Learning safe practice by improving care: student-led intervention on oxygen prescribing in a respiratory ward.

Background And Objective: The primary aim of this intervention was to improve oxygen prescribing in accordance with the 2008 British Thoracic Society guidelines for the prescription of emergency oxygen in adults.

Methods: Eight final year medical students reviewed the drug charts of all patients admitted to the respiratory ward on a daily basis in order to collect data on five audit questions: (1) Has oxygen (O2) been prescribed? (2) Has an O2 target saturation level been indicated? (3) Has O2 been prescribed as an 'as required' (PRN) or 'continuous therapy'? (4) Has the prescription been signed? (5) Has O2 been signed for in every drug round since the original prescription? Following an initial audit cycle an educational poster was distributed to all clinical staff via email and hard copies of the poster were placed strategically throughout the ward before its effectiveness was measured.

Results: During the pre-intervention phase, compliance with all five measures varied from 0 to 25%.

Encouraging healthy ageing: a vital element of NHS reform.

The implications of an ageing population are all around us, with issues such as increasing healthcare and social care costs, and a perceived pensions crisis, for example. However, too often the focus remains on how to manage the challenges of an ageing population rather than investing in research and implementing social reform to promote healthy ageing. This article reviews the major areas of medical, social/political and scientific research that together offer an opportunity to allow people to age in a healthy way.

Childhood self-poisoning: a one-year review.

Self-poisoning in children is a serious health concern accounting for 2% and 5% of childhood deaths in the developed and developing world, respectively. Type of poison and intent varies between age groups, with alcohol poisoning becoming increasingly common in teenagers. The aim of the study was to identify the characteristics of paediatric self-poisoning at Ninewells Hospital, Dundee, as a function of age, sex, intent and type of poison.

The role of interventional radiology in the management of surgical complications after pancreatoduodenectomy.

Objectives: This study evaluates the role of interventional radiology (IR) in the management of postoperative complications after pancreatoduodenectomy (PD).

Methods: A total of 120 consecutive patients were reviewed to identify IR procedures performed for early complications after PD.

Results: Findings showed that 24 patients (20.

Radiation-induced bone marrow apoptosis, inflammatory bystander-type signaling and tissue cytotoxicity.

Purpose: A study of irradiated (0.25-2 Gy) murine bone marrow has investigated the relationships between apoptotic responses of cells exposed in vivo and in vitro and between in vivo apoptosis and tissue cytotoxicity.

Materials And Methods: The time course of reduction in bone marrow cellularity in vivo was determined by femoral cell counts and apoptosis measurements obtained using three commonly used assays.

Paying the price for an incentive: an exploratory study of smokers' reasons for failing to complete an incentive based smoking cessation scheme.

Objectives: In 2009, one Scottish region launched a smoking cessation programme offering a weekly financial incentive of £12.50 over a 12-week period. However, a significant proportion of registered participants dropped out of the programme, some even failing to collect the financial reward they were owed.

Management of recurrent acute otitis media in children: systematic review of the effect of different interventions on otitis media recurrence, recurrence frequency and total recurrence time.

Objective: To conduct a systematic review comparing the effect of three interventions (prophylactic antibiotics, tympanostomy tube insertion and adenoidectomy) on otitis media recurrence, recurrence frequency and total recurrence time.

Methods: Literature on recurrent otitis media was identified using the PubMed and Scopus search engines for the period January 1990 to March 2011. A hand search of the reference lists of relevant articles and textbooks was conducted to identify additional studies.

Wnt5a inhibits the CpG oligodeoxynucleotide-triggered activation of human plasmacytoid dendritic cells.

Plasmacytoid dendritic cells (pDCs) fulfil multiple roles in immunity, and can secrete large amounts of interferon (IFN)-α. However, the available evidence suggests that they may actually counteract efficient antitumour immunity. Thus in melanoma, pDCs are abundant, but they are anergic and deficient in IFN-α secretion.

Medical student rankings of proposed sanction for unprofessional behaviours relating to academic integrity: results from a Scottish medical school.

The General Medical Council emphasizes the cultivation of professional behaviours among medical students from early undergraduate years. Learning professional behaviours, however, is a progression and is constituted of several developmental stages. Behaving with academic integrity may be the first stage.

Sudden hearing loss and pregnancy: a review.

Background: Acute hearing loss is a distressing albeit rare occurrence in pregnancy. Due to its infrequent presentation, little is known of its cause, and the best management is unclear.

Objective: To present a summary of current knowledge regarding sudden hearing loss in pregnancy and its management, by reviewing the published literature.

Bystander-type effects mediated by long-lived inflammatory signaling in irradiated bone marrow.

Radiation-induced bystander and abscopal effects, in which DNA damage is produced in nonirradiated cells as a consequence of communication with irradiated cells, indicate mechanisms of inducing damage and cell death additional to the conventional model of deposition of energy in the cell nucleus at the time of irradiation. In this study we show that signals generated in vivo in the bone marrow of mice irradiated with 4 Gy γ rays 18 h to 15 months previously are able to induce DNA damage and apoptosis in nonirradiated bone marrow cells but that comparable signals are not detected at earlier times postirradiation or at doses below 100 mGy. Bone marrow cells of both CBA/Ca and C57BL/6 genotypes exhibit responses to signals produced by either irradiated CBA/Ca or C57BL/6 mice, and the responses are mediated by the cytokines FasL and TNF-α converging on a COX-2-dependent pathway.

Do high-speed drills generate high-frequency noise in mastoid surgery?

Background: The introduction of increasingly high speed drills for mastoid surgery has heightened the concern that cochlea damage may occur in both the operated and nonoperated ear. It has been observed clinically that this damage could be associated with frequencies above 8,000 Hz and that, to observe these changes, high-frequency audiometry should be performed. Previous studies have investigated noise transmission to the cochlea at frequencies below 4,000 Hz only.

A minimally invasive temporary cavernoso-saphenous shunt in the management of priapism after failed conservative treatment.

Priapism is an urological emergency with detrimental consequences, if not managed expeditiously. Though a rare condition with an incidence between 0.3 and 1.

Use of minimally invasive parathyroidectomy techniques in sporadic primary hyperparathyroidism: systematic review.

The past two decades have seen rapidly changing attitudes towards the surgical management of primary hyperparathyroidism. Advances in localisation techniques and confidence with endoscopy have led to the development of numerous minimally invasive parathyroidectomy approaches, including open minimal incision and endoscopic and video-assisted parathyroidectomy. This paper systematically reviews the evidence for these methods to determine: (1) whether these new, minimally invasive techniques are comparable to conventional bilateral neck exploration methods in terms of success and complication rate; and (2) if they are comparable, which technique is likely to be best for cosmesis, patient safety and patient satisfaction.

Structure and function relationships in IgA.

Immunoglobulin A (IgA) has a critical role in immune defense particularly at the mucosal surfaces, and is equipped to do so by the unique structural attributes of its heavy chain and by its ability to polymerize. Here, we provide an overview of human IgA structure, describing the distinguishing features of the IgA1 and IgA2 subclasses and mapping the sites of interaction with host receptors important for IgA's functional repertoire. Remarkably, these same interaction sites are targeted by binding proteins and proteases produced by various pathogens as a means to subvert the protective IgA response.

Long-lived inflammatory signaling in irradiated bone marrow is genome dependent.

Ionizing radiation is carcinogenic, but genotype is a key determinant of susceptibility. Mutational DNA damage is generally attributed to cause disease, but irradiation also affects multicellular interactions as a result of poorly understood bystander effects that may influence carcinogenic susceptibility. In this study, we show that the bone marrow of irradiated mice will retain the ability to kill hemopoietic clonogenic stem cells and to induce chromosomal instability for up to 3 months after irradiation.

Consultant-based otolaryngology emergency service: a five-year experience.

Objective: To present our experience of running a consultant-based otolaryngology emergency care service for more than five years.

Materials And Methods: In 2003, we developed a system of consultant-based emergency service: consultants spent a week on-call providing a dedicated emergency service, with routine commitments cancelled.

Results: Our new system had advantages over traditional working practices in terms of consultant involvement, trainee education, continuity and efficiency.

Effect of surgical approach for total hip replacement on hip function using Harris Hip scores and Trendelenburg's test. A retrospective analysis.

Objective: A retrospective analysis of osteoarthritis patients undergoing primary hip arthroplasty, to assess which surgical approach produces the best functional results at one-year post-operatively, using common clinical scoring systems and tests. The aim of this study was to compare the anterolateral and the posterior approaches to total hip arthroplasty using Harris Hip scores and Trendelenburg's test by looking at pre-operative results and comparing them to post-operative results.

Methods: Data from 3416 consecutive cases were extracted from a multicentre database, maintained by the Tayside Arthroplasty Audit Group (TAAG) situated in Tayside, using only patients who had undergone a primary hip arthroplasty and had a clinical diagnosis of osteoarthritis.

Development of inventory for polyprofessionalism lapses at the proto-professional stage of health professions education together with recommended responses.

Aim: To identify behaviours and attitudes that exhibit poor professionalism at the proto-professional stage of undergraduate health professions education, and investigate the extent and nature of agreement by faculty on appropriate responses by undergraduate students in the UK.

Methods: A preliminary inventory of 69 items of behaviour and attitude was derived from literature review and 1-month observation at a UK teaching site. Reference Groups were formed by e-mail solicitation of senior medical educators in the UK and the Dundee Medical School to identify consensus on the relevant items and the appropriate responses.

Preliminary benchmarking of appropriate sanctions for lapses in undergraduate professionalism in the health professions.

Objective: To investigate the extent of consensus between faculty and students in order to benchmark appropriate sanctions for first-time offences with no mitigating factors in the area of Academic Probity by quota sampling in one cohort of medical, nursing and dental students in a Scottish university.

Methods: This study reports administration of a web-based preliminary inventory derived from the international research literature to a target population of health professions staff and students. This study was conducted at Scottish University College of Medicine, Dentistry, Nursing and Midwifery.

The effects of the mGluR5 receptor antagonist 6-methyl-2-(phenylethynyl)-pyridine (MPEP) on the stimulation of dopamine release evoked by nicotine in the rat brain.

Previous studies have shown that the prior administration of metabotropic glutamate receptor 5 (MGluR5) receptor antagonists inhibit responding for nicotine in an intravenous self-administration experiment. However, recent studies in this laboratory have shown that an mGluR5 receptor antagonist, MPEP (2-methyl-6-(phenylethynyl)-pyridine), also attenuates contextually-conditioned responding evoked by cues associated with the delivery or availability of nicotine. Thus, the results to date do not provide unequivocal evidence that the effects of mGluR5 receptor antagonists on responding for nicotine reflect a direct functional interaction between the antagonists and nicotine per se.

Trampoline-related injuries in children: a preliminary biomechanical model of multiple users.

Background: The recent popularity of domestic trampolines has seen a corresponding increase in injured children. Most injuries happen on the trampoline mat when there are multiple users present. This study sought to examine and simulate the forces and energy transferred to a child's limbs when trampolining with another person of greater mass.

IgA in the horse: cloning of equine polymeric Ig receptor and J chain and characterization of recombinant forms of equine IgA.

As in other mammals, immunoglobulin A (IgA) in the horse has a key role in immune defense. To better dissect equine IgA function, we isolated complementary DNA (cDNA) clones for equine J chain and polymeric Ig receptor (pIgR). When coexpressed with equine IgA, equine J chain promoted efficient IgA polymerization.

Molecular and epidemiological analysis of methicillin-resistant Staphylococcus aureus otorrhoea: hospital- or community-acquired?

Objectives: (1) To identify newly diagnosed cases of methicillin-resistant Staphylococcus aureus ear infection in our local population; (2) to determine the risk factors involved in these patients' clinical courses, and (3) to type the bacterial strains isolated and thus identify whether they were hospital- or community-acquired.

Design And Setting: Retrospective review of case notes, together with laboratory-based molecular studies in the departments of otolaryngology and medical microbiology in a university teaching hospital in Scotland, UK.

Subjects: Over a two-year period, 35 patients were identified with ear swabs positive for methicillin-resistant Staphylococcus aureus infection.

Radiation-induced delayed bystander-type effects mediated by hemopoietic cells.

Genetic lesions and cell death associated with exposure to ionizing radiation have generally been attributed to DNA damage arising as a consequence of deposition of energy in the cell nucleus. However, reports of radiation-induced bystander effects, in which DNA damage is produced in nonirradiated cells as a consequence of communication with irradiated cells, indicate additional mechanisms. At present, most information has been obtained using in vitro systems, and the in vivo significance of bystander factors is not clear.