Provision and standards of care for treatment and follow-up of patients with Autoimmune Hepatitis (AIH).

Background: Autoimmune hepatitis (AIH) is a substantial UK health burden, but there is variation in care, facilities and in opinion regarding management. We conducted an audit of service provision and care of patients with AIH in 28 UK hospitals.

Methods: Centres provided information about staffing, infrastructure and patient management (measured against predefined guideline-based standards) via a web-based data collection tool.

The effects of a UK lockdown on orthopaedic trauma admissions and surgical cases: A multicentre comparative study.

Aims: The current global pandemic due to COVID-19 is generating significant burden on the health service in the UK. On 23 March 2020, the UK government issued requirements for a national lockdown. The aim of this multicentre study is to gain a greater understanding of the impact lockdown has had on the rates, mechanisms and types of injuries together with their management across a regional trauma service.

A data linkage study of suspected seizures in the urgent and emergency care system in the UK.

Introduction: The urgent and emergency care (UEC) system is struggling with increased demand, some of which is clinically unnecessary. Patients suffering suspected seizures commonly present to EDs, but most seizures are self-limiting and have low risk of short-term adverse outcomes. We aimed to investigate the flow of suspected seizure patients through the UEC system using data linkage to facilitate the development of new models of care.

Time, change and peptic ulcer disease in Rotherham, UK.

Background And Aim: We have documented the changing pattern of peptic ulcer disease in our centre in the last quarter of the 20th century and speculate on the reasons thereof.

Patients And Methods: The profile of peptic ulcer disease patients presenting newly to our centre (population 250,000) from 1977 to 2001 was examined. All patients were prospectively followed and detailed records kept.

Reflux rising! An essay on witnessing a disease in evolution.

Background And Aim: The prevalence of gastro-oesophageal reflux disease is thought to be rising but supporting evidence is sparse. We assessed trends from data prospectively collected over 25 years at our centre which serves Rotherham's 250000 population.

Patients And Methods: Detailed computerised records have been kept of all patients investigated for upper gastrointestinal symptoms.

Use of telephone interviews to follow up patients after total hip replacement.

We studied the feasibility of telephone interviews to assess hip function in patients who had had a total hip replacement. One hundred patients attending the orthopaedic clinic for follow-up after undergoing total hip replacement were studied. A modified Harris hip score was used.

Pantoprazole in severe acid-peptic disease: the effectiveness and safety of 5 years' continuous treatment.

Objective: This is our final report on the clinical effectiveness and safety of long-term pantoprazole in patients with severe peptic ulcer or reflux disease during continuous treatment for up to 5 years.

Methods: Patients (n= 150) with peptic ulcer or reflux erosive oesophagitis running an aggressive course or with complications, and refractory to H2-receptor antagonists, were entered into this 5-year programme. Assessment was by serial endoscopy, clinical examination, serum gastrin estimation, gastric mucosal histology and mucosal endocrine cell quantification.

Primary total hip replacement for acute displaced subcapital femoral fractures with a minimal three-year follow-up.

The aim of the study was to review the results of total hip replacement (THR) in relatively fit and mobile patients with Garden 3 and 4 fractures of the neck of femur. Forty-one patients who underwent THR for displaced intracapsular hip fractures from 1993 to 2001 were reviewed. Only those patients with three years or more follow-up were reviewed.

Evaluation of the IRIS 939 UDx flow microscope as a screening system for urinary tract infection.

Aims: To evaluate the IRIS flow microscope for the examination of urine specimens and to compare its performance with that of manual methods; in addition, to assess its usefulness as a screening system for the detection of significant bacteriuria in a routine clinical laboratory.

Methods: The IRIS system was compared with manual quantitative microscopy for the detection of formed elements and with a variety of culture methods to detect urinary tract infection.

Results: The IRIS had a higher sensitivity for the detection of clinically significant formed elements than did manual methods, and using a combination of bacterial and white cell counts produced a sensitivity and specificity of 94.

History in our lifetime: the changing nature of refractory duodenal ulcer in the era of histamine H2 receptor antagonists.

Background And Aim: This prospective cohort observational study, set in a district hospital, presents our experience (1976-1993) of duodenal ulcer refractory to histamine H2 receptor antagonists (defined as not healed after 3 months' treatment) and comments on onset, outcome and spontaneous decline.

Methods: Patients were treated mainly with cimetidine, the dose being titrated (up to 3.2 g daily) according to response, and followed by serial check endoscopy and clinical assessment.

Pantoprazole: a new proton pump inhibitor in the management of upper gastrointestinal disease.

Pantoprazole, the third proton pump inhibitor (PPI) to become available, has been extensively investigated. Pantoprazole inhibits acid more powerfully than histamine H(2) receptor antagonists (H(2)RAs) and omperazole 20 mg and raises median 24-h gastric pH from about 1.5 to 3-4 in healthy volunteers and in duodenal ulcer patients to above 5.

Reflecting on the nursing contribution to vascular access.

Intravenous (IV) therapy and care has become indispensable in today's modern healthcare environment. However, in a striking reversal of fortune, it has been suggested that the provision of IV services is often taken for granted and underpinned by routine and habit (Lundgren and Ek, 1996; Creamer, 2000). In an attempt to promote reflection within the profession, this article asks key questions about ownership and responsibility, level of ability, appropriateness of device selection, documentation and evaluation of IV care.

Oesophageal acid-peptic strictures in the histamine H2 receptor antagonist and proton pump inhibitor era.

Background And Aim: We present a survey on the incidence, demography and natural history (re-dilatation rates) of patients with oesophageal acid-peptic stricture seen between 1977 and 1995.

Patients And Methods: Prospective, cohort observational study. Stricture severity was graded mild, moderate or severe (needing forcible dilatation with bougies).

Intermittent and on-demand use of proton pump inhibitors in the management of symptomatic gastroesophageal reflux disease.

The epidemic of gastroesophageal reflux disease (GERD) in industrialized nations is currently spreading to less-developed ones, with more than half of the patients having symptomatic or mild erosive GERD. The long-term management of GERD has been dominated by daily maintenance treatment with proton pump inhibitors (PPI) to prevent relapse. It is common, however, for many patients with mild disease and infrequent symptom relapses to use a PPI only when symptoms demand.

A new platelet parameter, the mean platelet component, can demonstrate abnormal platelet function and structure in myelodysplasia.

The mean platelet component (MPC) is a new platelet parameter generated by the Bayer ADVIA 120 full blood count analyser as part of the routine complete blood count (CBC) test cycle. We report a case of myelodysplasia with bleeding complications and abnormal template bleeding time in whom low mean platelet component parameters were associated with partial platelet granule deficiency, demonstrated by transmission electron microscopy. We suggest that the mean platelet component is an inexpensive and rapid test to screen for platelet dysfunction related to ultrastructural abnormalities in myelodysplasia.

An undervalued specialty.

I am sure many other nurses working in this field have similar experiences and feel their achievements are not always recognized and valued. To go home at the end of a working day knowing that you have provided good-quality individualized care to all your patients is extremely satisfying, and I am sure is not always achievable on many general wards. Is it not time that dermatology was given some acknowledgement?

Pseudomembranous esophagitis.

Background: Little is known of pseudomembranous esophagitis, a condition of striking endoscopic appearance. Presented here is a description of its nature and outcome.

Method: Information on all patients with upper GI disease seen in our unit are held in a computerized database that includes presentation, diagnosis (including pseudomembranous esophagitis), treatment, and outcome.

Tonsillar metastasis: A rare presentation of gastric carcinoma.

Metastatic carcinoma of the tonsil is uncommon. Tonsillar metastases rarely become apparent before the diagnosis of the primary neoplasm. We describe only the second reported case of tonsillar metastasis as a presenting feature of gastric carcinoma.

Screening for malnutrition.

This article recommends that screening for malnutrition is used in both primary care and hospital settings. The authors also outline how nurses are ideally placed to screen patients for evidence of malnutrition and to offer first line nutritional advice and care.

Bile acid malabsorption in persistent diarrhoea.

Unlabelled: We have investigated bile acid malabsorption (BAM), and its response to treatment, in patients seen in this district general hospital with chronic continuous or recurrent diarrhoea.

Methods: Seven-day retention of 75-SeHCAT was measured (normal: > 10%).

Treatment: Patients were initially given conventional therapy (prednisolone +/- ASA drugs in Crohn's disease, and antidiarrhoeals in the others).

The role of colour flow Doppler in the investigation of the salivary gland tumour.

Aims: Ultrasound is a highly effective imaging technique to determine salivary gland tumours and may help to identify many benign lesions. The aim of this study is to evaluate whether colour Doppler is able to further differentiate the malignant tumour.

Methods: Fifty-six patients with salivary gland lesions were prospectively assessed using ultrasound imaging with colour flow and power Doppler.

Giant gastric ulcer: its natural history and outcome in the H2RA era.

Objective: The aim of this paper is to study the natural history and outcome of medical treatment of giant gastric ulcer in the histamine H2-receptor antagonist era.

Methods: All patients with gastric ulcer were prospectively followed. We assessed the special features (in particular, demography and treatment outcome) in patients with giant gastric ulcer, defined as ulcers large enough to occupy at least one wall.