Intrathecal baclofen pumps in the management of hypertonia in childhood: a UK and Ireland wide survey.

Background: Intrathecal baclofen (ITB) is a useful treatment for hypertonia where non-invasive treatments have been ineffective or poorly tolerated. There is an absence of national guidance on selection criteria and a lack of literature regarding patient characteristics and treatment details for children and young people (CYP) receiving ITB therapy in the UK and Ireland. We aimed to gather patient and treatment characteristics for CYP receiving ITB in the UK and Ireland.

Epithelial downgrowth as a complication of toxic anterior segment syndrome.

We present a case of epithelial downgrowth that arose within 1 month of routine clear corneal phacoemulsification. The case was complicated by unexplained total corneal edema from the first postoperative day. Histological analysis following penetrating keratoplasty showed complete endothelial cell loss and an epithelial cyst on the internal surface of Descemet's membrane.

A prospective pilot study to validate the management protocol for patients presenting with acute urinary retention: a community-based, nonhospitalised protocol.

Acute urinary retention (AUR) in males is managed conventionally by hospital admission, alpha-adrenergic therapy, and trial without catheter. To reduce inpatient bed pressures, we set up a protocol to manage such patients in the community. We review our results in this paper.

Vasectomy reversal: is the microscope really essential?

Objective: To evaluate the outcomes of bilateral vasectomy reversal procedure in relation to the macroscopic technique, surgical time and duration of obstructive interval.

Materials And Methods: We performed a retrospective study over a twelve-year period using a macroscopic technique. All cases of vasectomy reversal were consecutive and performed by the same surgeon.

Functional intercomparison of intraoperative radiotherapy equipment - Photon Radiosurgery System.

Background: Intraoperative Radiotherapy (IORT) is a method by which a critical radiation dose is delivered to the tumour bed immediately after surgical excision. It is being investigated whether a single high dose of radiation will impart the same clinical benefit as a standard course of external beam therapy. Our centre has four Photon Radiosurgery Systems (PRS) currently used to irradiate breast and neurological sites.

Endoscopic-assisted probing for congenital nasolacrimal duct obstruction.

Purpose: To determine the success rate of initial probing in children with congenital nasolacrimal duct obstruction (CNLDO) at different ages using nasal endoscopy, and to identify the anatomical sites of blockage within the drainage system.

Methods: A total of 87 eyes from 67 consecutive children with CNLDO underwent endoscopic nasolacrimal duct (NLD) probing under general anaesthetic. Patients who had had previous probings were excluded from the study.

An audit of the use of isolation facilities in a UK National Health Service trust.

To aid the ongoing battle against hospital-acquired infection in the UK, all acute National Health Service (NHS) trusts should have audit data about how dedicated isolation beds within the trust are being used. In a previously published audit, we demonstrated that one-third of patients admitted to a dedicated isolation room in Tayside were not thought to be an infection risk by experienced healthcare staff. Since this audit, Tayside's isolation facilities have moved from a small peripheral 'fever' hospital to a large central teaching hospital site.

New therapeutic agents for resistant Gram-positive infections.

Gram-positive bacteria are an increasingly common cause of community acquired and nosocomial infections, and their resistance to antibiotics is increasing. The recent reports from several continents of methicillin-resistant Staphylococcus aureus with reduced glycopeptide-susceptibility is of grave concern. New agents are required to meet these threats and several classes of compounds are under development.

Contrast-enhanced magnetic resonance cholangiography using mangafodipir compared with standard T2W MRC sequences: a pictorial essay.

Mangafodipir, a manganese-containing hepatobiliary contrast agent, is excreted in bile. We review the principles and practice of a contrast-enhanced MRC technique using mangafodipir and compare it with standard T2-weighted magnetic resonance cholangiography (MRC) sequences. Potential applications include the evaluation of leaks and strictures; the assessment of drainage in normal, surgically by-passed, stented and obstructed biliary systems; the diagnosis of cholecystitis; and the evaluation of normal and variant biliary anatomy.

Test result variation and the quality of evidence-based clinical guidelines.

Background: There is a plethora of supposedly evidence-based published clinical guidelines, most often prepared under the auspices of professional bodies. Many guidelines contain numerical laboratory test results as criteria for clinical action, very often simply quoted as single numbers. Every test result is subject to a number of sources of variation.

Investigating six-month health outcomes of patients with angina discharged from a chest pain service.

Hospital admissions for patients with suspected cardiac chest pain are increasing. The development of a chest pain service allows rapid diagnosis, investigation and treatment. Since the in-patient stay is often short, there is limited time for education and risk factor management.

The management of dyspepsia.

Dyspepsia is a general term that describes pain or discomfort that is centred in the upper abdomen. It reportedly affects up to 40 per cent of adults in any one year. A test and treat strategy is now recommended for all patients with uncomplicated dyspepsia.

Two-dimensional flow quantitative MRI of aortic arch blood flow patterns: Effect of age, sex, and presence of carotid atheromatous disease on prevalence of spiral blood flow.

Purpose: To determine the effect of age, sex, and presence of carotid atheromatous disease on the presence of aortic spiral blood flow pattern using two-dimensional flow quantitative magnetic resonance imaging (MRI).

Materials And Methods: Sixty subjects (37 women, 23 men) were examined. Prospective phase contrast flow quantitative MRI (1.

Out-patient and home-parenteral antibiotic therapy (OHPAT): evaluation of the impact of one year's experience in Tayside.

Objective: An out-patient and home parenteral antibiotic therapy programme for the treatment of suitable infections was developed over a four year period. This paper describes the impact of one year's experience of its implementation on various measures of outcome.

Design: Each patient treatment has a full integrated care pathway (ICP) and patient satisfaction questionnaire completed.

How a specialist nurse helps patients undergoing deep brain stimulation.

Deep brain stimulation is becoming the most frequently used neurosurgical treatment for patients with complex Parkinson's disease. This paper reports on the creation of a clinical nurse specialist role in a Scottish hospital's movement disorder team to support patients going through this treatment and their families, working with the neuroscience nurses and multidisciplinary team.

Clinical governance: implementing a change in workplace practice.

The development of a draft guideline on confirming placement of nasogastric tubes laid the basis for a senior nurse to use the principles of clinical governance to lead an improvement in practice. Key factors included risk management, dissemination of draft guidelines reflecting current evidence and changing practice. Good communication was vital to the project.

Unnecessary peripheral intravenous catheterisation on an acute medical admissions unit: a preliminary study.

BACKGROUND: The ability to secure peripheral intravenous access is regarded as a basic medical skill that is often required for the management of patients admitted to acute medical admission wards. The decision to insert a peripheral intravenous catheter (PIC) is usually taken by relatively inexperienced members of the acute medical team and is primarily based on 'traditional' or 'routine' practice, rather than on an assessment of need. Furthermore, there appears to be little recognition of the potentially serious adverse events associated with PIC insertion.

Prophylactic intravenous indomethacin for preventing mortality and morbidity in preterm infants.

Background: Patent ductus arteriosus (PDA) and intraventricular haemorrhage (IVH) are both associated with increased mortality and morbidity in preterm infants. Indomethacin has been used successfully to treat symptomatic PDA and may also prevent or limit IVH in the neonatal period. There are however potential unwanted side effects of indomethacin, in particular a potential for reduced organ perfusion that might outweigh any clinical benefits.

Patient information: involving the user group.

A review within an acute hospital trust identified problems with in-house information, including a lack of patient involvement, poor quality print and over-use of technical language. A project was set up to improve the quality of the trust's information leaflets.