Neutrophil to lymphocyte count ratio as an early indicator of blood stream infection in the emergency department.

Objectives: Early identification of patients with blood stream infection (BSI), especially bacteraemia, is important as prompt treatment improves outcome. The initial stages of severe infection may be characterised by increased numbers of neutrophils in the peripheral blood and depression of the lymphocyte count (LC). The neutrophil to LC ratio (NLCR) has previously been compared with conventional tests, such as C-reactive protein (CRP) and white cell count (WCC), and has been proposed as a useful marker in the timely diagnosis of bacteraemia.

Pericyazine for schizophrenia.

Background: Pericyazine is a 3-cyano-10 (3-4'-hydroxypiperidinopropyl) phenothiazine. It is overall pharmacologically similar with chlorpromazine, though particularly sedating. Dopamine receptor subtype analysis has not been performed for pericyazine, but the drug appears to induce greater noradrenergic than dopaminergic blockade.

Hepatitis, rhabdomyolysis and multi-organ failure resulting from statin use.

Objective: To report a case of hepatitis, rhabdomyolysis and multi-organ failure resulting from the use of statins.

Case Summary: A 70 year old Caucasian woman was admitted with general malaise, myalgia and jaundice. She was being treated with a statin for aortic stenosis, the dose of which had been increased approximately 6 months earlier.

The psychological and social characteristics of patients referred for NHS cosmetic surgery: quantifying clinical need.

Purpose: Elective cosmetic surgery is expanding in the UK in both the public and private sectors. Because resources are constrained, many cosmetic procedures are being excluded within the National Health Service. If guidelines on who can receive such surgery are to be evidence-based, information is needed about the level of dysfunction in patients referred for elective surgery and whether this is related to their degree of physical abnormality.

The sterility of hospital-prepared Soffban bandages.

An evaluation of the sterility of hospital-prepared Soffban bandages was undertaken. Discs of Bacillus stearothermophilus were inserted into the bandage rolls, prior to sterilization in "porous load" autoclaves. The discs were subsequently removed and placed in culture media, with growth of the organism indicating failure of sterilization.

Champion start.

A new role for older people's champions was first described in the National Service Framework for Older People (NSF) ( Department of Health 2001 ). Older people's champions have a crucial role to play in helping to implement the NSF, particularly in rooting out age discrimination. There is much interest in how the roles and responsibilities are being developed in different areas.

Balancing cost-effectiveness with quality in tissue viability.

The 21st century has seen an increase in the importance placed on the skills of healthcare practitioners. They now need to be able to demonstrate cost-effectiveness and balance it with quality in the delivery of care in the NHS. This emphasis is driven largely by the emergence of initiatives such as evidence-based practice, clinical governance and cost-effectiveness evaluations.

Clinical decision guidelines for NHS cosmetic surgery: analysis of current limitations and recommendations for future development.

Because of increasing demand for publicly funded elective cosmetic surgery, clinical decision guidelines have been developed to select those patients who should receive it. The aims of this study were to identify: the main characteristics of such guidelines; whether and how they influence clinical decision making; and ways in which they should be improved. UK health authorities were asked for their current guidelines for elective cosmetic surgery and, in a single plastic surgery unit, we examined the impact of its guidelines by observing consultations and interviewing surgeons and managers.

Raised pulmonary artery pressures measured with Doppler echocardiography in rheumatoid arthritis patients.

Objective: To study the prevalence of echocardiographic abnormality and pulmonary hypertension in an unselected population of patients with rheumatoid arthritis (RA).

Method: One hundred and forty-six RA patients, irrespective of cardiopulmonary symptoms, were assessed clinically and by echocardiography, including pulmonary artery pressure measurement, ECG, pulmonary function tests and high-resolution computed tomography scanning of the thorax.

Results: Two-dimensional echocardiography demonstrated significant cardiac disease in the form of reduced left ventricular ejection fraction (<64%) in 9% of patients, moderate mitral regurgitation in 4%, aortic stenosis in 4%, aortic regurgitation in 3% and Valsalva sinus rupture in 0.