Topical 5-aminolaevulinic acid photodynamic therapy for the treatment of skin conditions other than non-melanoma skin cancer.

Topical 5-aminolaevulinic acid (ALA) photodynamic therapy (PDT) is used increasingly for superficial non-melanoma skin cancer (NMSC) and dysplasia. However, the relative accumulation of the photosensitizer protoporphyrin IX (PpIX) in diseased tissue is not specific for neoplastic disease, and has been shown after the application of ALA to benign proliferative skin conditions such as viral warts and psoriasis. This review appraises the quality of evidence available for the use of topical ALA-PDT in the treatment of skin conditions other than NMSC.

The use of adult isolation facilities in a UK infectious diseases unit.

The emergence and re-emergence of communicable infections, especially those due to antibiotic resistant nosocomial pathogens, is likely to increase the burden on the limited isolation facilities of the UK. It was our perception, however, that isolation beds are not always used optimally; with patients requiring isolation sometimes being housed in open-bay beds, whilst other non-communicable patients are unnecessarily isolated. The main aim of this study was to test this hypothesis in a regional infectious diseases (ID) unit.

The knowledge and attitudes of surgical staff towards the use of opioids in cancer pain management: can the Hospital Palliative Care Team make a difference?

The principles of cancer pain management are well established, but evidence suggests that these are not incorporated into daily practice and patients are still in pain. Deficiencies in knowledge and inappropriate attitudes towards the use of opioids may partially explain why the management of cancer pain is still such a widespread problem. This study assessed the knowledge and attitudes of 135 nursing and medical staff working in a surgical unit, before and after working with a newly established Hospital Palliative Care Team.

Development of patient-centred performance indicators to guide the delivery of pharmaceutical care in a district general hospital.

The aim of this study was to audit clinical pharmacy practice in an acute hospital setting against the individual patient care guidelines set out in the CRAG "Framework for Practice" document, and then to develop practical, patient-centred performance indicators that could be used locally to monitor the delivery of pharmaceutical care. A series of four audits were undertaken to establish key elements in the process of providing pharmaceutical care to patients. Four standard statements describing the performance of the pharmacy service in providing patient care were developed through peer discussion and formulation of ideas based around these data.

Optimal analytical performance for point of care testing.

Quality specifications for the reliability of performance characteristics of laboratory testing, particularly precision and bias, are necessary prerequisites for creation and control of analytical quality. Many strategies have been promulgated for setting these specifications. Recently, the available approaches have been fixed into a hierarchical framework that has now been accepted by experts in the field to be the best current approach to a global strategy for setting quality specifications in laboratory medicine.

Optimal Analytical Performance for POCT.

Quality specifications for the reliability performance characteristics of laboratory tests, particularly precision and bias, are necessary prerequisites for creation and control of analytical quality. Many strategies have been promulgated for setting these. Recently, the available approaches have been fixed into a hierarchical framework that has now been agreed by experts in the field to be the best current approach to a global strategy to set quality specifications in laboratory medicine.

Litigation and defensive clinical practice: quantifying the problem.

Objective: To assess the evidence for claims about a rise in defensive clinical practice, particularly within maternity care; to describe an attempt to quantify the extent of defensive practice; and to identify areas for further research.

Design: Review of existing literature and a large scale postal survey.

Participants: Over 2000 midwives and obstetricians, mostly based in Scotland.

Community antibiotic therapy, hospitalization and subsequent respiratory tract isolation of Haemophilus influenzae resistant to amoxycillin: a nested case-control study.

The study objective was to determine whether recent community antibiotic prescribing and hospitalization are associated with beta-lactam resistance in respiratory isolates of Haemophilus influenzae. Data obtained for hospitalization and community prescribing (in the previous 3 months) from 412 adults (>15 years) in whom an episode of respiratory tract infection had been described, during which H. influenzae was isolated, were analysed.

Fluoroscopically guided transcervical fallopian tube recanalization of post-sterilization reversal mid-tubal obstructions.

Purpose: To assess the technical success and early outcome of fluoroscopically guided transcervical fallopian tube recanalization (FTR) in mid-tubal occlusion following sterilization reversal surgery.

Methods: From July 1995 to January 1998, patients with greater than 12 months secondary infertility underwent hysterosalpingography (HSG). FTR was performed in proximal or mid-tubal occlusion.

A randomised controlled trial evaluating the use of enteral nutritional supplements postoperatively in malnourished surgical patients.

Background: Patients who undergo surgery are at risk of malnutrition due to periods of starvation, the stress of surgery, and subsequent increase in metabolic rate. There are limited data on nutritional outcome of surgical patients.

Aims: To investigate changes in nutritional status and the influence of oral supplements on nutritional status, morbidity, and quality of life in postoperative surgical patients.

Cost considerations in the evaluation of new therapies for gram-positive bacteria.

The rapid emergence of antibiotic resistance in hospitals and the community, particularly amongst Gram-positive cocci, has not been paralleled by adequate understanding of the true clinical and economic impact of infection with resistant pathogens. Furthermore, the development of novel compounds to combat this threat has been slow until recently when a number of new agents, some with a unique structure and mode of action (e.g.

Recurrent aseptic meningitis following non- steroidal anti-inflammatory drugs--a reminder.

Non-steroidal anti-inflammatory drugs (NSAIDs) are rarely associated with side-effects affecting the central nervous system. A case of NSAID-induced recurrent aseptic meningitis is presented. Seven episodes of aseptic meningitis were documented in the patient's life-time (up to the age of 30).

Out-patient parenteral antimicrobial therapy--a viable option for the management of cutaneous leishmaniasis.

Cutaneous infection with Leishmania braziliensis complex requires treatment with parenteral pentavalent antimonials to prevent development of mucocutaneous leishmaniasis. Patients with imported disease are usually managed in hospital because of concerns over drug toxicity. This study describes the clinical features and outcome of infection treated in the UK in an out-patient setting.