Sproat R.,Monklands Hospital
Otology and Neurotology | Year: 2017
OBJECTIVE:: To investigate postoperative audiological outcomes and complication rates for fully endoscopic and microscopic stapes surgery carried out by a single surgeon in one center. PATIENTS:: All patients having undergone endoscopic and non-endoscopic stapes surgery for otosclerosis from September 2009 to August 2016 under a single surgeon. INTERVENTION(S):: Stapedotomy using either an operating microscope or endoscope for visualization. Stapedotomy was carried out using a standard approach. MAIN OUTCOME MEASURE(S):: Pre- and postoperative audiometry and complications. RESULTS:: Thirty-four patients who underwent endoscopic stapes surgery and 47 patients who underwent non-endoscopic stapes surgery were included in this study. Seventy-nine percent of both endoscopic and non-endoscopic groups had the average air-bone gap closed to less than 10 dBHL, respectively; the difference was not significant (p = 0.940, χ test). No patients with sensorineural hearing loss, vertigo, or facial nerve paresis were reported. Two of 34 patients (6%) of the endoscopic group had the chorda tympani cut intraoperatively for access compared with 11 of 47 patients (23%) of the non-endoscopic group. Sixteen of 47 patients (34%) required an endaural incision for access in the non-endoscopic group; no endaural incisions were made in the endoscopic group. CONCLUSION:: Air-bone gap closure and patient complications did not vary significantly between endoscopic and non-endoscopic groups in this study of 34 endoscopic procedures. There is a requirement for further studies with larger sample sizes and longer follow-up periods to fully gauge the safety and effectiveness of this technique. Copyright © 2017 by Otology & Neurotology, Inc. Image copyright © 2010 Wolters Kluwer Health/Anatomical Chart Company
Pearsall R.,Monklands Hospital |
Smith D.J.,University of Glasgow |
Pelosi A.,St Johns Hospital |
Geddes J.,University of Oxford
BMC Psychiatry | Year: 2014
Background: Individuals with serious mental illness are at a higher risk of physical ill health. Mortality rates are at least twice those of the general population with higher levels of cardiovascular disease, metabolic disease, diabetes, and respiratory illness. Although genetics may have a role in the physical health problems of these patients, lifestyle and environmental factors such as levels of smoking, obesity, poor diet, and low levels of physical activity also play a prominent part.Methods: We conducted a systematic review and meta-analysis of randomised controlled trials comparing the effect of exercise interventions on individuals with serious mental illness.Searches were made in Ovid MEDLINE, Embase, CINAHL, PsycINFO, Biological Abstracts on Ovid, and The Cochrane Library (January 2009, repeated January 2013) through to February 2013.Results: Eight RCTs were identified in the systematic search. Six compared exercise versus usual care. One study assessed the effect of a cycling programme versus muscle strengthening and toning exercises. The final study compared the effect of adding specific exercise advice and motivational skills to a simple walking programme. The review found that exercise improved levels of exercise activity (n = 13, standard mean difference [SMD] 1.81, CI 0.44 to 3.18, p = 0.01). No beneficial effect was found on negative (n = 84, SMD = -0.54, CI -1.79 to 0.71, p = 0.40) or positive symptoms of schizophrenia (n = 84, SMD = -1.66, CI -3.78 to 0.45, p = 0.12). No change was found on body mass index compared with usual care (n = 151, SMD = -0.24, CI -0.56 to 0.08, p = 0.14), or body weight (n = 77, SMD = 0.13, CI -0.32 to 0.58, p = 0.57). No beneficial effect was found on anxiety and depressive symptoms (n = 94, SMD = -0.26, CI -0.91 to 0.39, p = 0.43), or quality of life in respect of physical and mental domains.Conclusions: This systematic review showed that exercise therapies can lead to a modest increase in levels of exercise activity but overall there was no noticeable change for symptoms of mental health, body mass index, and body weight. © 2014 Pearsall et al.; licensee BioMed Central Ltd.
Paton L.,Monklands Hospital |
Gupta S.,Monklands Hospital |
Blacoe D.,Monklands Hospital
Anaesthesia | Year: 2013
A 53-year-old man with hypopharyngeal stenosis following curative chemoradiotherapy for a tongue base tumour presented three years later for an attempt at pharyngeal dilatation. The first attempt 6 months previously was abandoned when awake fibreoptic intubation failed due to partial airway obstruction and desaturation when the fibrescope was advanced. As mask ventilation was anticipated to be possible, a further attempt at intubation after induction of anaesthesia was judged appropriate. The backup plan was jet ventilation via a cricothyroid cannula sited pre-induction. However, neither mask nor jet ventilation proved possible after the induction of anaesthesia and neuromuscular blockade with rocuronium. Swift administration of sugammadex on a background of thorough pre-oxygenation allowed return of spontaneous breathing before the development of hypoxia and so avoided the need for surgical airway rescue. This case demonstrates the utility of sugammadex in restoring spontaneous respiration in a 'can't ventilate' scenario, provided that the airway has not been traumatised by instrumentation. This article is accompanied by an Editorial by Mendonca, pp 795-799 of this issue. © 2013 The Association of Anaesthetists of Great Britain and Ireland.
Gupta G.,Monklands Hospital
Journal of the European Academy of Dermatology and Venereology | Year: 2015
Background Lmax, the maximum lesion count during treatment, is a new concept for evaluating the efficacy of field-directed treatments for actinic keratosis (AK) against clinical and subclinical lesions. Imiquimod 3.75% is a field-directed AK treatment, which can detect and clear clinical and subclinical lesions across an entire sun-exposed field such as the full face or balding scalp.Objectives To evaluate the importance of integrating Lmax into daily clinical practice by describing the clinical features and outcomes obtained in the first 10 patients who were treated with imiquimod 3.75% in a UK dermatology department.Methods Ten AK patients were treated with imiquimod 3.75% in two 2-week treatment cycles separated by a 2-week treatment-free interval. Lesions were counted before, during and 2 months after treatment was completed. Patients compared the imiquimod 3.75% regimen with their previous AK therapies in terms of treatment duration and side-effect profile.Conclusions Imiquimod 3.75% in daily clinical practice enables dermatologists to detect and clear clinical and subclinical AK lesions across a large sun-exposed area. Patients generally find imiquimod 3.75% easy-to-use with a better side-effect profile than other AK treatments.Results All 10 patients in this cohort had used two or more prior AK treatments including 5-flurouracil, diclofenac, imiquimod 5% and photodynamic therapy. The patients had a median of 10 AK lesions on clinical presentation and a median Lmax of 14. The median lesion count was zero 2 months after treatment was completed. All patients thought that imiquimod 3.75% was easy-to-use and that the duration of treatment was better than that of previous AK therapies. Seven of the patients considered the side-effect profile of imiquimod 3.75% to be better than that of their prior AK treatments. © 2014 European Academy of Dermatology and Venereology.
Ritchie N.D.,University of Glasgow |
Baggott A.V.,Monklands Hospital |
Andrew Todd W.T.,Monklands Hospital
Journal of Travel Medicine | Year: 2012
Background Acetazolamide has been reported to be effective in the prevention of acute mountain sickness (AMS). Our aim was to conduct a systematic review of randomized, placebo-controlled trials of acetazolamide in the prevention of AMS. Methods Studies were identified by searching the MEDLINE, Embase, Cochrane Clinical Trials Register, and ClinicalTrials.gov databases. Primary end point was difference in incidence of AMS between acetazolamide and placebo groups. Results Acetazolamide prophylaxis was associated with a 48% relative-risk reduction compared to placebo. There was no evidence of an association between efficacy and dose of acetazolamide. Adverse effects were often not systematically reported but appeared to be common but generally mild. One study found that adverse effects of acetazolamide were dose related. Conclusions Acetazolamide is effective prophylaxis for the prevention of symptoms of AMS in those going to high altitude. A dose of 250 mg/day has similar efficacy to higher doses and may have a favorable side-effect profile. © 2012 International Society of Travel Medicine.
Ellis G.,Monklands Hospital
Cochrane database of systematic reviews (Online) | Year: 2011
Comprehensive geriatric assessment (CGA) is a multidimensional, interdisciplinary diagnostic process to determine the medical, psychological and functional capabilities of a frail elderly person in order to develop a co-ordinated and integrated plan for treatment and long-term follow up. We sought to evaluate the effectiveness of CGA in hospital for older adults admitted as an emergency. We searched the Cochrane Effective Practice and Organisation of Care (EPOC) Group Register, the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library), the Database of Abstracts of Reviews of Effects (DARE), MEDLINE, EMBASE, CINAHL and AARP Ageline, and handsearched high-yield journals. We searched for randomised controlled trials comparing CGA (whether by mobile teams or in designated wards) to usual care. Two review authors initially assessed eligibility and trial quality and extracted published data. Twenty-two trials evaluating 10,315 participants in six countries were identified. Patients in receipt of CGA were more likely to be alive and in their own homes at up to six months (OR 1.25, 95% CI 1.11 to 1.42, P = 0.0002) and at the end of scheduled follow up (median 12 months) (OR 1.16, 95% CI 1.05 to 1.28, P = 0.003) when compared to general medical care. In addition, patients were less likely to be institutionalised (OR 0.79, 95% CI 0.69 to 0.88, P < 0.0001). They were less likely to suffer death or deterioration (OR 0.76, 95% CI 0.64 to 0.90, P = 0.001), and were more likely to experience improved cognition in the CGA group (OR 1.11, 95% CI 0.20 to 2.01, P = 0.02). Subgroup interaction in the primary outcomes suggests that the effects of CGA are primarily the result of CGA wards. Comprehensive geriatric assessment increases a patient's likelihood of being alive and in their own home at up to 12 months.
Ellis G.,Monklands Hospital
Cochrane database of systematic reviews (Online) | Year: 2010
BACKGROUND: Many patients experience depression, social isolation and anxiety post stroke. These are associated with a poorer outcome. Ameliorating these problems may improve patient wellbeing. OBJECTIVES: To evaluate the impact of a healthcare worker or volunteer whose multi-dimensional roles have been grouped under the title 'stroke liaison worker'. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (searched February 2009), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 1, 2009), MEDLINE (1966 to 2009), EMBASE (1980 to 2009) and four other databases. We performed a cited reference search, searched conference proceedings and trials registers, checked reference lists and contacted authors and trial investigators. SELECTION CRITERIA: Randomised controlled trials investigating the impact of a stroke liaison worker versus usual care. DATA COLLECTION AND ANALYSIS: We invited trialists to participate in a review of individual patient data. Primary outcomes for patients were subjective health status and extended activities of daily living. Primary outcomes for carers were subjective health status including measures of carer strain. MAIN RESULTS: We included 16 trials involving 4759 participants. Analysis did not show a significant overall difference for subjective health status (standardised mean difference (SMD) -0.03, 95% confidence interval (CI) -0.11 to 0.04, P = 0.34) or extended activities of daily living (SMD 0.04, 95% CI -0.03 to 0.11, P = 0.22). There was no overall significant effect for the outcome of carer subjective health status (SMD 0.04, 95% CI -0.05 to 0.14, P = 0.37). Patients with mild to moderate disability (Barthel 15 to 19) had a significant reduction in dependence (odds ratio (OR) 0.62, 95% CI 0.44 to 0.87, P = 0.006). This would equate to 10 fewer dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. Similar results were seen for the outcome of death or dependence for the subgroup with Barthel 15 to 19 (OR 0.55, 95% CI 0.38 to 0.81, P = 0.002). This risk difference equates to 11 fewer dead or dependent patients (95% CI 17 fewer to 4 fewer) for every 100 patients seen by the stroke liaison worker. AUTHORS' CONCLUSIONS: There is no evidence for the effectiveness of this multifaceted intervention in improving outcomes for all groups of patients or carers. Patients with mild to moderate disability benefit from a reduction in death and disability. Patients and carers do report improved satisfaction with some aspects of service provision.
McGoldrick C.,Monklands Hospital
Occupational Medicine | Year: 2012
According to 2009 statistics, the human immunodeficiency virus (HIV) infected an estimated 86 500 individuals within the UK, although around one-quarter were unaware of their infection. In the majority of cases, it is now considered a long-term controllable but incurable infection. Indeed, most HIV-positive individuals are able to work. Employment is across most, if not all, workforce sectors and protection against workplace discrimination is provided by the Equality Act 2010. Issues including confidentiality, workplace adjustments, vaccinations and travel restrictions may be relevant to the occupational health of HIV-positive workers. There are special considerations concerning HIV-infected health care workers, including avoidance of performing exposure-prone procedures. Prevention of HIV acquisition in the workplace is relevant to a diverse range of occupational environments, and HIV post-exposure prophylaxis should be considered after potential HIV exposure incidents. If a worker contracts HIV by occupational means, financial help may be available. © The Author 2012. Published by Oxford University Press on behalf of the Society of Occupational Medicine. All rights reserved.
Wilson A.,Monklands Hospital
Cytopathology | Year: 2016
National cervical screening programmes are considering a move to HPV primary screening. HPV testing requires the cervical sample to be placed in liquid based cytology (LBC) media and the triage cytology test will be carried out using LBC preparations. The resources required for conversion training from conventional smears to LBC should not be underestimated as errors can be made without the use of a structured training plan and monitoring of performance. In the UK, many labs have converted between the two main LBC technologies, Thinprep and Surepath. The same logic apples: all staff including primary screeners and cytopathologists must undergo a structured conversion course with clear and measurable outcomes to ensure the competence of all staff before going “live” with the new technology. It is expected that conversion training will take approximately 39 hrs and a minimum of 95% high grade sensitivity and 70% specificity must be achieved. © 2016 John Wiley & Sons Ltd
Sil A.,Monklands Hospital |
Barr G.,Monklands Hospital
Journal of Laryngology and Otology | Year: 2012
Method: Numerous studies have considered the benefits, and the disadvantages, of the Epworth Sleepiness Scale. Following an extensive literature review, we found that the evidence was inconclusive as regards the diagnostic efficacy of Epworth scoring for obstructive sleep apnoea syndrome. We undertook a retrospective study of 343 patients who underwent a sleep assessment over a 10-year period at the Monklands Hospital. Analysis and results: A total of 238 patients did not have sleep apnoea whereas 105 patients did. The mean Epworth score in patients with obstructive sleep apnoea syndrome was 10.94 (95 per cent confidence interval 9.46-11.42), and in the non-apnoeic group it was 7.73 (95 per cent confidence interval 7.04-8.41). Logistic regression and receiver operating characteristic curves were used to assess the predictive ability of Epworth scoring. The scores only explained 7-10 per cent of the variation in the probability of occurrence of obstructive sleep apnoea syndrome. The odds ratio for Epworth scoring was 1.118, and only 69 per cent of cases were correctly classified by the Scale. Conclusions: The literature review suggested that the Epworth Sleepiness Scale is associated with a low effect size and/or low predictive value when correlated or regressed on the Apnoea-Hypopnoea Index or Respiratory Disturbance Index, thus limiting its value as a screening test. Our study concluded that the Epworth Scale is only marginally useful in predicting the occurrence of obstructive sleep apnoea syndrome. We believe that every patient with a direct or witnessed history of sleep apnoea with obstructive symptoms have some form of sleep assessment. © JLO (1984) Limited 2011.