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Robertson L.C.,University of West of Scotland | Al-Haddad M.,Western Infirmary of Glasgow
Anaesthesia and Intensive Care Medicine | Year: 2013

Critical illness is a life-threatening multisystem process that can result in significant morbidity or mortality. In most patients, critical illness is preceded by a period of physiological deterioration; but evidence suggests that the early signs of this are frequently missed. All clinical staff have an important role to play in implementing an effective 'Chain of Response' that includes accurate recording and documentation of vital signs, recognition and interpretation of abnormal values, patient assessment and appropriate intervention. Early-warning systems are an important part of this and can help identify patients at risk of deterioration and serious adverse events. Assessment of the critically ill patient should be undertaken by an appropriately trained clinician and follow a structured ABCDE (airway, breathing, circulation, disability and exposure) format. This facilitates correction of life-threatening problems by priority and provides a standardized approach between professionals. Good outcomes rely on rapid identification, diagnosis and definitive treatment and all doctors should possess the skills to recognize the critically ill patient and instigate appropriate initial management. Crown Copyright © 2013 Published by Elsevier Ltd. All rights reserved.

MacDonald M.R.,Golden Jubilee National Hospital | Connelly D.T.,Golden Jubilee National Hospital | Connelly D.T.,Royal Infirmary | Hawkins N.M.,Aintree Cardiac Center | And 9 more authors.
Heart | Year: 2011

Objective To determine whether or not radiofrequency ablation (RFA) for persistent atrial fibrillation in patients with advanced heart failure leads to improvements in cardiac function. Setting Patients were recruited from heart failure outpatient clinics in Scotland. Design and intervention Patients with advanced heart failure and severe left ventricular dysfunction were randomised to RFA (rhythm control) or continued medical treatment (rate control). Patients were followed up for a minimum of 6 months. Main outcome measure Change in left ventricular ejection fraction (LVEF) measured by cardiovascular MRI. Results 22 patients were randomised to RFA and 19 to medical treatment. In the RFA group, 50% of patients were in sinus rhythm at the end of the study (compared with none in the medical treatment group). The increase in cardiovascular magnetic resonance (CMR) LVEF in the RFA group was 4.5±11.1% compared with 2.8±6.7% in the medical treatment group (p=0.6). The RFA group had a greater increase in radionuclide LVEF (a prespecified secondary end point) than patients in the medical treatment group (+8.2±12.0% vs +1.4±5.9%; p=0.032). RFA did not improve N-terminal pro-B-type natriuretic peptide, 6 min walk distance or quality of life. The rate of serious complications related to RFA was 15%. Conclusions RFA resulted in long-term restoration of sinus rhythm in only 50% of patients. RFA did not improve CMR LVEF compared with a strategy of rate control. RFA did improve radionuclide LVEF but did not improve other secondary outcomes and was associated with a significant rate of serious complications.

Hussey K.,Western Infirmary of Glasgow | Chandramohan S.,Western Infirmary of Glasgow
Seminars in Interventional Radiology | Year: 2014

This article is a review of the evidence regarding the management of patients with critical limb ischemia. The aim of the study is to discuss the definition, incidence, and clinical importance of critical limb ischemia, as well as the aims of treatment in terms of quality of life and limb salvage. Endovascular and surgical treatments should not be viewed as competing therapies. In fact, these are complementary techniques each with strengths and weaknesses. The authors will propose a strategy based on the available evidence for deciding the optimal approach to management of patients with critical limb ischemia. © 2014 by Thieme Medical Publishers, Inc.

Gillespie A.,Western Infirmary of Glasgow | Moir J.S.,Western Infirmary of Glasgow | Miller R.,Hairmyres Hospital
Journal of Foot and Ankle Surgery | Year: 2014

Complex regional pain syndrome (CRPS) is an uncommon complication of orthopedic surgery, and few investigators have considered the incidence in foot and ankle surgery. In the present retrospective cohort study of 390 patients who had undergone elective foot and/or ankle surgery in our department from January to December 2009, the incidence of postoperative CRPS was calculated and explanatory variables were analyzed. A total of 17 patients (4.36%) were identified as meeting the International Association for the Study of Pain criteria for the diagnosis of CRPS. Of the 17 patients with CRPS, the mean age was 47.2 ± 9.7years, and 14 (82.35%) were female. All the operations were elective, and 9 (52.94%) involved the forefoot, 3 (17.65%) the hindfoot, 3 (17.65%) the ankle, and 2 (11.76%) the midfoot. Twelve patients (70.59%) had new-onset CRPS after a primary procedure, and 5 (29.41%) had developed CRPS after multiple surgeries. Three patients (17.65%) had documented nerve damage intraoperatively and thus developed new-onset CRPS type 2. Blood test results were available for 14 patients (82.35%) at a minimum of 3months postoperatively, and none had elevated inflammatory markers. Five of the patients (29.41%) were smokers, and 8 (47.06%) had had a pre-existing diagnosis of anxiety and/or depression. From our findings, we recommend that middle-age females and those with a history of anxiety or depression, who will undergo elective foot surgery, should be counseled regarding the risk of developing CRPS during the consent process. We recommend similar studies be undertaken in other orthopedic units, and we currently are collecting data from other orthopedic departments within Scotland. © 2014 American College of Foot and Ankle Surgeons.

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