Palacios S.,Instituto Palacios |
Currie H.,NHS Dumfries and Galloway |
Mikkola T.S.,University of Helsinki |
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.
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.
Jayasinghe S.,NHS Dumfries and Galloway |
Connor M.,Royal Infirmary |
Donaldson S.,NHS Dumfries and Galloway |
Austin H.,NHS Dumfries and Galloway |
Foster A.,Royal Infirmary
Journal of Clinical Pathology | Year: 2010
A case of Listeria monocytogenes induced spontaneous bacterial peritonitis (SBP) is reported in a patient with primary biliary cirrhosis. It is an indolent illness and may not show a neutrophil reaction in peritoneal fluid. Enrichment broth was required to isolate L monocytogenes in the patient. This is not routinely used in the UK and therefore isolates may be missed. L monocytogenes remains sensitive to ampicillin, penicillin and gentamicin, but is resistant to cephalosporin antibiotics. The rising incidence of listeriosis in the population suggests that the incidence of SBP from L monocytogenes is likely to increase.
Watson V.,University of Aberdeen |
Carnon A.,NHS Dumfries and Galloway |
Ryan M.,University of Aberdeen |
Cox D.,NHS Dumfries and Galloway
Journal of Public Health (United Kingdom) | Year: 2012
Background: Health-care organizations need to prioritize their resource use and should incorporate the publics preferences into their priority setting process. Methods: We apply a discrete choice experiment (DCE) to obtain weights, from the public, for use in a priority setting exercise. Ten attributes were chosen: location of care, public consultation, use of technology, service availability, patient involvement, management of care, evidence of effectiveness, health gain, risk avoidance and priority area. From the DCE responses, weighted benefit scores were calculated and used to rank development bids from across a health-care organization. Results: Sixty-eight members of the public completed the DCE. All attributes except risk avoidance were significant. The most important attribute levels were a large health gain to many people: care being provided in teams, using latest or cutting-edge technology and 24 h service availability. Local priorities were valued higher than national priorities. Ninety-five bids were ranked in order of overall score. The ranked list of development bids provided a useful tool to inform prioritization decisions. Conclusions: DCEs can offer a theoretically valid and practical means of incorporating the views of the public in an accessible, transparent and streamlined decision-making process when health-care organizations are prioritizing their resources. © 2012 The Author, Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved.
Whitelaw S.,University of Glasgow |
Smart E.,NHS Dumfries and Galloway |
Kopela J.,NHS Dumfries and Galloway |
Gibson T.,Nithsdale Local Health Partnership |
King V.,NHS Dumfries and Galloway
Health Education | Year: 2011
Purpose: Social marketing is increasingly being seen as a potentially effective means of pursuing health education practice generally and within various specific areas such as mental health and wellbeing and more broadly in tackling health inequalities. This paper aims to report and reflect on the authors' experiences of undertaking a health education initiative in a rural National Health Service (NHS) health board in Scotland that utilised social marketing methodology and sought to develop wider capacity and ensure implementation in two topic areas: breast-feeding prevalence and being overweight and obesity among young people. Design/methodology/approach: Case study insights were gathered from service users and professionals using various methods (key informant interviews/focus groups; face-to-face stakeholder workshops; action-planning events; on-line survey; desk based research; complemented by general reflection from Social Marketing Sustainability Steering Group meetings). Findings: The project broadly achieved the goal of deploying social marketing principles and developing capacity in informing progress in each of the case studies and on occasions, initiatives were able to determine a relatively profound understanding of audiences and deliver activity on the ground within a large rural health board. Originality/value: Developing social marketing capacity is possible, though longer term sustainability is dependent on addressing a series of challenges, such as creating conducive long term planning mechanisms, gaining management support and securing on-going resources. © Emerald Group Publishing Limited.
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.
Murphie P.,NHS Dumfries and Galloway |
Hex N.,University of York |
Setters J.,University of York |
Little S.,NHS Dumfries and Galloway
Breathe | Year: 2016
“Non-delivery” home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers. Educational aims Provide update for oxygen prescribers on options for home oxygen provision. Provide update on the evidence base for available self-fill oxygen technologies. Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems. © 2016, European Respiratory Society. All rights reserved.
Spiritual well-being and quality of life among Icelanders receiving palliative care: data from Icelandic pilot-testing of a provisional measure of spiritual well-being from the European Organisation for Research and Treatment of Cancer
PubMed | University of Iceland, NHS Dumfries and Galloway, Reykjavik University, Mount Vernon Hospital and University College London
Type: | Journal: European journal of cancer care | Year: 2015
Palliative care focuses on improving quality of life (QoL). This study examined the feasibility of the Icelandic version of a provisional European Organisation for Research and Treatment of Cancer (EORTC) measure of spiritual well-being (SWB), and explored the relationship between SWB and QoL for palliative care patients in Iceland. Instruments from the EORTC were used: the provisional measure of SWB, which was undergoing pilot-testing in Iceland, and the EORTC QLQ C15-PAL. The correlation between scores was examined and descriptive statistics were used. Structured interviews explored feasibility. Thirty persons participated with average age 72years. Belief in God or a higher power had the mean 3.33 on a 1-4 scale and the mean for overall SWB was 5.73 on a 1-7 scale. The mean score for global health/QoL was 59.4, physical functioning 48.5 and emotional functioning 78.9 on a 0-100 scale. Overall QoL was positively correlated with SWB showing r(30)=0.386, P=0.035. The participants found that answering the provisional EORTC QLQ-SWB prompted an emotional response and took the opportunity to discuss the subject. The provisional SWB measure was found relevant for the Icelandic context, and the study indicates that SWB and QoL are closely connected.
PubMed | NHS Dumfries and Galloway and University of York
Type: Journal Article | Journal: Breathe (Sheffield, England) | Year: 2016
Non-delivery home oxygen technologies that allow self-filling of ambulatory oxygen cylinders are emerging. They can offer a relatively unlimited supply of ambulatory oxygen in suitably assessed people who require long-term oxygen therapy (LTOT), providing they can use these systems safely and effectively. This allows users to be self-sufficient and facilitates longer periods of time away from home. The evolution and evidence base of this technology is reported with the experience of a national service review in Scotland (UK). Given that domiciliary oxygen services represent a significant cost to healthcare providers globally, these systems offer potential cost savings, are appealing to remote and rural regions due to the avoidance of cylinder delivery and have additional lower environmental impact due to reduced fossil fuel consumption and subsequently reduced carbon emissions. Evidence is emerging that self-fill/non-delivery oxygen systems can meet the ambulatory oxygen needs of many patients using LTOT and can have a positive impact on quality of life, increase time spent away from home and offer significant financial savings to healthcare providers.Provide update for oxygen prescribers on options for home oxygen provision.Provide update on the evidence base for available self-fill oxygen technologies.Provide and update for healthcare commissioners on the potential cost-effective and environmental benefits of increased utilisation of self-fill oxygen systems.
Inglis S.C.,British Heart Foundation Glasgow Cardiovascular Research Center |
Inglis S.C.,University of Technology, Sydney |
Lewsey J.D.,University of Glasgow |
Chandler D.,NHS Dumfries and Galloway |
And 3 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.