Collier A.,Ayr Hospital |
Ghosh S.,AMRI Institute of Diabetes and Hormonal Disorders |
Hair M.,NHS Ayrshire and Arran
Diabetic Medicine | Year: 2015
Aim: To explore the gender differences, along with the relationships between BMI, glycaemic control, cardiovascular risk factors and the prevalence of diabetes complications, in a representative population-based group of people with Type 1 and Type 2 diabetes. Methods: Data were obtained from general practices in Ayrshire and Arran, Scotland for 15 351 patients. Results: In the cohort with Type 1 diabetes, after adjustment for age, men had a significantly lower BMI (P = 0.007) and significantly lower total cholesterol (P = 0.005), HDL-cholesterol (P = 2.5*10-17) and HbA1c levels (P = 0.003) than women. By contrast, men had higher blood pressure, both systolic (P = 0.034) and diastolic (P = 0.0003), and higher non-fasting triglyceride levels (P = 0.001). Men with Type 1 diabetes had a higher prevalence of neuropathy (P = 0.021). Among people with Type 2 diabetes, men had a significantly lower BMI (P = 4.26*10-37), and significantly lower total cholesterol (P = 2.96*10-62) and HDL-cholesterol levels (P = 8.25*10-141) but higher non-fasting triglyceride levels (P = 0.0002). In Type 2 diabetes, men had a higher prevalence of ischaemic heart disease (P = 1.66*10-25), stroke (P = 0.002) and peripheral vascular disease (P = 1.68*10-12), while women were older (P = 4.83*10-23), heavier and had a higher prevalence of hypertension (P = 5.32*10-12). More people with Type 2 diabetes were on lipid-lowering treatment (84.7 vs 52.4%; P = 5.51*10-8) than were those with Type 1 diabetes. The prevalence of retinopathy was higher among non-smokers thank smokers in people with both Type 1 and Type 2 diabetes (Type 1, P = 0.016; Type 2, P = 0.001). Conclusions: The study shows gender differences between Type 1 and 2 diabetes that are of clinical significance and require further investigation. Follow-up of the patients included in the present study should give us much greater understanding of the importance of gender in the development of metabolic abnormalities and diabetes complications. © 2014 The Authors.
Harris B.,University of Edinburgh |
Andrews P.J.D.,NHS Lothian |
Murray G.D.,University of Edinburgh |
Forbes J.,University of Edinburgh |
Moseley O.,NHS Ayrshire and Arran
Health Technology Assessment | Year: 2012
Background: Brain injuries resulting from trauma and stroke are common and costly. Cooling therapy may reduce damage and potentially improve outcome. Head cooling targets the site of injury and may have fewer side effects than systemic cooling, but there has been no systematic review and the evidence base is unclear. Objective: To assess the effect of non-invasive head cooling after traumatic brain injury (TBI) and stroke on intracranial and/or core body temperature, functional outcome and mortality, determine adverse effects and evaluate cost-effectiveness. Review methods: Search strategy Major international databases [including MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, the British Library's Electronic Table of Contents (Zetoc)], The Cochrane Library, trial registers, country-specific databases (including China, Japan), Google Scholar, hypothermia conference reports and reference lists of papers were searched with no publication or language restrictions. The searches were conducted from March 2010 to April 2011, with no back date restriction. Selection criteria For formal analysis of effect of head cooling on functional outcome and mortality: randomised controlled trials (RCTs) of non-invasive head cooling in TBI or stroke in adults (aged ≥ 18 years). RCT prespecified in protocol to include adequate randomisation and blinded outcome assessment. For assessment of effect on temperature and adverse effects of cooling methods/devices: studies of any type in TBI, stroke, cardiac arrest and neonatal hypoxic-ischaemic encephalopathy (adverse effects only). Data collection and analysis A study assessment and data collection form was developed and piloted. Data on functional outcome, mortality, temperature change and adverse effects of devices were sought and extracted. Two authors independently assessed RCTs for quality using the Cochrane Renal Group checklist. Results: Out of 46 head-cooling studies in TBI and stroke, there were no RCTs of suitable quality for formal outcome analysis. Twelve studies had useable data on intracranial and core body temperature. These included 99 patients who were cooled after TBI or stroke and 198 patients cooled after cardiac arrest. The data were too heterogeneous for a single summary measure of effect (many studies had no measure of spread) and are therefore presented descriptively. The most effective techniques for which there were adequate data (nasal coolant and liquid cooling helmets) could reduce intracranial temperature by ≥ 1 °C in 1 hour. The main device-related adverse effects were localised skin problems, which were generally mild and self-limiting. There were no suitable data for economic modelling, but an exploratory model of possible treatment effects and cost-effectiveness of head cooling in TBI was created using local patient data. Limitations: We conducted extensive and sensitive searches but found no good-quality RCTs of the effect of head cooling on functional outcome that met the review inclusion criteria. Most trials were small and/or of low methodological quality. However, if the trial reports did not reflect the true quality of the research, there may be some excluded trials that should have been included. Temperature data were often poorly reported which made it difficult to assess the effect of head cooling on temperature. Conclusions: Whether head cooling improves functional outcome or has benefits and fewer side effects compared with systemic cooling or no cooling could not be established. Some methods of head cooling can reduce intracranial temperature, which is an important first step in determining effectiveness, but there is insufficient evidence to recommend its use outside of research trials. The principal recommendations for research are that active cooling devices show the most promise for further investigation and more robust proof of concept of intracranial and core body temperature reduction with head cooling is required, clearly showing whether temperature has changed and by how much. © Queen's Printer and Controller of HMSO 2012.
Braehler C.,NHS Ayrshire and Arran |
Braehler C.,University of Glasgow |
Gumley A.,NHS Ayrshire and Arran |
Gumley A.,University of Glasgow |
And 5 more authors.
British Journal of Clinical Psychology | Year: 2013
Objectives: Compassion focused therapy (CFT) was developed to stimulate capacities for soothing and affiliation to self and others as a way to regulate the threat system. This feasibility study aimed to assess the safety, the acceptability, the potential benefits, and associated change processes of using group CFT with people recovering from psychosis. Design: A prospective, randomized, open-label, blinded end point evaluation design was used. Method: Forty adult patients with a schizophrenia-spectrum disorder were randomized to CFT plus treatment as usual (TAU; n = 22) or to TAU alone (n = 18). Group CFT comprised 16 sessions (2 hr each, 1 x week). Participants were assessed prior to randomization and at the end of treatment. Assessments included semi-structured interviews to elicit narratives of recovery from psychosis and self-report measures. At the end of treatment, participants were rated on the Clinical Global Impression Scale. Narratives were coded using the Narrative Recovery Style Scale to provide measures of change in compassion and avoidance. Change processes were correlated with changes in depression, personal beliefs about illness, fear of recurrence, and positive and negative affect. Results: Group CFT was associated with no adverse events, low attrition (18%), and high acceptability. Relative to TAU, CFT was associated with greater observed clinical improvement (p < 0.001) and significant increases in compassion (p = 0.015) of large magnitude. Relative to TAU, increases in compassion in the CFT group were significantly associated with reductions in depression (p = 0.001) and in perceived social marginalization (p = 0.002). Discussion: Findings support the feasibility of group CFT in psychosis and suggest that changes in compassion can be achieved, which appear to reduce depression in particular. This is the first randomized controlled evaluation of CFT. Conclusion: Compassion focused therapy appears as a safe, acceptable, promising, and evolving intervention for promoting emotional recovery from psychosis. Practitioner Points Compassion focused therapy appears safe to use with people recovering from psychosis. © 2012 The British Psychological Society.
Reilly J.S.,Health Protection Scotland |
Reilly J.S.,Glasgow Caledonian University |
Stewart S.,Health Protection Scotland |
Christie P.,NHS Quality Improvement Scotland |
And 7 more authors.
Journal of Hospital Infection | Year: 2012
Background: A Health Technology Assessment (HTA) model on effectiveness of meticillin-resistant Staphylococcus aureus (MRSA) screening in Scotland suggested that universal screening using chromogenic agar was the preferred option in terms of effectiveness and cost. Aim: To test the model's validity through a one-year pilot-study. Method: A large one-year prospective cohort study of MRSA screening was carried out in six acute hospitals in NHS Scotland, incorporating 81,438 admissions. Outcomes (MRSA colonization and infection rates) were subjected to multivariable analyses, and trends before and after implementation of screening were compared. Findings: The initial colonization prevalence of 5.5% decreased to 3.5% by month 12 of the study (P < 0.0001). Colonization was associated with the number of admissions per patient, specialty of admission, age, and source of admission (home, other hospital or care home). Around 2% of all admissions with no prior history of MRSA infection or colonization tested positive. Those who were screen positive on admission and not previously known positive were 12 times more likely than those who screened negative to develop infection, increasing to 18 times if they were both screen positive and previously known positive. MRSA infections (7.5 per 1000 inpatient-days overall) also reduced significantly over the study year (P = 0.0209). Conclusion: The risk factors identified for colonization and infection indicate that a universal clinical risk assessment may have a role in MRSA screening. © 2011 The Healthcare Infection Society.
Crabtree J.,NHS Ayrshire and Arran
Nursing times | Year: 2010
Nurses in acute settings often lack the knowledge and experience to provide appropriate care for patients with dementia. Two specialist nurses at the Biggart Hospital in South Ayrshire, Scotland, used a questionnaire to determine staff attitudes to patients with dementia and designed a multidisciplinary training programme to improve practice in dementia care. This article describes the development, implementation and evaluation of the first stage of the programme.
Gifford F.J.,John Stevenson Lynch Renal Unit |
Methven S.,John Stevenson Lynch Renal Unit |
Boag D.E.,NHS Ayrshire and Arran |
Spalding E.M.,John Stevenson Lynch Renal Unit |
Macgregor M.S.,John Stevenson Lynch Renal Unit
QJM | Year: 2011
Introduction: Most UK laboratories use the MDRD4 formula to estimate glomerular filtration rate (eGFR), but this may exaggerate chronic kidney disease (CKD) prevalence. In a large adult population, we examined the impact of the more accurate CKD-EPI formulae on prevalence estimates, and on secular trends in prevalence. Methods: We extracted all serum creatinine (SCr) results for adults, processed in our laboratory during two 1-year periods (2004, 2009-10). To minimize the effect of acute illness, a patient's lowest SCr was used for each period. eGFR (traceable to isotope dilution mass spectrometry value) was calculated using the MDRD4 and CKD-EPI formulae. Prevalence estimates were compared, with subgroup analysis by age and sex. Results: In 2004, 102 322 patients had SCr tested (35.4% of the adult population), rising to 123 121 (42.3%) in 2009-10. The proportion tested rose with age to 86% of 85- to 89-year olds. The prevalence of CKD stages 3-5 was lower with the CKD-EPI formulae than the MDRD4 formula. The CKD-EPI formulae reclassified 17 014 patients (5.8%) to milder stages of CKD, most commonly from eGFR 60-89 ml/min/1.73m 2 and CKD stage 3A, in women, and in those <70 years old. 5172 patients (1.8%), mostly elderly women, were reclassified to more severe stages of CKD. Between the two time periods, the prevalence of CKD stages 3-5 rose from 5.44% to 5.63% of the population using MDRD4, but was static at 4.94% with CKD-EPI. Conclusion: The CKD-EPI formulae, which are more accurate than the MDRD4 formula at higher GFR, reduced the estimated prevalence of CKD stages 3-5 by 0.5% in 2004 and 0.7% in 2009-10. The greatest reclassification was seen in CKD 3A, particularly amongst middle-aged females. The minor rise in CKD prevalence between 2004 and 2009-10 seen with the MDRD4 formula was not confirmed with the CKD-EPI formulae. The CKD-EPI formulae may reduce overdiagnosis of CKD, but further assessment in the elderly is required before widespread implementation. © The Author 2011. Published by Oxford University Press.
Ferguson K.B.,NHS Ayrshire and Arran |
Bharadwaj R.,NHS Ayrshire and Arran |
MacDonald A.,NHS Ayrshire and Arran |
Syme B.,NHS Ayrshire and Arran |
Bal A.M.,NHS Ayrshire and Arran
Annals of the Royal College of Surgeons of England | Year: 2014
Pasteurella multocida is a rare cause of prosthetic joint infection. This infection generally follows significant animal contact, usually licks and scratches. We report a case of P multocida infection that was treated with linezolid with salvage of the implant. Linezolid is generally active against Gram-positive organisms only with the exception of Pasteurella, which is Gramnegative. We extensively review the previous reported cases of implant infection with P multocida.
Giebaly D.E.,NHS Ayrshire and Arran
BMJ case reports | Year: 2012
The authors report a rare case of piriformis pyomyositis, in a teenage rugby player, who was initially feverish and presented to us with low back pain, sciatica and inability to mobilise due to pain. Subsequent imaging investigations (MRI scan) revealed abscess formation in the piriformis muscle with compression effect on the ipsilateral sciatic nerve. A course of intravenous antibiotic therapy followed by oral antibiotics fully resolved his symptoms and returned inflammatory markers back to normal.
Srinivasan S.,NHS Ayrshire and Arran
BMJ case reports | Year: 2010
Fuchs heterochromic uveitis (FHU) in its classic presentation is a unilateral, chronic, low grade, often asymptomatic anterior uveitis. It is characterized by a classic triad of iris heterochromia, cataract and keratic precipitates. Neovascularization of the iris and the anterior chamber (AC) angle (radial and circumferential) occurs in 6-22% of cases. This angle and iris new vessels can sometimes lead to a characteristic filiform haemorrhage and formation of hyphaema after AC paracentesis and is a hallmark of FHU known as Amsler-Verrey sign. This haemorrhage has been previously associated with trivial trauma, mydriasis, applanation tonometry, gonioscopy, or it may occur spontaneously. In the setting of cataract surgery it has been previously reported with the use of a Honan balloon. We report a case of cataract and FHU where the Amsler-Verrey sign developed intraoperatively during a phacoemulsification procedure. To the best of our knowledge, this is the first documented report of this sign occurring intraoperatively during cataract surgery.
Crabtree J.,NHS Ayrshire and Arran.
Nursing times | Year: 2010
In NHS Ayrshire and Arran, almost 5500 people have a dementia diagnosis. This could increase by as much as 60% over the next 20 years (Alzheimer Scotland, 2007). National dementia strategies in the U.K. have identified a need for better training that supports staff in general hospitals. While all clinical settings will admit people with dementia, their specialist care needs are not always being met Better awareness will help ensure these are addressed on both admission and throughout their care journey. This is the second article describing a nurse led initiative to improve approaches towards dementia in a general community hospital. The first article (Crabtree and Mack, 2010) focused on raising awareness of dementia, while this follow-up article describes the development and implementation of a dementia champions programme.