://doi.org/10.1177/00369330211072247","url":null,"abstract":"<p><strong>Background: </strong>Lower Urinary Tract Dysfunction (LUTD) is a condition that is common in stroke patients and affects their quality of life and psychological state.</p><p><strong>Aim: </strong>To determine the factors affecting LUTD severity in stroke patients and to evaluate its relationship with functional status.</p><p><strong>Method: </strong>77 stroke patients were included in our study. Demographic and stroke characteristics of all patients were recorded. Functional Ambulation Scale (FAS), Functional Independence Measure (FIM), the Core Lower Urinary Tract Symptom Score (CLSS) Questionnaire, Beck Depression Scale were administered to the patient. 33 of 77 patients had urodynamic study and these patients constituted the subgroup of the study. Patients were grouped according to type of disorder, type of detrusor and detrusor sphincter dyssynergia (DSD) using urodynamic study findings.</p><p><strong>Result: </strong>The mean CLSS of men was significantly higher than women (<i>P</i> = 0.017). A significant positive correlation was found between age and CLSS (<i>P</i> = 0.035 r = 0.24) and negative correlation was found between total FIM and all sub-parameter scores and mean of CLSS (<i>P</i> = 0.001 r = -0.467).</p><p><strong>Conclusion: </strong>LUTD is common in stroke patients and the presence of urinary symptoms is associated with poor functional status. No significant relationship was observed between urodynamic data except maximum flow rate and CLSS.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 2","pages":"64-70"},"PeriodicalIF":2.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39786102","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":"Evaluating xanthochromia in the diagnosis of subarachnoid haemorrhage in Scotland in the Era of modern computed tomography.","authors":"Stephen Rankin,&nbsp;Jacqueline McGuire,&nbsp;Mohamed Chekroud,&nbsp;Likhith Alakandy,&nbsp;Babu Mukhopadhyay","doi":"10.1177/00369330211072264","DOIUrl":"https://doi.org/10.1177/00369330211072264","url":null,"abstract":"<p><strong>Aim: </strong>Cerebrospinal fluid (CSF) analysis for xanthochromia is routinely used to exclude subarachnoid haemorrhage (SAH). In this study, we evaluated the sensitivity and specificity of xanthochromia (by NEQAS-spectrophotometry) in routine clinical practice in three acute hospitals, in patients with suspected SAH. We explored whether including CSF red cell count (RCC) with xanthochromia improved diagnostic accuracy.</p><p><strong>Methods: </strong>In this retrospective analysis, all xanthochromia results were assessed over three consecutive years. Clinical information and Registry data were analysed to find all patients diagnosed with SAH. We correlated xanthochromia data with clinical and radiological findings.</p><p><strong>Results: </strong>There were 1761 xanthochromia performed. Of these, 26 (1.5%) were positive, 1624 (92%) negative and 72 (4.1%) were inconclusive. Of the 26 tests that were positive, 9 (35%) had confirmed SAH, 17 (65%) were falsely positive, with no false negative tests in our series. Xanthochromia identified 6% of all SAH diagnosed in the study. Incorporating RCC <1000 with xanthochromia, reducing false positive tests by 38% and inconclusive test by 85%.</p><p><strong>Conclusion: </strong>The positive yield of xanthochromia is low but identified 6% of SAH. NEQAS-spectrophotometry is an excellent diagnostic method with 100% sensitivity, 99% specificity. Incorporating RCC markedly reduces false positive and inconclusive tests reducing need for further imaging.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 2","pages":"71-77"},"PeriodicalIF":2.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39741059","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":"Evaluation of the optimal duration for retrograde intrarenal stone surgery to prevent postoperative complications","authors":"Y. Yitgin, Nurullah Altınkaya, Nurmanbet Turaliev, S. Guven, R. Ergul, A. Boyuk, S. Verep, T. Tefik, M. A. Karagoz, M. Ibis, M. I. Gokce, K. Sarıca","doi":"10.1177/00369330221099621","DOIUrl":"https://doi.org/10.1177/00369330221099621","url":null,"abstract":"Objective To evaluate retrograde intrarenal surgery (RIRS) outcomes and to determine the effect of operative time on complications of RIRS. Methods Patients undergoing RIRS for renal stones were evaluated. These patients were divided into two groups according to the operation time (Group 1<60 minutes and Group 2>60 minutes). Peroperative outcomes such as fluoroscopy time, stone-free rates, complications and duration of hospitalization were compared. Results Group 1 consisted of 264 patients and Group 2 consisted of 297 patients. SFR rates, duration of hospitalization, and postoperative urinary tract infection rates were similar in both groups. Fluoroscopy time was 7.8±7.3 (0-49) sec in group 1 and 13.1±9.8 (0-81) sec in group 2. Complications according to modified Clavien–Dindo classification system (MCDCS) were 13 and 32 patients (Grade 1), 31 and 63 patients (Grade 2), 1 and 1 patient (Grade 3) in group 1 and 2, respectively. There was statistical difference between the two groups in terms of duration of fluoroscopy time and the MCDCS. Although duration of hospitalization and UTI rates were higher in group 2, no statistical significance was observed among groups. Conclusion Limiting the operation time to 60 minutes in RIRS seems to be important in reducing postoperative complications.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"121 - 125"},"PeriodicalIF":2.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44263931","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":"Surgical skills and COVID-19 pandemic: Impact and way forward","authors":"G. Nabi","doi":"10.1177/00369330221095709","DOIUrl":"https://doi.org/10.1177/00369330221095709","url":null,"abstract":"The Covid-SARS-19 pandemic has changed the global ways of life, impacting various domains of living such as social life, national economies, work, and temporary curtailing of opportunities in surgical training. 1,2 The temporary cessation of skill courses and conferences by the organisations and professional bodies have impacted training of future surgical workforce. In this issue Ms Gowda et al. 3 report, impact of Covid-19 pandemic on the technical skills of urology trainees attending national BOOTS camp. 4 The study fi nds a detrimental effect of pandemic on the technical skills of trainees, whereas a similar study by Etheridge et al. from Singapore 5 showed an improvement in non-technical and team man-agement skills. Improvement in teamwork during disas-ters has also been observed in other area. 6,7 Together with other publications, the published literature provides background for the future policy making in surgical training. The observations reported by the authors suggest that lack of exposure to real-life surgical skills particularly in complex tasks such as laparoscopic suturing has resulted in poor technical skills gain by the trainees. 8 The role of simulation can help in retaining basic surgical skills and principles upto a point, but further re fi nement is only pos-sible through operating on patients in surgical operating room environment. A drop in upto 60% of operative volume based on a review of operating logbooks of trainees in Europe and USA us idea are likely the","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"49 - 50"},"PeriodicalIF":2.7,"publicationDate":"2022-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"44594785","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":"Matthew Baillie (1761–1823): From Shotts to Duntisbourne Abbots","authors":"M. Muqit, A. Larner","doi":"10.1177/00369330221093752","DOIUrl":"https://doi.org/10.1177/00369330221093752","url":null,"abstract":"Matthew Baillie was born in Shotts, Lanarkshire, Scotland in 1761 and died at Duntisbourne Abbots, Gloucestershire, England in 1823. In the intervening years he established himself as one of the foremost anatomists of his day, publishing one of the earliest treatises on pathological anatomy, and then as physician, eventually ministering to the Royal household and other notable patients and earning a considerable fortune in the process. Amongst his many honours he received an Honorary Fellowship of the Royal College of Physicians of Edinburgh, where he is commemorated in the frieze in the Great Hall. This article follows the trajectory of his career, introducing material not found in previous biographies.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"129 - 133"},"PeriodicalIF":2.7,"publicationDate":"2022-04-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42935183","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 Renal Association","authors":"Sylvia McConnell, R. Battle, Emma, Cannon, Samina Hussain, P. Phelan, David Turner, O. EoinD., Sullivan, K. Mylonas, Cyril, Carvalho, David P. Baird, Marie, Docherty, Carolynn Cairns, M. Kevin, Gallagher, A. Laird, C. Neil, Henderson, Tamir Chandra, Kristina, Kirschner, B. Conway, Laura, Denby, G. H. Dihazi, M. Zeisberg, J. Hughes, H. Dihazi, David, A. Ferenbach","doi":"10.1177/00369330221087797","DOIUrl":"https://doi.org/10.1177/00369330221087797","url":null,"abstract":"Intro: Sodium/glucose cotransporter-2 inhibitors (SGLT2i) reduce risk of progressive kidney disease both in and out with the setting of diabetes. The aims of this study were to quantify the current uptake of canagliflozin within patients with type 2 diabetes in nephrology units within the west of Scotland and to identify barriers to prescribing. Methods: A retrospective analysis of the Scottish Electronic Renal Patient Record (SERPR) was performed to patients to secondary care nephrology services within NHS Greater Glasgow and Clyde (GGC) and NHS Lanarkshire who were eligible for SGLT2i. Canagliflozin is licensed for treatment of diabetic kidney disease (DKD) in patients with type 2 diabetes, estimated glomerular filtration rate (eGFR) >30 ml/min/1.73 m, urinary albumin:creatinine ratio (uACR) >30 mg/mmol. A questionnaire was produced to identify attitudes towards prescribing SGLT2i’s. The survey was composed of 5 questions on GoogleForms and Survey Monkey platforms. These were disseminated via email to prescribers in NHS GGC (nephrology only) and NHS Lanarkshire (nephrology and medical specialties). Results: From the retrospective SERPR analysis, there were 74 patients in NHS Lanarkshire identified as eligible, of whom 8 (11%) had been prescribed canagliflozin. In NHS GGC, 148 patients were identified as eligible of whom 57 (38.5%) had been prescribed canagliflozin. There were 58 survey responses gathered in NHS Lanarkshire and 18 responses from NHS GGC. Within NHS Lanarkshire 35.5% of respondents were consultants, 19.0% were registrars, and 34.5% were foundation or core trainee doctors. Respondents in NHS Lanarkshire felt that the main responsibility for prescribing SGLT2i lay with diabetes (55.1%), then all specialties equally (39.7%), GP (20.7%) and cardiology (17.2%). Only 24.1% of respondents in NHS Lanarkshire had started a patient on an SGLT2i and 29.3% felt they had access to adequate information to commence a patient on SGLT2i. Within NHS GGC, 72.2% of respondents were consultants and 11.1% were registrars, 83.3% had prescribed SGTL2i and 94.4% of respondents felt as though they had adequate information to commence patients of SGLT2i treatment. Within NHS GGC 61.1% of respondents felt every specialty had equal responsibility to start patients on SGLT2i, followed by diabetes (33.3%), nephrology (33.3%) and GP (27.8%). Conclusion: SGLT2i prescribing in patients with DKD remains low. A variety of factors contribute towards this, including inadequate provision of information to clinicians regarding commencing SGLT2i, concerns over serious side effects of SGLT2i (such as euglycemic DKA) and disagreement over whose responsibility it should be to commence these medications. Providing furthereducation and readily accessible prescribing resources to clinicians, and particularly to training grade doctors, may help to increase uptake of SGLT2i.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"NP1 - NP24"},"PeriodicalIF":2.7,"publicationDate":"2022-04-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"49555625","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":"Multicentric analysis of the perceptions and knowledge of digital health amongst undergraduate medical students","authors":"Mohamed Nauzan Mohamed Nazeer, H. Baig, A. Subeh, Q. Khan, Saad Atif Majeed, Mohammad Ashraf","doi":"10.1177/00369330221080749","DOIUrl":"https://doi.org/10.1177/00369330221080749","url":null,"abstract":"Introduction Digital health (DH) is continuously evolving by use of information and communications technology to improve healthcare provision, thereby reshaping systems and clinical practices. Recent studies identified an overwhelming lack of awareness of DH within the profession. This study aimed to analyse student perceptions and knowledge of DH to assess confidence in its use to develop greater DH awareness and literacy. Methods Students enrolled in undergraduate medical degrees were invited to take part in an online survey assessing aspects of DH including demography, familiarity, attitudes, level of knowledge and confidence. Anonymised data was collated and subsequently analysed to review DH awareness. Results A total of 143 students participated from nine British universities with 28.7% of respondents admitting low levels of familiarity of DH concepts. Students anticipated negative repercussions of DH including reduced data security (42.7%) and deterioration in doctor-patient relationship (30%); while improvements in healthcare access and health-outcomes are expected by 89.5% and 68.5%, respectively. 71.4% of participants believed they had minimal experience of exposure to DH and 76% believed they did not possess the necessary skills to utilise DH. Only 3.5% of students had some exposure to DH teaching during their course. Conclusion There is an important requirement to address the lack of knowledge and exposure of students to DH, particularly as the world targets the COVID-19 pandemic. DH is forming the basis of the ‘new normal’ in healthcare, however the full potential of DH cannot be achieved unless there is an increase in its teaching incorporated into medical school curricula.","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"56 - 63"},"PeriodicalIF":2.7,"publicationDate":"2022-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42096931","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":"Extra-peritoneal Laparoscopic Resection of Benign Prostate Adenoma >150 CC with preservation of posterior wall of prostatic urethra: Dundee Technique and early outcomes.","authors":"Hollie A Clements,&nbsp;Ghulam Nabi","doi":"10.1177/00369330211068123","DOIUrl":"https://doi.org/10.1177/00369330211068123","url":null,"abstract":"<p><strong>Background: </strong>There are limited options for men with large benign prostates (>150cc) and bladder outflow obstruction due to benign prostatic hyperplasia (BPH). Management options include surgery (open or minimal access) and endoscopic procedures. There is a paucity of literature on outcomes for prostates >150cc.</p><p><strong>Methods: </strong>In this case series we describe a step-by-step, illustrated, modified extra-peritoneal technique of laparoscopic prostatectomy with preservation of the posterior prostatic urethra. This involves creation of extra-peritoneal space, transverse incision of prostate capsule, progressive adenoma dissection, resection, and closure of the capsule.</p><p><strong>Results: </strong>Ten patients underwent this procedure between 2015 and 2019. The mean age was 72.4 years and mean prostate size was 215.5cc. Mean procedure duration was 200 min and there were no intraoperative complications. Most patients were discharged on postoperative day 1. Mean intraoperative blood loss was 120 ml with no patient requiring blood transfusion. At follow up (mean 37 months) no patients had residual symptoms of BPH.</p><p><strong>Conclusion: </strong>We describe a novel extraperitoneal laparoscopic technique for benign prostates of >150cc with very good outcomes. The transferability of this technique to centres with laparoscopic expertise at minimal extra cost and future adaptability in the robotic setting are some of the advantages of this technique.</p>","PeriodicalId":21683,"journal":{"name":"Scottish Medical Journal","volume":"67 1","pages":"30-37"},"PeriodicalIF":2.7,"publicationDate":"2022-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39750239","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}