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Dumfries, United Kingdom

Inglis S.C.,British Heart Foundation Glasgow Cardiovascular Research Center | Inglis S.C.,University of Technology, Sydney | Inglis S.C.,Heart Health | Lewsey J.D.,University of Glasgow | And 4 more authors.
British Journal of Surgery | Year: 2012

Background: This study examined trends for all first hospital admissions for peripheral artery disease (PAD) in Scotland from 1991 to 2007 using the Scottish Morbidity Record. Methods: First admissions to hospital for PAD were defined as an admission to hospital (inpatient and day-case) with a principal diagnosis of PAD, with no previous admission to hospital (principal or secondary diagnosis) for PAD in the previous 10 years. Results: From 1991 to 2007, 41 593 individuals were admitted to hospital in Scotland for the first time for PAD. Some 23 016 (55.3 per cent) were men (mean(s.d.) age 65.7(11.7) years) and 18 577 were women (aged 70.4(12.8) years). For both sexes the population rate of first admissions to hospital for PAD declined over the study interval: from 66.7 per 100 000 in 1991-1993 to 39.7 per 100 000 in 2006-2007 among men, and from 43.5 to 29.1 per 100 000 respectively among women. After adjustment, the decline was estimated to be 42 per cent in men and 27 per cent in women (rate ratio for 2007 versus 1991: 0.58 (95 per cent confidence interval 0.55 to 0.62) in men and 0.73 (0.68 to 0.78) in women). The intervention rate fell from 80.8 to 74.4 per cent in men and from 77.9 to 64.9 per cent in women. The proportion of hospital admissions as an emergency or transfer increased, from 23.9 to 40.7 per cent among men and from 30.0 to 49.5 per cent among women. Conclusion: First hospital admission for PAD in Scotland declined steadily and substantially between 1991 and 2007, with an increase in the proportion that was unplanned. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. Source

Dreyer J.,NHS Dumfries and Galloway | Hannay J.,Gartnavel General Hospital | Lane R.,Association of Surgeons of Great Britain and Ireland
World Journal of Surgery | Year: 2014

Background: In Africa surgical trainees (residents) are often 'at the coalface' in managing surgical emergencies. A practical course on management of surgical emergencies was developed, as requested and guided by the learning needs of surgical trainees in East/Central Africa, to teach structured thinking processes in surgical emergencies; to thoroughly assess participants' knowledge, technical and non-technical skills; and to correlate assessment scores with participants' feedback on course quality. Methods: Curriculum design was aimed at learners' needs, as guided by local trainers and previous teaching. A 5-day course was developed on emergencies in critical care and trauma, general surgery, orthopaedics, obstetrics and urology; delivered through lectures, tutorials and practical sessions, with individual mentoring. Participants' knowledge was assessed through end-of-course tests and, with their practical and non-technical skills, evaluated formatively. Opportunity for immediate detailed feedback was provided, and for follow-up 6 months later. Results: All participants completed the course successfully, passed knowledge tests, and received satisfactory scores in continuous assessment. There was good correlation between formative and summative assessment scores. Candidates rated course content, delivery and usefulness very highly; 'open text' noted no such previous training. After six months 90 % of course participants indicated that the course had significantly improved their ability to manage surgical emergencies. Conclusions: An intensive course on management of surgical emergencies can be effectively delivered by a small core faculty for each specialty. Feedback from participants and local faculty indicated that this course filled a specific learning niche. Effective assessment can be based on continuous evaluation during course participation. © 2013 Société Internationale de Chirurgie. Source

Finlay S.,Royal Infirmary | Bray B.,Kings College London | Lewington A.J.,University of Leeds | Hunter-Rowe C.T.,NHS Dumfries and Galloway | And 3 more authors.
Clinical Medicine, Journal of the Royal College of Physicians of London | Year: 2013

In 2009, the National Confidential Enquiry into Patient Outcome and Death (NCEPOD) report identified significant deficiencies in the management of acute kidney injury (AKI) in hospitals in the UK. Many errors arose from failure to recognise patients with AKI and those at risk of developing AKI. Currently, there is no universally accepted risk factor assessment for identifying such patients on admission to acute medical units (AMUs). A multicentre prospective observational study was performed in the AMUs of 10 hospitals in England and Scotland to define the risk factors associated with AKI and to assess quality of care. Data were collected on consecutive acute medical admissions over two separate 24-h periods. Acute kidney injury was present in 55/316 (17.7%) patients, with sepsis, hypovolaemia, chronic kidney disease (CKD) and diabetes mellitus identified as the major risk factors. Deficiencies in patient care were identified, reinforcing the continuing need to improve the management of AKI. © Royal College of Physicians, 2013. Source

Clark D.,University of Glasgow | Graham F.,NHS Dumfries and Galloway | Centeno C.,University of Navarra
Medicine (United Kingdom) | Year: 2015

The last quarter of the 20th century produced considerable advances in hospice and palliative care. In many countries, specialist services developed, education programmes got underway and in some cases palliative care ideas began to infiltrate national health policies. Globally, however, palliative care still faces many challenges: lack of recognition and understanding on the part of the health professions and the public; limited expression in health policy; insufficient funding; few accredited training programmes; and a paucity of evidence to demonstrate efficacy and cost benefits. We describe what is known about the development of palliative care around the world, how its clinical focus is changing and what prospects there are for further development. © 2015 Elsevier Ltd. Source

Palacios S.,Instituto Palacios | Currie H.,NHS Dumfries and Galloway | Mikkola T.S.,University of Helsinki | Dragon E.,Pfizer
Maturitas | Year: 2015

Current guidelines recommend that hormone therapy (HT) in postmenopausal women with a uterus include a progestin to protect against endometrial hyperplasia. However, many concerns relating to HT use appear to be related to the progestin component, including cardiovascular risk, breast stimulation, and irregular vaginal bleeding. Conjugated estrogens (CE) combined with the selective estrogen receptor modulator bazedoxifene (BZA) is a new progestin-free HT option for alleviating estrogen deficiency symptoms in postmenopausal women with a uterus for whom treatment with progestin-containing therapy is not appropriate. Five double-blind, randomized, placebo-controlled, phase 3 studies, known as the Selective estrogens, Menopause, And Response to Therapy (SMART) trials have investigated the efficacy of CE/BZA for relieving vasomotor symptoms (VMS), and effect on bone mass, as well as endometrial and breast safety in postmenopausal women. In a 12-week study, CE 0.45 mg/BZA 20 mg significantly reduced the number and severity of hot flushes compared with placebo at weeks 4 and 12. Unlike estrogen-progestin therapy (EPT), CE 0.45 mg/BZA 20 mg did not increase breast density compared with placebo. In clinical trials up to 2 years, CE/BZA had a favorable tolerability profile, demonstrated by amenorrhea rates similar to placebo. Vascular disorders including venous thromboembolic events (pulmonary embolism, retinal vein thrombosis, deep vein thrombosis, and thrombophlebitis) were rare events, occurring in less than 1 per 1000 patients. CE/BZA was associated with significantly higher incidences of amenorrhea and lower incidences of bleeding compared with CE/medroxyprogesterone acetate in 2 comparative trials. Therefore, CE 0.45 mg/BZA 20 mg provides an effective, well-tolerated, progestin-free alternative to EPT for postmenopausal women with a uterus. © 2015 Elsevier Ireland Ltd. All rights reserved. Source

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