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Derry, United Kingdom

Hall P.S.,Altnagelvin Hospital
BMJ case reports | Year: 2013

A 30-year-old man presented with a 6- month history of nausea, vomiting and diarrhoea. This was associated with 25 kg weight loss and a right-sided abdominal colic. He had been provisionally diagnosed with Crohn's disease 6 months back and treated with budesonide and mesalazine. Investigations including C reactive protein, white cell count, coeliac antibodies, fasting gut hormones and faecal elastase were all normal. Colonoscopy and ileoscopy were normal both macroscopically and microscopically. Small bowel series and labelled white cell scan were both unremarkable. A CT scan suggested the presence of mild right-sided abdominal lymphadenopathy. Laparoscopy of entire small bowel and colon was normal. But had something been missed? An adrenocorticotrophic hormone stimulation test demonstrated inadequate cortisol response and a diagnosis of adrenal insufficiency was confirmed. Addison's disease can present with a variety of gastrointestinal symptoms and should be considered in the diagnostic work-up of these patients. Source

Mccolgan P.,University College London | Mckeown P.P.,Queens University of Belfast | Selai C.,University College London | Doherty-Allan R.,Health and Social Care Library | Mccarron M.O.,Altnagelvin Hospital
European Journal of Neurology | Year: 2013

A fear of neurology and neural sciences (neurophobia) may have clinical consequences. There is therefore a need to formulate an evidence-based approach to neurology education. A comprehensive systematic review of educational interventions in neurology was performed. BEI, Cochrane Library, Dialog Datastar, EBSCO Biomedical, EBSCO Psychology & Behavioral Sciences, EMBASE, ERIC, First Search, MDConsult, Medline, Proquest Medical Library and Web of Knowledge databases were searched for all published studies assessing interventions in neurology education among undergraduate students, junior medical doctors and residents up to and including July 2012. Two independent literature searches were performed for relevant studies, which were then classified for level of evidence using the Centre of Evidence-based Medicine criteria and four levels of Kirkpatrick educational outcomes. One systematic review, 16 randomized controlled trials (RCTs), nine non-randomized cohort/follow-up studies, 33 case series or historically controlled studies and three mechanism-based reasoning studies were identified. Educational interventions showed favourable evaluation or assessment outcomes in 15 of 16 (94%) RCTs. Very few studies measured subsequent clinical behaviour (two studies) and patient outcomes (one study). There is very little high quality evidence of demonstrably effective neurology education. However, RCTs are emerging, albeit without meeting comprehensive educational criteria. An improving evidence base in the quality of neurology education will be important to reduce neurophobia. © 2013 EFNS. Source

Sheiman R.G.,Beth Israel Deaconess Medical Center | Mullan C.,Altnagelvin Hospital | Ahmed M.,Beth Israel Deaconess Medical Center
International Journal of Hyperthermia | Year: 2012

Purpose: To calculate a modified heat capacity (mHC) of small hepatocellular carcinomas (HCCs) in vivo during radio frequency ablation (RFA) and to determine if (mHC) correlates with tumour vascularity, adjacent vessels or local recurrence. Patients and methods: This study was IRB approved and informed consent was obtained from all patients. Before formal RFA, ambient HCC temperature and temperature 1min after heating at constant wattage were measured in 29 patients. From temperature change and wattage, individual mHCs (joules required to increase tumour temperature by 1° Celsius) were calculated. PreRFA, threephase computerised tomography (CT) scans were reviewed blindly for hepatic arteries, hepatic veins and portal veins abutting or within 3mm of tumour edge from which twelve vascular parameters were quantified. Tumour enhancement (homogeneous or heterogeneous on arterial phase) was also assessed. Multiple regression was used to correlate mHC with vascular parameters and tumour enhancement. Cox proportional hazard model was used to examine the relationship of mHC to local recurrence. Results: There was significant correlation of mHC with lesion enhancement (P=0.0018), length of hepatic arteries (P<0.0001) and total hepatic vein volume in contact with tumour (P=0.016). No correlation was found with any nonabutting vessel or portal vein parameter. The chance of local recurrence increased with increasing mHC. Conclusion: Because the modified heat capacity of small HCCs in our study population correlated with HCC enhancement, abutting hepatic arteries, the volume of abutting hepatic veins and local recurrence, it may be an indicator of the heat sink effect (HSE) and supports the HSE as a risk factor for local recurrence. © 2012 Informa UK Ltd All rights reserved: reproduction in whole or part not permitted. Source

McCarron M.O.,Altnagelvin Hospital | Stevenson M.,Queens University of Belfast | Loftus A.M.,Aberfoyle Medical Practice | McKeown P.,Queens University of Belfast
Clinical Neurology and Neurosurgery | Year: 2014

Introduction As general practice (GP) is the main source of referrals to neurologists, neurology education for GP trainees is important. We investigated the existence of neurophobia, contributing factors and potential prevention strategies among GP trainees. Methods In a questionnaire survey interest, knowledge, confidence and perceived difficulty in neurology were compared with different medical specialties. Reasons for difficulty with neurology, postgraduate neurology education experience, learning methods and suggested teaching improvements were examined. Results Of 205 GP trainees, 118 (58%) completed the questionnaire. Threshold analyses justified categorical intervals for the Likert responses. Trainees recorded poorer knowledge (p < 0.001), less confidence (p < 0.001) and more perceived difficulty (p < 0.001) with neurology than with any other medical specialty. GP trainees had less interest in neurology than any other medical specialty (Duncan test, p < 0.001). There was a similar gradation in difficulty and confidence perception across medical specialties. Hospital and community-based neurology teaching was graded as "poor" or "very poor" by over 60% of GP trainees. There were multiple perceived causes of neurophobia, including neuroanatomy and poor quality teaching. More organised clinical teaching and referral guidance were suggested to address GP neurophobia. Conclusions Neurophobia is common among GP trainees in Northern Ireland. GP trainees have clear and largely uniform ideas on improving their neurology education. GP training posts should reflect the importance of neurology within the GP curriculum. © 2014 Elsevier B.V. Source

McCarron M.O.,Altnagelvin Hospital | Sands C.,Altnagelvin Hospital | McCarron P.,Queens University of Belfast
Clinical Neurology and Neurosurgery | Year: 2010

Objective: Neurologists working in district general hospitals (DGHs) in the UK frequently rely on neuroimaging reports from general radiologists. Neuroradiologists and general radiologists may disagree in the interpretation of magnetic resonance imaging and computerized tomographs of brain and spine. We sought to analyse disagreements between reports from general radiologists and neuroradiologists in selected patients and to examine the impact of a four-point quality-improvement program in a DGH neuroimaging reporting service. Methods: A single neurologist selected patients for reporting by neuroradiologists following a recommendation from general radiologists, or because of a concern by the neurologist. Differences between general radiologists and neuroradiologists in pre-planned primary and secondary findings and advice for further investigations were compared. Results: Primary finding disagreements occurred in 41 of 307 patients (13.4%) and secondary finding disagreements were identified in 62 patients (20.2%). There was no evidence from either result of improvement compared to an earlier study, p = 0.45 and p = 0.52 respectively. Neuroradiologists suggested further investigations in 42 patients (13.7%). Recurrent areas of disagreement included distinguishing perivascular spaces from ischemia, while recurrent missed lesions included subdural hemorrhage and cortical dysplasia. Conclusions: Despite implementation of a quality-improvement program neuroradiologists frequently identified major discrepancies and recommended additional investigations in this DGH neuroimaging service. Future research should identify interventions which are more effective in improving neuroimaging reports in DGHs. © 2009 Elsevier B.V. All rights reserved. Source

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