Differing commissioning arrangements may contribute to geographic variation in clinical management of digital ulcers in systemic sclerosis.

Phosphodiesterase inhibitors (such as sildenafil) and endothelin receptor antagonist, bosentan, are effective for digital ulcer disease in systemic sclerosis (SSc-DU) and are endorsed in international treatment recommendations. Commissioning of high-cost drugs, such as bosentan, however, differs across devolved nations of the UK. We report a multicentre service evaluation project to examine 'real world' management of SSc-DU before and following the 2015 UK Scleroderma Study Group (UKSSG) guidance, across south-west (SW) England and Wales.

Decompression sickness in Ireland--a review.

In the last decade there has been an increase in the incidence of decompression sickness in Ireland. The modern diver, equipped with specially developed diving equipment, is exposed to abnormal physiological conditions. This has resulted in a spectrum of medical conditions, which need to be recognised, diagnosed and treated.