Rationalising neurosurgical head injury referrals: development and validation of the Liverpool Head Injury Tomography Score (Liverpool HITS) for mild TBI.

A radiological scoring system to define a 'surgically significant' mild Traumatic Brain Injury (TBI) could stratify neurosurgical referrals, and improve communication between referral centres and neurosurgical units, as most referrals are not accepted. A computed tomography (CT) scoring system based on radiological injuries sustained in a TBI was developed and validated. All neurosurgical referrals to a major tertiary neurosurgery centre in England, UK with a mild TBI (GCS 13-15) during the period of 1st January to 30th October 2017 were scored retrospectively and stratified according to their mean score, and if they were accepted for transfer to the neurosurgical centre.

Designing digital prescribing: A new approach with branch diagrams.

Background: There is ample evidence that digital prescribing improves delivery of care and reduces harm, but there is not much guidance on how to design a solution.

Aims: This was written to provide a Blueprint to organisations creating electronic medication management solutions.

Methods: We created a full set of electronic prescribing Functional Requirement User Stories (FRUS's) to guide the design of a digital prescribing solution.

Pegylated interferon-α-2b reduces corticosteroid requirement in patients with Behçet's disease with upregulation of circulating regulatory T cells and reduction of Th17.

Objective: To determine whether the addition of 26 weeks of subcutaneous peginterferon-α-2b could reduce the requirement for systemic corticosteroids and conventional immunosuppressive medication in patients with Behçet's disease (BD).

Methods: We conducted a multicentre randomised trial in patients with BD requiring systemic therapy. Patients were randomised to 26 weeks of peginterferon-α-2b in addition to their standard care or to standard care only and followed 6-monthly for 3 years with BD activity scores and quality of life questionnaires.

Inpatients' expectations and experiences of hospital pharmacy services: qualitative study.

Introduction: Hospital pharmacists' have traditionally focused on the manufacture and supply of medicines. However, the increasing complexity and range of medicines and a greater awareness of medication errors has facilitated a change towards a patient-centred role. Given this movement, it is surprising that a search of the published literature shows very little research that evaluated patients' views of hospital-based pharmacy services.

Does the application of an algorithm for non-invasive ventilation in chronic obstructive pulmonary disease improve the initiation process and patient outcomes?

Objectives: Non-invasive ventilation (NIV) for acute hypercapnic respiratory failure in chronic obstructive pulmonary disease (COPD) has been shown to decrease endotracheal intubation and mortality; however, little guidance exists on NIV initiation. This study aimed to explore patient outcomes and the process of NIV initiation following the introduction of an algorithm.

Design: Prospective, modified time-series study.

Management of Type 2 diabetes and pregnancy.

Pregnancy complicated by diabetes presents risks for the mother and her baby and a challenge to those responsible for their care. Type 2 diabetes now represents a significant and rapidly increasing proportion of pregestational diabetes. Outcomes of pregnancies complicated by Type 2 diabetes are certainly no better and sometimes worse than for Type 1 diabetes.

Capillary blood glucose monitoring.

This article, the first in a series of articles relating to clinical skills in nursing, outlines the procedure of capillary blood glucose monitoring. This is a convenient way of monitoring blood glucose patterns and can be a useful aid in guiding treatment changes in patients with type 1 and type 2 diabetes, especially during periods of illness or frequent hypoglycaemia.

Insulin therapy in the management of type 1 and type 2 diabetes.

This article describes the role of insulin therapy in the management of patients with type 1 and type 2 diabetes. It outlines the different types of insulin available, insulin regimens and the key role of nurses in patient education.

Pregnancy in women with diabetes--after the CEMACH report, what now?

The second of three studies being undertaken by the Confidential Enquiry into Maternal and Child Health (CEMACH) has recently reported its findings and recommendations. The standards of diabetes and maternal care and the outcomes of 3808 pregnancies in England, Wales and Northern Ireland are described. Pre-pregnancy planning and care before conception is poor.

Antimuscarinic antibodies in primary Sjögren's syndrome reversibly inhibit the mechanism of fluid secretion by human submandibular salivary acinar cells.

Objective: Sjögren's syndrome (SS) is an autoimmune condition affecting salivary glands, for which a clearly defined pathogenic autoantibody has yet to be identified. Autoantibodies that bind to the muscarinic M3 receptors (M3R), which regulate fluid secretion in salivary glands, have been proposed in this context. However, there are no previous data that directly show antisecretory activity.

Analysis of patients' rights: dementia and PEG insertion.

The decision to provide or withhold artificial feeding in patients with advanced dementia presents a multifaceted ethical dilemma. This article analyses the issues of rights regarding such patients and explores the ethical principles of beneficence, non-maleficence, respect/autonomy, justice and veracity. Evidence points strongly to hand-feeding being the method of choice for these patients (Finucane et al, 1999; Li, 2002).

Predictors of speech and swallowing function following primary surgery for oral and oropharyngeal cancer.

Objectives: To examine the association between the speech and swallowing aspect of health-related quality of life (HRQOL) and selected clinical parameters, and particularly to determine those that are predictive of good outcomes at 1 year after surgery.

Design: Prospective questionnaire and clinical study.

Setting: Regional Maxillofacial Unit.

Preoperative intensive, community-based vs. traditional stoma education: a randomized, controlled trial.

Purpose: Conventional practice in colorectal surgery involves stoma education being imparted postoperatively. Proficiency in stoma management often delays patients' discharge following colorectal surgery. The aim of this randomized, controlled trial was to compare preoperative intensive, community-based stoma education with conventional postoperative stoma education after elective colorectal surgery.

The role of exercise training in patients with chronic heart failure.

The National Institute for Clinical Excellence (NICE) has recommended that exercise training be offered to patients with chronic heart failure (CHF). This recommendation is supported by research-based evidence from a variety of studies over the past 10 years. Initially, the studies were concerned primarily with the safety and effectiveness of exercise in these high-risk patients, but more recent studies have begun to investigate the most appropriate methods of exercise for this patient population.

Treatment setting and treatment outcome in alcohol dependency: residential and day-care options compared.

When empowered to select either a residential or a day care treatment programme for problem drinking, more patients favour the latter option. Those completing the full programme, which was similar in content in both settings, were followed up at approximately 9 months after initial engagement in treatment. Attrition was a major problem, particularly in the day-patient sample.

A reply.

Curtis, J. and Lewis-Jones, H. (2000).

Fully intermittent dosing with drugs for tuberculosis.

Background: The number of people infected with tuberculosis continues to rise world-wide. Rifampicin-containing treatment regimens can achieve high cure rates. Intermittent drug treatment delivered in the community has the potential to improve adherence to treatment.

Fully intermittent dosing with drugs for tuberculosis.

Background: The number of people infected with tuberculosis continues to rise world-wide. Rifampicin-containing treatment regimens can achieve high cure rates. Intermittent drug treatment delivered in the community has the potential to improve adherence to treatment.

The 'dedicated airway': a review of the concept and an update of current practice.

The term 'dedicated airway' was first used in connection with nasal fibreoptic intubations using the cuffed nasopharyngeal airway. Since that time, the concept has developed and the term has been extended to include fibreoptic intubation techniques involving both the laryngeal mask airway and cuffed oropharyngeal airway. 'Dedicated airway' can now be defined as: 'An upper airway device dedicated to the maintenance of airway patency while other major airway interventions are anticipated or are in progress.

Respiratory effects of low-dose bupivacaine interscalene block.

In this double-blind study, interscalene brachial plexus (ISBP) block was performed in 11 volunteers using 10 ml of either 0.25% (n = 6) or 0.5% (n = 5) bupivacaine with epinephrine 1:200,000.

Magnetic resonance imaging in the assessment of cervical nodal metastasis in oral squamous cell carcinoma.

Objective: The accurate pre-operative assessment of cervical lymph nodes is a well recognized problem in the management of patients with oral squamous cell carcinoma. Imaging techniques have improved the accuracy of staging but cannot determine if nodal enlargement is due to reactive changes or malignant involvement. We assessed the diagnostic performance of magnetic resonance imaging (MRI) in detecting metastatic disease within the neck in oral cancer patients.