Research teaching in learning disability nursing: Exploring the views of student and registered learning disability nurses.

Background: Whilst there is a need to develop the research base within learning disability nursing it is also significant that currently there is little published data as to how research is taught to this group of nurses.

Objectives: To increase understanding of how research is currently taught to learning disability nurses within the UK.

Design: A survey design was used.

Low maternal vitamin B12 status is associated with lower cord blood HDL cholesterol in white Caucasians living in the UK.

Background And Aims: Studies in South Asian population show that low maternal vitamin B12 associates with insulin resistance and small for gestational age in the offspring. Low vitamin B12 status is attributed to vegetarianism in these populations. It is not known whether low B12 status is associated with metabolic risk of the offspring in whites, where the childhood metabolic disorders are increasing rapidly.

A case of multicentric carcinoid in a patient with psoriatic spondyloarthropathy.

We describe the first case of a patient presenting with multicentric carcinoid occurring in the lung and subsequently in the rectum, with chronic psoriatic arthritis. Although reports have been published regarding carcinoid syndrome occurring alongside rheumatoid arthritis, no reports have been made on such a case. Initial presentation of carcinoid syndrome in this patient was insidious and atypical with few symptoms, including shortness of breath and long standing abdominal bloating.

Vitamin B12 insufficiency induces cholesterol biosynthesis by limiting s-adenosylmethionine and modulating the methylation of SREBF1 and LDLR genes.

Background: The dietary supply of methyl donors such as folate, vitamin B12, betaine, methionine, and choline is essential for normal growth, development, and physiological functions through the life course. Both human and animal studies have shown that vitamin B12 deficiency is associated with altered lipid profile and play an important role in the prediction of metabolic risk, however, as of yet, no direct mechanism has been investigated to confirm this.

Results: Three independent clinical studies of women (i) non-pregnant at child-bearing age, (ii) in early pregnancy, and (iii) at delivery showed that low vitamin B12 status was associated with higher total cholesterol, LDL cholesterol, and cholesterol-to-HDL ratio.

Osteomyelitis, discitis, epidural and psoas abscess secondary to Salmonella enterica in a man with diabetes mellitus and newly diagnosed α-thalassaemia trait.

We report the case of a 65-year-old man with type 2 diabetes mellitus and α-thalassaemia trait. Investigations for relapsing and remitting fever found vertebral osteomyelitis, discitis and epidural and psoas abscess secondary to Salmonella enterica.

Prevention of Parastomal Hernia Using Pre-peritoneal Mesh - Long Term Outcome of a Prospective Study.

Background: Parastomal hernia is a frequent complication after stoma formation. The objective of this prospective study was to find long-term outcome of prophylactic mesh placement in the pre-peritoneal space in order to prevent parastomal hernia.

Methods: Patients undergoing elective formation of permanent stoma were included in the study.

A successful spontaneous pregnancy in abetalipoproteinemia: Amsterdam or the art of vitamin replacement?

Abetalipoproteinemia is a rare metabolic disorder that causes disturbed lipid absorption with consequent hypocholesterolaemia and liposoluble avitaminosis. The broad spectrum of presentations includes malabsorption, failure to thrive and acanthocytosis in children, while later in life expected manifestations include coagulopathy, myopathy, retinitis pigmentosa, peripheral neuropathy, hyporeflexia and ataxia. These neurological complications stem from demyelination secondary to vitamin E deficiency.

Quality of diabetes care worldwide and feasibility of implementation of the Alphabet Strategy: GAIA project (Global Alphabet Strategy Implementation Audit).

Background: The Alphabet Strategy (AS) is a diabetes care checklist ensuring "important, simple things are done right all the time." Current audits of diabetes care in developed countries reveal wide variations in quality with performance of care processes frequently sub-optimal. This study had three components:• an audit to assess diabetes care quality worldwide,• a questionnaire study seeking opinions on the merits of the AS,• a pilot study to assess the practicality of implementation of the AS in a low socioeconomic setting.

"Left-sided" Chilaiditi sign? A large gastric perforation with secondary pancreatitis.

Background: Although the Chilaiditi sign correctly underestimates the radiological presence of air-under-the-diaphragm, in few cases it has lead to delays in the diagnosis of underlying pneumoperitoneum. In this article we report the case of a young lady presenting with acute pancreatitis and radiographic findings of "left-sided" Chilaiditi sign with underlying a large gastric perforation.

Case Report: A 35 year old Caucasian female presented to the Emergency Department with a twenty-four hour history of severe epigastric pain radiating into her back.

Goblet cells carcinoid with mucinous adenocarcinoma of the vermiform appendix: a step towards the unitary intestinal stem cell theory?

Associations of various histotypes in appendiceal neoplasms may help elucidate the histogenesis of such uncommon tumors. We present the fourth published case of Goblet Cell Carcinoid (GCC) associated with mucinous adenocarcinoma of the appendix. This association has been described only for GCC and not for classic appendix carcinoids which are thought to originate from neuroendocrine-committed cells.

Can someone call my PA?

The aim of this paper is to outline the background of the Physician Associate (known in the USA as physician assistant¹) role in the USA and follow its recent journey to the UK where it is becoming a rapidly developing new healthcare role. Through the use of two case studies from UK Hospital Trusts who are currently utilising Physician Associates (PAs) in their workforce we describe the implementation and development opportunities for the role, with particular reference to their role in Acute Medicine teams of the future.

Evaluation of the clinical and cost effectiveness of intermediate care clinics for diabetes (ICCD): a multicentre cluster randomised controlled trial.

Background: Configuring high quality care for the rapidly increasing number of people with type 2 diabetes (T2D) is a major challenge worldwide for both providers and commissioners. In the UK, about two thirds of people with T2D are managed entirely in primary care, with wide variation in management strategies and achievement of targets. Pay for performance, introduced in 2004, initially resulted in improvements but disparities exist in ethnic minorities and the improvements are levelling off.

Mucocutaneous manifestations in a UK national cohort of juvenile-onset systemic lupus erythematosus patients.

Objective: To determine whether mucocutaneous manifestations are associated with major organ involvement in a UK national cohort of juvenile-onset SLE (JSLE) patients.

Methods: JSLE patients (n = 241) from 15 different centres whose diagnosis fulfilled four or more of the ACR criteria were divided into two groups: those with at least one ACR mucocutaneous criterion (ACR skin feature positive) and those without (ACR skin feature negative) at diagnosis. The relative frequency of skin involvement was described by the paediatric adaptation of the 2004 British Isles Lupus Assessment Group (pBILAG-2004) index.

Managing a patient with excessive belching.

A 50-year-old man with end-stage renal failure was referred by his general practitioner with dyspeptic symptoms. On further questioning the patient complained of a 10-year history of frequent belching. This was noticeably worse after meals and during times of stress.

Medical influences, surgical outcomes: role of common medications on the risk of perforation from untreated diverticular disease.

Numerous drugs, largely used in the wards or at home, have a significant influence on patients with untreated diverticular disease. The consequences can be disastrous, may require an emergency operation, postoperative intensive care, and overall influence the patient's length of stay and the final outcomes. Bearing these considerations in mind the routine or chronic administration of pain-killers, steroids and non-steroidal anti-inflammatory should be balanced in patients with known diverticular disease as it normally happens with other conditions potentially affected by these drugs (i.

CT pulmonary angiography using a reduced volume of high-concentration iodinated contrast medium and multiphasic injection to achieve dose reduction.

Aim: To evaluate whether a reduced volume of a higher-concentration iodinated contrast medium delivered with a multiphasic injection could be used in computed tomography pulmonary angiography (CTPA) to achieve a reduction in dose without adversely affecting image quality.

Materials And Methods: The CTPA images were retrospectively evaluated of 69 patients who received 100 ml of 300 mg iodine/ml ioversol, injected at constant rate of 5 ml/s and 70 patients who received 75 ml of 350 mg iodine/ml ioversol contrast medium delivered using a multiphasic injection protocol (starting at 5 ml/s and reducing exponentially). The degree of opacification in the proximal pulmonary arteries was measured in Hounsfield units.

Spontaneous, isolated caecal necrosis: report of a case, review of the literature, and updated classification.

Isolated necrosis of the caecum is a rare cause of abdominal pain. In the absence of occlusive vascular disease it has a number of well documented associations, the commonest of which is patients' receiving haemodialysis for endstage renal failure. It has also been associated with shock states, cardiac failure, ischaemic heart disease, diabetes and drugs such as cocaine, thiopentone and cytotoxic agents.

Diabetes care during Hajj.

Keeping well during Hajj is a challenge for people with diabetes. However, with proactive planning and education, it may prove to be an excellent opportunity for reviewing management and enhancing diabetes education to reduce diabetes-related short- and long-term problems. People with diabetes should have enough time to consider a management plan.

Endovascular repair of a spontaneous ilio-iliac fistula presenting as pulmonary embolism.

Spontaneous rupture of a common iliac artery aneurysm into the common iliac vein is a rare phenomenon. We report the case of a 68 year old man admitted with acute cardiac failure and massive pulmonary embolism as a complication of a spontaneous ilio-iliac fistula, secondary to aneurysmal rupture. The aneurysm was successfully excluded using an aorto-uni-iliac stent graft.

Emergency endovascular treatment of popliteal aneurysms.

Popliteal artery aneurysm (PAA), despite being rare, is the most common peripheral aneurysm. It can present as acute thrombosis and occlusion of the aneurysmal segment, and distal embolization, causing either chronic or acute limb ischemia. It has traditionally been treated with open surgical reconstruction.

Detection and survival of colorectal cancer from a 2 week wait service.

Aim: To determine detection strategies for colorectal cancer (CRC) and to analyse subsequent survival from a 2 week wait (2WW) service.

Method: Retrospective analysis of 2WW and hospital CRC databases from January 2006 to July 2009. Survival was assessed using Kaplan Meier survival curves and Cox's proportional hazard models.

Ward rounds: missed learning opportunities in diagnostic changes?

Background: The introduction of the European Working Time Directive has resulted in the on-call general surgery junior doctor regularly missing consultant-led post-take ward rounds (PTWRs). This study aimed to determine the frequency with which the admission diagnosis was changed on the PTWR, and thus whether an educational opportunity for trainees is missed.

Methods: Prospective observational study of consecutive admissions to a general surgery department over a 4-week period was conducted.