Clinical record keeping in patients receiving antibiotics in hospital.

Background: Antibiotic prescribing is associated with the growth of antibiotic resistance in micro-organisms. Prescribing therefore needs to be restricted by well-designed antibiotic protocols. Audit of such protocols is only possible if clinical information about infection is properly recorded.

Limb amputation on renal replacement therapy.

Ten (10) diabetic and 7 non-diabetic patients on renal replacement therapy have undergone limb amputation in the authors' unit in the 1988 to 1996 period. The article examines the course of illness and survival patterns in this distinct and increasing sub-set in the amputee population. Rehabilitation and survival were significantly better in the diabetic group and it is recommended that it would be helpful for both prognosis and analysis if the sub-set of amputees on treatment for chronic renal failure is further divided into diabetic and non-diabetic sub-sets.

How do you measure the impact of an antibiotic policy?

The principle aim of antibiotic policies is to bring about a change in prescribing which will lead to decreased cost, reduction of resistance and improved quality (judicious, safe and appropriate) of antibiotic prescribing. Before embarking upon developing, disseminating and subsequently implementing an antibiotic policy clinicians and key decision makers need to make explicit at the onset of policy development, how they plan to evaluate its impact. Quality indicators of the process of implementing policies and their impact on various outcomes need to be identified.

Feasibility of an outpatient and home parenteral antibiotic therapy (OHPAT) programme in Tayside, Scotland.

Outpatient and home parenteral antibiotic therapy (OHPAT) is under-utilized in the U.K. We performed a feasibility study over a 5-month period in a regional U.

Aortic bifurcation reconstruction: use of the Memotherm self-expanding nitinol stent for stenoses and occlusions.

Purpose: To assess the technical success, initial clinical outcome, and intermediate follow-up of the Memotherm nitinol self-expanding stent in aortic bifurcation reconstruction.

Methods: Thirty-three patients (13 male, 20 female), mean age 64 years, were treated, who had symptoms classified by the Surgical Vascular Society/International Society of Cardiovascular Surgery (SVS/ICVS) classification as grade 2 in 11 (33%), grade 3 in 19 (58%) and grade 4 in 3 (9%) patients. Lesions were classified according to severity and type.

Disruption of skin perfusion following longitudinal groin incision for infrainguinal bypass surgery.

Objective: The objective of our study was to investigate whether such an incision results in a reduction in blood flow, and therefore haemoglobin oxygen saturation, across the wound.

Design: Microvascular oxygenation was measured with lightguide spectrophotometry in 21 patients undergoing femoropopliteal or femorodistal bypass procedures. A series of measurements were made in the groin, medial and lateral to the surface marking of the femoral artery.

Strategies to rationalize sepsis management--a review of 4 years' experience in Dundee.

Hospitals worldwide are facing an unprecedented crisis of rising cost of antibacterials due to the increasing rapid emergence and dissemination of antibiotic-resistant organisms, improper use of antibiotics and the use of broad spectrum parenteral agents. The last 25 years has seen the introduction of many measures to improve the quality of sepsis management, and specifically antimicrobial use. The present paper reviews the development, implementation and evaluation of some of the key strategies employed within the Dundee Teaching Hospitals NHS Trust (DTHT) to enhance recognition and assessment of sepsis and to rationalize the early and often empiric antibiotic treatment of patients in hospital with infection.

Acute Herpes zoster in Tayside: demographic and treatment details in immunocompetent patients 1989-1992.

Medical records of 105 patients admitted to Tayside hospitals with acute Herpes zoster without underlying immunosuppression were examined retrospectively for the period 1984-1992. In this elderly population (median age: 79 years) there was a female preponderance (70.5%), most admissions were for trigeminal zoster (49.

Evaluation of the impact of non-inpatient i.v. antibiotic treatment for acute infections on the hospital, primary care services and the patient.

The aim of this study was to assess the feasibility of providing i.v. antibiotic therapy outside hospital.

Sequential switch therapy for lower respiratory tract infections: a European perspective.

Traditionally, serious lower respiratory tract infections (LRTIs) are treated in hospital and with parenteral antibiotics. During the past decade, there has been an impetus to reduce the overall cost of antimicrobial therapy. The availability of new oral antibiotics with superior pharmacokinetics profiles and safety has enabled clinicians increasingly to consider their use in managing serious infections effectively.

Glutaraldehyde-tanned bovine carotid artery graft for infrainguinal vascular reconstruction: 5-year follow-up.

Objective: To assess the long-term patency of a modified biological conduit, the glutaraldehyde-tanned bovine carotid artery, in above-knee infrainguinal arterial reconstruction.

Patients And Methods: Prospective follow-up of a cohort of 58 above-knee femoropopliteal grafts in 55 patients. Graft patency was assessed at yearly intervals with doppler ankle pressure measurements.

Developing a multidisciplinary protocol for enteral feeding.

The management of planned change is discussed using a change model. Protocols are described and defined. The process of multidisciplinary protocol development is identified.

The radiological appearance of atherosclerotic popliteal artery aneurysms: the "dog-leg" sign.

The radiological appearance of popliteal aneurysms is described. Althought the lumen of the artery is often of normal diameter there is elongation of the vessel which frequently results in an acute "dog-leg". This sign has not been previously described.

Use of lightguide spectrophotometry to investigate the effect of postural changes on skin oxygenation in deep venous insufficiency.

Background: Postural changes play an important role in the development of venous disease. The aim of this study was to investigate skin oxygenation in patients with deep venous insufficiency.

Methods: Haemoglobin oxygen saturation (SO2) was measured with macro- and micro-lightguide spectrophotometry in clinically normal skin at the gaiter area with the leg in the supine position, raised to 45 degrees and on standing.

A jaundiced farmer.

A previously well farmer became deeply jaundiced after dipping sheep with organophosphate sheep dips. He had failed to wear adequate protective clothing and presumably absorbed toxic compounds through his skin. There is currently major interest in these compounds because of their protean clinical manifestations.

Limitations of typhoid vaccination for travellers.

Around one-third of travellers to endemic areas receive pre-travel typhoid vaccination, increasingly with the new parenteral vaccination Typhim Vi (Mérieux). More than 200 cases of Salmonella typhi and S. paratyphi infection are imported into the UK each year.

Impact of an infection consultation service for bacteraemia on clinical management and use of resources.

Since 1993, the infection consultation service for bacteraemia has seen 310 patients in the Medical and Surgical Directorates at Ninewells Hospital and Kings Cross Hospital. A random sample of 100 was audited. Case-notes were incomplete for five patients, leaving 95 fully-audited patients.

Cryptococcal meningitis.

Fungal meningitis caused by the yeast Cryptococcus neoformans is most commonly seen in patients with defective T-lymphocyte function. This article focuses on the clinical presentation, diagnosis and management of patients with cryptococcal meningitis, in the setting of AIDS and other immunocompromised hosts, and in 'normal' individuals.

Use of lightguide spectrophotometry to quantify skin oxygenation in a variable model of venous hypertension.

A variable model of venous hypertension was used to examine the immediate effect on skin oxygenation and blood flow. Measurements were carried out using laser Doppler flowmetry, transcutaneous oximetry and both macro- and micro-lightguide spectrophotometry to measure haemoglobin saturation (SO2). Assessments were performed on 20 normal subjects and in ten patients with deep venous insufficiency lying supine with a pressure cuff left uninflated (P0), then inflated to 40 mmHg (P40), 60 mmHg (P60) and 80 mmHg (P80).