Dilemma of diagnosing sulphonylurea overdose in children: deliberations and considerations before reaching a diagnosis.

A 15-year-old non-diabetic Caucasian girl presented with sudden onset of seizures, unrecordable blood glucose readings and acute renal failure. She denied any medication ingestion and no other precipitating factors were encountered for this acute presentation. She was treated with intravenous glucose infusion and hydrocortisone injection.

Resource use and outcomes associated with initiation of injectable therapies for patients with type 2 diabetes mellitus.

Introduction: Management of type 2 diabetes mellitus (T2DM) often requires intervention with oral and injectable therapies. Across National Health Service (NHS) England, injectable therapies may be initiated in secondary, intermediate or primary care. We wished to understand resource utilization, pathways of care, clinical outcomes, and experience of patients with T2DM initiated on injectable therapies.

Do the clinical competencies of musculoskeletal outpatient physiotherapists improve after they have participated in a bespoke in-service education programme designed around individual and service continuing professional development needs?

Objective: To determine whether the clinical competencies of musculoskeletal outpatient physiotherapists improve if they participate in an annual in-service education programme designed around clinical practice needs.

Design: A within-subject, without-control, experimental, pre-test post-test study.

Setting: Clinical and educational facilities of Doncaster and Bassetlaw Hospitals NHS Foundation Trust and locality-based outpatient facilities.

Factors affecting reversal following Hartmann's procedure: experience from two district general hospitals in the UK.

Purpose: Restoration of gastrointestinal continuity following Hartmann's procedure is a challenging task associated with significant morbidity and mortality. New strategies to avoid a stoma are not readily available in general hospitals. Knowledge of the factors related to reversal is required to develop treatment strategies and counsel patients realistically.

Discharging pin sites following K-wire fixation of distal radial fractures: a case for pin removal?

The aim of this study was to find out whether discharging pin sites following Kirschner-wire fixation of distal radial fractures warrant early wire removal. In a prospective study of 50 patients with a closed distal radial fracture treated by manipulation and either percutaneous or mini-incision Kirschner-wiring, we identified 14 patients (28%) with discharging pin sites. All of the cases were observed within the first two weeks following surgery.

Ruptured abdominal aortic aneurysm masquerading as isolated hip pain: an unusual presentation.

The rupture of an abdominal aortic aneurysm (AAA) is a catastrophic event. Misdiagnosis by first-contact emergency physicians remains a serious concern. Varied and frequently nonspecific presentations lead to erroneous diagnostic impressions and cause significant delays in definitive intervention.

A comparative study examining the decision-making processes of medical and nursing staff in weaning patients from mechanical ventilation.

A prolonged period of mechanical ventilation is costly for both the patient, in terms of the risk of complications such as ventilator-acquired pneumonia, and to the health service due to the high cost of maintaining a patient in intensive care. The recognition of the role nurses can play in the weaning process and the desire to try and reduce weaning times led to the introduction of nurse-managed weaning on the intensive care unit which is the focus of this study. This means that both doctors and nurses are now responsible for making decisions about weaning.

The precision and accuracy of templating the size of unicondylar knee arthroplasty.

In trauma and joint arthroplasty, preoperative templating is an important step that can help in the selection of implant size, position and alignment. Although the precision (reproducibility) of templating in unicondylar knee arthroplasty has been assessed previously, the accuracy has never been studied. Our aim is to assess the precision and accuracy of using the templating system for one commonly used unicondylar knee arthroplasty, ALPHANORM design (Alphanorm Medizintechnik, Germany).

Congenital trigeminal anaesthesia.

Two patients with congenital trigeminal nerve anaesthesia are described. The first (male, aged 14 years) had an isolated unilateral loss of sensation in all three divisions of the trigeminal nerve with no other abnormalities. The second patient (male, aged 3 years 6 months) had bilateral loss of sensation in all three divisions of the trigeminal nerve, associated with other neurological abnormalities.

Audit on prescription of long-term oxygen treatment.

An audit was undertaken to assess the compliance to British Thoracic Society guidelines (1997) in the prescription of long-term oxygen treatment (LTOT) in Bassetlaw District General Hospital. A total of 34 patients were prescribed LTOT in our hospital between March 1993 and October 1998. The average age of patients was 71 years, 31 patients had COPD and three had chronic asthma.

The Nottingham Study of Neurotic Disorder: influence of cognitive therapists on outcome.

Background: In previously published papers from the Nottingham Study of Neurotic Disorder a short treatment package of cognitive-behaviour therapy was no more effective than placebo drug treatment after 10 weeks' assessment in a cohort of 210 patients with neurotic disorders. This paper examines the outcome over two years of the patients treated by cognitive-behaviour therapy separated into two therapist groups, those who were competent in administering treatment and those of uncertain competence.

Method: The therapists (mainly community psychiatric nurses) of 70 patients with an original DSM-III diagnosis of either dysthymic, panic or generalised anxiety disorder were separated into two groups on the basis of their perceived competence by their supervisor (DK).

Adult respiratory distress syndrome due to mycoplasma pneumonia.

A previously fit 48-year-old man was admitted with an acute respiratory failure due to mycoplasma pneumonia that was confirmed by raised mycoplasma titre on complement fixation test. It was also associated with disseminated intravascular coagulopathy. The patient made a full recovery but required intermittent positive pressure ventilation.

The use of cognitive behavior therapy with a normalizing rationale in schizophrenia. Preliminary report.

Sixty-four consecutively referred patients with schizophrenia were treated with cognitive-behavioral psychotherapy as an adjunct to standard treatment. A destigmatizing rationale to explain symptom emergence was devised and supplemented these techniques. They proved safe to use and appeared acceptable to patients and their relatives.

Current concepts in the management of sarcoidosis.

Sarcoidosis can affect almost every organ. It has diverse clinical presentations and a variable natural history. Lungs and intrathoracic lymph nodes are the most commonly involved tissues.

Face processing impairments and delusional misidentification.

We report detailed investigations of the face processing abilities of four patients who had shown symptoms involving delusional misidentification. One (GC) was diagnosed as a Frégoli case, and the other three (SL, GS, and JS) by symptoms of intermetamorphosis. The face processing tasks examined their ability to recognize emotional facial expressions, identify familiar faces, match photographs of unfamiliar faces, and remember photographs of faces of unfamiliar people.

Mania induced by lorazepam withdrawal: a report of two cases.

Although depression is a well recognised component of the benzodiazepine withdrawal syndrome there have, as yet, been no convincing reports of mania. We report two cases of mania induced by abrupt discontinuation of lorazepam. Both cases were treated by reintroduction of the benzodiazepine followed by gradual dose reduction.

Aggressive behaviour: evaluation of a non-seclusion policy of a district psychiatric service.

An increasing number of psychiatric services have non-seclusion policies. Evaluation of a policy of using specified observation levels instead of seclusion was made over a two-year period. The number of violent incidents recorded in health service facilities was low (exactly 50).