Kilmarnock, United Kingdom
Kilmarnock, United Kingdom

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Bal A.M.,Crosshouse Hospital | Gould I.M.,Royal Infirmary
Current Opinion in Infectious Diseases | Year: 2011

Purpose of review: Antimicrobial stewardship is now recognized as a formal strategy for curbing the upward trend in antibiotic resistance. Literature on antimicrobial stewardship has focused on areas of strategic importance and operational delivery. A number of barriers have been recognized in the implementation of successful programs. These include lack of physician participation, lack of diagnostic facility, absence of formal mechanism of data collection, variation between countries, and lack of cooperative strategies. In this review, we suggest strategies to overcome these barriers. Recent findings: In the last few years, it has been recognized that an executive program is necessary for successful implementation of strategies to control the growing antibiotic resistance. Efforts have been made at higher levels of government through organizations such as the European Centre for Disease Prevention and Control. The need for community healthcare involvement has also been recognized. At a local level, strategies to promote cooperation between various committees (e.g. infection control and antimicrobial management teams) have been proposed and adopting antibiotic care bundles as part of patient safety and healthcare is being explored. Summary: We suggest that executive level planning, local cooperation, sustained education, emphasis on de-escalation, and use of care bundles could stem the tide of growing resistance. © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins.


MacGregor M.S.,Crosshouse Hospital
NDT Plus | Year: 2011

Health care policy is encouraging expansion of home haemodialysis, aiming to improve patient outcomes and reduce cost. However, most patient outcome data derive from retrospective observational studies, with all their inherent weaknesses. Conventional thrice weekly home haemodialysis delivers a 22-51% reduction in mortality, but why should that be? Frequent and/or nocturnal haemodialysis reduces mortality by 36-66%, with comparable outcomes to deceased donor kidney transplantation. Approaches which might improve the quality of future observational studies are discussed. Patient-relevant outcomes other than mortality are also discussed. © 2011 The Author.


Chalmers C.M.,Crosshouse Hospital | Chalmers C.M.,Gartnavel General Hospital | Bal A.M.,Crosshouse Hospital
British Journal of Anaesthesia | Year: 2011

Candida species are a common cause of nosocomial bloodstream infection. Such infections commonly affect patients in the intensive care unit (ICU) and carry a high mortality. There are published guidelines for the management of fungal infections, but there are no data on the usual management of invasive Candida infections in UK ICUs. Methods. An electronic survey was sent by email to a representative clinician in 236 ICUs, over 90 of units in the UK. Questions related to the institution of empirical therapy and to the management of proven candidaemia. Results. There were 72 responses. A minority of units follow a policy regarding the management of these infections but the involvement of microbiologists is usual. Empirical therapy is used in 85.9 of units, often for patients perceived to be at high risk. Fluconazole is the most commonly used antifungal agent, both for empirical therapy and for the treatment of proven candidaemia. For candidaemic patients, 73.9 of ICUs frequently or always remove central venous catheters within 48 h, while 15.1 frequently or always arrange ophthalmology review. Conclusion. s.Management of fungal infections is relatively consistent among responding units. However, recent developments in the field have not yet been incorporated into standard practice. Adherence to published guidelines could be improved, potentially reducing morbidity and mortality from these common infections. © The Author [2011].


Chalmers C.,Crosshouse Hospital
Journal of Laryngology and Otology | Year: 2010

Objective: To present the first reported case of Haemophilus influenzae type b epiglottitis leading to necrotising fasciitis.Method: Case report and review of the literature regarding the association of necrotising fasciitis with Haemophilus influenzae infection and with epiglottitis.Case report: A previously well, 64-year-old woman presented with epiglottitis, and subsequently developed necrotising fasciitis of her chest wall. The cause of both infections was Haemophilus influenzae serotype b. This organism has frequently been implicated in epiglottitis, but has not previously been reported to cause simultaneous necrotising fasciitis. The patient became critically ill, requiring intensive care management, but following surgical debridement and antibiotic treatment she made a full recovery.Conclusion: Although increasingly uncommon, clinicians must continue to be proficient in the diagnosis and management of epiglottitis, and to be aware of its full range of possible complications. This case report highlights a previously unknown and potentially fatal complication of Haemophilus influenzae type b epiglottitis. Copyright © JLO (1984) Limited 2009.


Jarvie E.,Crosshouse Hospital | Ramsay J.E.,Crosshouse Hospital
Seminars in Fetal and Neonatal Medicine | Year: 2010

Rates of obesity among the pregnant population have increased substantially and adiposity has a damaging effect on every aspect of female reproductive life. This review summarises epidemiological data concerning obesity-related complications of pregnancy. Obesity is linked to a number of adverse obstetric outcomes as well as increased maternal and neonatal morbidity and mortality. These complications include miscarriage, congenital abnormalities, pre-eclampsia, gestational diabetes mellitus, iatrogenic preterm delivery, postdates pregnancy with increased rates of induction of labour, caesarean section, postpartum haemorrhage, shoulder dystocia, infection, venous thromboembolism, and increased hospital stay. It is important to consider obese pregnant women as a high risk group with a linear increase in risk of complications associated with their degree of obesity. Their obstetric management should be consultant-led and involve a multidisciplinary team approach to improve outcome. © 2009 Elsevier Ltd. All rights reserved.


Aitken E.,Crosshouse Hospital | Osman M.,Crosshouse Hospital
Breast Journal | Year: 2010

With increasing numbers of early, screen-detected breast cancers and the emergence of sentinel-node biopsy, surgical management of the axilla is evolving. In recent years many authors have searched for favorable subcategories of tumors in which it may be possible to avoid axillary lymph node clearance. The aim of this study is to determine preoperative factors that might predict lymph node negative axillae. A retrospective analysis of 623 patients with invasive breast cancer was performed. A number of clinical and pathological variables were analyzed. Uni- and multivariate analysis was carried out to determine factors predictive for lymph node metastases. Age, tumor size, grade, histology and lymphovascular invasion were found to be independent predictors of nodal positivity but, contrary to other recent studies, we found no effect of ER/PR (estrogen-receptor / progesterone-receptor) or HER-2 status. The strongest predictor of lymph node metastases was tumor size >50 mm (OR 2.33), followed by the presence of lymphovascular invasion (OR 1.33). Our results could be used for preoperative counseling and planning axillary surgery in patients with invasive breast cancer. We propose that the predictive factors identified in this study could be used in combination with axillary ultrasound to selectively target patients for sentinel-node biopsy or to target the use of ultrasonographic assessment of the axilla. However, no consistent and reliable markers have been identified to predict patients that can safely avoid axillary surgery.


Dunleavy A.D.,Crosshouse Hospital
British Journal of Hospital Medicine | Year: 2012

This article will outline some of the common prescribing errors that occur and how to avoid them when prescribing for renal patients including patients with chronic kidney disease, established renal failure and transplant patients.


Williamson S.,Crosshouse Hospital | Greene S.A.,University of Dundee
Clinical Endocrinology | Year: 2010

Objective To measure the UK and Ireland incidence of childhood (<15 years) thyrotoxicosis and to describe the presenting features. Context Incidence data on thyrotoxicosis in childhood are not available for the UK and Ireland. Recent studies have reported an apparent increase in cases in Europe. Design A national prospective surveillance study for 12 months from September 2004, co-ordinated by The British Paediatric Surveillance Unit (BPSU). Patients and measurements All paediatricians across the UK and Ireland were requested monthly to report new cases. Details of presenting features were then obtained by questionnaire. Results One hundred ten cases of acquired childhood thyrotoxicosis were identified in the UK and Ireland. The incidence of acquired thyrotoxicosis was 0·9 per 100,000 <15 years olds in the UK and Ireland, (95% CI: 0·8-1·1). Autoimmune thyrotoxicosis accounted for 96% of cases. There was an increasing incidence with age in each sex. Females have a significantly higher incidence than males in the 10- to 14-year age group. A variety of presenting symptoms were reported: weight loss (64%), fatigue/tiredness (54%), change in behaviour' (50%) and heat intolerance (47%). 4.5% cases were asymptomatic. The commonest signs were goitre (78%) and tremor (58%). There were no cases of thyroid storm. Conclusions This national population survey defines the incidence of thyrotoxicosis in children in the UK and Ireland during 2004-2005, which was lower than expected in comparison with other European studies. The survey illustrates contemporary presenting characteristics of the disease. © 2010 Blackwell Publishing Ltd.


Bal A.M.,Crosshouse Hospital
Indian journal of medical ethics | Year: 2010

Private medical colleges in India are under the scanner. There is a longstanding debate about the selection methodology that should be followed for admissions in medical colleges. A significant proportion of aspirants are able to afford medical education in private colleges despite not clearing entrance examinations. Others gain entry purely on the basis of caste. Medicine deals with human life and, consequently, there is a widespread feeling that admission criteria in medical schools should be based only on merit as assessed in entrance examinations. This article examines some of these contentious issues.


Amoore J.N.,Crosshouse Hospital
Blood Pressure Monitoring | Year: 2012

Aim Blood pressure (BP), a key vital sign, monitors general health. Oscillometric devices are increasingly used for measurement, although their accuracy continues to be critically debated. A functional block diagram is used to review the components that affect accuracy. Methods A block diagram is presented covering the components from cuff to algorithm. The oscillometric waveform is described, considering factors that can alter its shape. Methods used to assess accuracy, including the potential use of simulators, are described. Results and discussion The block diagram focuses attention on cuff, amplifier, signal processing and algorithm. The importance of correct cuff size is emphasized. Accuracy can be affected by the extraction of the oscillometric pulses and the interpolation to compensate for higher deflation rates. Modern electronic amplifiers are assumed to be stable and do not drift, an assumption largely untested. Crucial to accuracy is the algorithm, but there is no standard algorithm and limited theoretical basis, leading to significant measurement errors in groups of patients, even by approved devices. The causes are not well understood, but differences in oscillometric waveform shape between patient groups have been observed and may explain auscultatory- oscillometric differences. The ability of theoretical models to explain the effects of arterial stiffness on BP measurements is discussed. Validation remains statistical though steps have been taken to improve it. Conclusion The indirect nature of BP measurement poses particularly problems for ensuring accuracy. Critical assessment has done much to improve standards, but a solid theoretical understanding of the technique has not been formulated and further work is required. © 2012 Wolters Kluwer Health.

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