Amir I.,NHS Lothian
Ear, nose, & throat journal | Year: 2015
We describe the cases of 2 brothers in their early 50s, born to consanguineous parents, who presented with acute stridor as a result of adult-onset bilateral abductor vocal fold paralysis. Both patients had a history of adult-onset asthma. No other associated symptoms were evident, and findings on neurologic examination and all other investigations were normal. Both patients required emergency surgical tracheostomy. Another brother with a similar history had died of an airway problem when he was 53 years of age; 2 other younger brothers and 3 younger sisters were currently unaffected. To the best of our knowledge, this is the first report of adult-onset familial bilateral vocal fold paralysis in the absence of associated features. The parents' consanguinity suggested an autosomal recessive basis to this disorder. In addition to describing the features of this case, we review the literature relating to adult-onset familial vocal fold paralysis.
News Article | December 14, 2016
Scotland’s public spending watchdogs are planning to investigate a multibillion-pound scheme to build privately funded roads, schools and hospitals after serious doubts emerged about its value for money. Audit Scotland and the Accounts Commission will scrutinise the Scottish government’s privately financed NPD (non-profit distribution) programme after it breached strict European Union rules on government spending. The inquiry is due to start in 2018 and will test whether Scotland’s equivalent of the private finance initiative – a funding method for public projects that became widespread under the Blair and Brown governments – is economically efficient. It is understood preparatory work for the investigation has already begun. The error over interpreting EU rules is expected to cost Nicola Sturgeon’s government the equivalent of £932m in lost expenditure because it must now match the private finance spending under the NPD programme with money borrowed from the Treasury. The scramble for matching funds is expected to have knock-on effects on public expenditure in Scotland. Further details about the hit to Scotland’s finances are expected to emerge on Thursday when Derek Mackay, the Scottish finance secretary, publishes next year’s draft budget. Mary Alexander, deputy Scottish secretary for Unite, one of the trade unions that will protest against the NPD programme outside the Scottish parliament on Thursday, said the deals tied public authorities into “exorbitant” 25- to 30-year contracts. “The funding model rolled out by the Scottish government is nothing other than a public relations repackaging of the private finance initiative, with zero transparency and minimal accountability,” she said. The NPD programme, which was introduced by former first minister Alex Salmond, echoes the PFI structure by allowing private companies to build hospitals, schools and roads with debt finance which is then paid off by the taxpayer over a period of decades. Critics argue that the process costs governments more over the long term and fails to hold private operators to account. The Office for National Statistics raised the pressure on the NPD programme last year by deciding that the £865m in construction costs of four major private finance projects – the Aberdeen bypass, two hospitals and a blood transfusion service headquarters – must be added to government accounts under new EU spending rules because the schemes are heavily controlled by the public sector. Scottish ministers now admit a fifth scheme, to build a new hospital on Orkney for £67m, needs to be added to that. Because these projects must now go on the Scottish government balance sheet, ministers have less room to finance other infrastructure schemes. Opposition MSPs have been leading calls for a formal Holyrood investigation into the non profit distribution programme - or NPD - and the government agency which set it up, the Scottish Futures Trust. A joint investigation by the Guardian and the Ferret website has also found that the private consortium building Scotland’s largest NPD hospital in Dumfries – one of the four projects singled out by the ONS – is expected to generate £160m in interest and finance fees on loans totalling £242m, including the £212m spent on building the hospital. According to documents released by NHS Dumfries & Galloway under FoI legislation, the consortium – whose members include insurance group Aviva and building firm Laing O’Rourke – is charging an interest rate of 5.1% on borrowings of £218m. This results in the consortium earning more than £100m in interest payments from the public sector. It is also charging 11.3% on a further £24.2m in “subordinate debt”, which will earn financiers £37.5m in interest. If Scottish ministers had instead used public borrowing they would expect interest rates from the state-run national loans fund of about 1.6%. NHS Dumfries & Galloway failed to respond to questions on this from the Guardian. The joint investigation has also established that the NHS will be charged about three times as much as staff would earn for electricians, joiners and plumbers employed by the private contractors building and running new mental health facilities at the Royal Edinburgh hospital. The contractors, Galliford Try, will charge NHS Lothian £33 an hour for an electrician and £26 for a painter – excluding overheads and VAT. An NHS electrician’s wage starts at £9.82 an hour; a painter’s £8.59. Lothian NHS said health service pay rates did not include employee and tax costs, and said the contractors’ fees were competitive. Public spending experts, trade unions and opposition parties said these disclosures raise substantial questions about the NPD programme. Since the launch of the private finance scheme by the Scottish Futures Trust, dozens of health centres, hospitals, roads, colleges and schools have been built under two models: NPD and a related scheme known as “hub”, in which public bodies pool different building projects into joint contracts in the hope it lowers costs. These projects are on course to cost up to £9bn because they include substantial private maintenance contracts lasting for up to 30 years. However, the Scottish Futures Trust failed to forecast that new EU rules on private financing for public infrastructure meant that all the NPD contracts which were signed after September 2014 would be counted as public assets. As a result, ministers had to match their capital costs with the equivalent value from public borrowing – a figure which has now reached £932m. This accounting exercise means that £932m in public borrowing money cannot now be spent, while the NHS and Transport Scotland must still pay the higher interest rates and fees charged for those projects by private financiers. Neil Findlay, the Labour MSP and convenor of Holyrood’s health committee, said this reinforced his view there was a strong case for a Holyrood investigation alongside Audit Scotland’s. “We need to find out who actually owns these so called ‘public services’, who benefits and profits from investment in them, what is the scale of that profit, what is the impact on workers affected by any change in ownership and whether we could do things better in a way that offers far better value for the public pound,” he said. Jim and Margaret Cuthbert, economists who specialise in investigating private finance projects, said the NPD system could be an improvement on PFI because it should involve greater controls on private profits. But they said the ONS report on the Aberdeen bypass raised concerns over the high finance charges levied under NPD projects. “There is extremely limited information about what is going on. And that is really probably the biggest problem about [Scottish Futures Trust] activities – the lack of information we have, the lack of accountability,” Jim Cuthbert said. Caroline Gardner, auditor general at Scotland’s public spending watchdog, said the Scottish government had to take a far more strategic approach to its investment plans and finances. Gardner said this was a pressing need because the chancellor’s autumn statement last month allocated Scotland an extra £800m in capital funding from the Treasury. “We will continue to keep a close eye on the Scottish government’s approach, including its plans for funding its investment programme, and report where appropriate,” she said. The Scottish government said the revised EU rules were released after its NPD projects were underway. A spokesman insisted they still offered value for money, and helped strengthen Scotland’s economy. “The NPD and hub models are an improvement on previous PFI deals,” he said. “They enable investment in public projects in Scotland to be brought forward more quickly than would otherwise be available through our capital allocation and limited borrowing powers.” He added: “We have been open and transparent about the impact of classification on the NPD programme and is willing to assist Audit Scotland should they choose to undertake any further review.”
Harper S.F.,NHS Lothian
Clinical Psychology and Psychotherapy | Year: 2013
Therapists working with people who have complex problems associated with psychosis may find it difficult to apply currently available cognitive behavioural therapy (CBT) manuals to client's presenting problems. This can lead to activation of negative therapist beliefs about themselves, the client or the therapy and subsequent problems maintaining the therapeutic relationship. This paper describes the integration of a range of models and concepts derived from CBT which were used to assist one such client with complex problems associated with psychosis. As such, it is proposed that taking a flexible, formulation driven approach to therapy can assist therapists to remain client centred and work effectively. The therapy described draws on a number of concepts including those taken from schema focussed therapy, mindfulness and compassionate mind training. Therapist and client summary letters were used as part of the described intervention, but in addition, the client's summary is reproduced in the paper aiming to address the issue of the under reporting in the literature of the client's perspective on therapy. Copyright © 2011 John Wiley and Sons, Ltd. Copyright © 2013 John Wiley and Sons, Ltd. 20 1 January/February 2013 10.1002/cpp.771 Practitioner Report Practitioner Reports Copyright © 2011 John Wiley and Sons, Ltd..
Hill J.V.,NHS Lothian |
Leeming D.,University of Huddersfield
International Journal of Mental Health and Addiction | Year: 2014
Public perception of alcohol addiction is frequently negative, whilst an important part of recovery is the construction of a positive sense of self. In order to explore how this might be achieved, we investigated how those who self-identify as in recovery from alcohol problems view themselves and their difficulties with alcohol and how they make sense of others’ responses to their addiction. Semi-structured interviews with six individuals who had been in recovery between 5 and 35 years and in contact with Alcoholics Anonymous were analysed using Interpretative Phenomenological Analysis. The participants were acutely aware of stigmatising images of ‘alcoholics’ and described having struggled with a considerable dilemma in accepting this identity themselves. However, to some extent they were able to resist stigma by conceiving of an ‘aware alcoholic self’ which was divorced from their previously unaware self and formed the basis for a new more knowing and valued identity. © 2014, Springer Science+Business Media New York.
Koutsavlis I.,NHS Lothian
Anemia | Year: 2016
Hemoglobin thresholds and triggers for blood transfusions have changed over the years moving from a higher to a lower level. This review article summarizes the current evidence of transfusion thresholds in the hospitalized as well as in the outpatient setting and particularly in myelodysplasia. Fatigue is the main reported symptom in this group of patients and current clinical trials are looking for a more liberal approach of red cell transfusion and the effect on quality of life as opposed to the restrictive strategy used in the critical care setting. Practical considerations, the cost effectiveness of this strategy in addition to the possible complications, and the use of quality of life questionnaires have also been reviewed. © 2016 Ioannis Koutsavlis.
Lakha F.,NHS Lothian |
Gorman D.R.,NHS Lothian |
Mateos P.,University College London
Public Health | Year: 2011
Objectives: Health inequalities between ethnic minorities and the general population are persistent. Addressing them is hampered by the inability to classify individuals' ethnicity accurately. This is addressed by a new name-based ethnicity classification methodology called 'Onomap'. This paper evaluates the diagnostic accuracy of Onomap in identifying population groups by ethnicity, and discusses applications to public health practice. Study design: Onomap was applied to three independent reference datasets (birth registration, pupil census and register of Polish health professionals) collected in Britain and Poland at individual level (n = 260,748). Methods: Results were compared with the reference database ethnicity 'gold standard'. Outcome measures included sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). Ninety-five percent confidence intervals and Chi-squared tests were used. Results: Onomap identified the majority of those in the British participant group with high sensitivity and PPV (>95%), and low misclassification (<5%), although specificity and NPV were lowest in this group (56-87%). Outcome measures for all other non-British groupings were high for specificity and NPV (>98%), but variable for sensitivity and PPV (17-89%). Differences in misclassification by gender were statistically significant. Using maiden name rather than married name in women improved classification outcomes for those born in the British Isles (0.53%, 95% confidence interval 0.26-0.8%; P < 0.001) but not for South Asian or Polish groups. Conclusions: Onomap offers an effective methodology for identifying population groups in both health-related and educational datasets, categorizing populations into a variety of ethnic groups. This evaluation suggests that it can successfully assist health researchers, planners and policy makers in identifying and addressing health inequalities. © 2011 The Royal Society for Public Health.
Dobie J.,NHS Lothian
British Journal of Community Nursing | Year: 2010
There is a paucity of research in relation to district nurses' (DNs) experiences of palliative care provision in adult care homes (CHs) despite their substantial involvement. The aim of this study was to demonstrate the current involvement of DNs in CHs and identify the potential implications for future practice in providing palliative care in this setting. The findings suggested that even experienced DNs, wanted support and education about when to commence palliative care. They also wanted earlier involvement with CH residents who have a life-limiting condition and CH managers were seen as being essential contributors towards planning care. There was concern among DNs as to how the Liverpool Care Pathway could be introduced into CHs with untrained carers and finally, DN alignment to CHs was shown to improve continuity of care for residents and produce more effective partnership working between DNs, general practitioners and CH staff.
Frerk C.,Northampton General Hospital |
Mitchell V.S.,University College London |
McNarry A.F.,NHS Lothian |
Mendonca C.,Coventry University |
And 5 more authors.
British Journal of Anaesthesia | Year: 2015
These guidelines provide a strategy to manage unanticipated difficulty with tracheal intubation. They are founded on published evidence. Where evidence is lacking, they have been directed by feedback from members of the Difficult Airway Society and based on expert opinion. These guidelines have been informed by advances in the understanding of crisis management; they emphasize the recognition and declaration of difficulty during airway management. A simplified, single algorithm now covers unanticipated difficulties in both routine intubation and rapid sequence induction. Planning for failed intubation should form part of the pre-induction briefing, particularly for urgent surgery. Emphasis is placed on assessment, preparation, positioning, preoxygenation, maintenance of oxygenation, and minimizing trauma from airway interventions. It is recommended that the number of airway interventions are limited, and blind techniques using a bougie or through supraglottic airway devices have been superseded by video- or fibre-optically guided intubation. If tracheal intubation fails, supraglottic airway devices are recommended to provide a route for oxygenation while reviewing how to proceed. Second-generation devices have advantages and are recommended. When both tracheal intubation and supraglottic airway device insertion have failed, waking the patient is the default option. If at this stage, face-mask oxygenation is impossible in the presence of muscle relaxation, cricothyroidotomy should follow immediately. Scalpel cricothyroidotomy is recommended as the preferred rescue technique and should be practised by all anaesthetists. The plans outlined are designed to be simple and easy to follow. They should be regularly rehearsed and made familiar to the whole theatre team. © 2015 The Author. Published by Oxford University Press on behalf of the British Journal of Anaesthesia.
Xu Y.,University of Edinburgh |
Brenn T.,Western General Hospital |
Brown E.R.S.,Western General Hospital |
Doherty V.,NHS Lothian |
Melton D.W.,University of Edinburgh
British Journal of Cancer | Year: 2012
Background: The incidence of malignant melanoma is increasing faster than that for any other cancer. Histological examination of skin excision biopsies remains the standard method for melanoma diagnosis and prognosis. Significant morphological overlap between benign and malignant lesions complicates diagnosis, and tumour thickness is not always an accurate predictor of prognosis.Methods: To identify improved molecular markers to support histological examination, we used microarray analysis of formalin-fixed and paraffin-embedded samples from different stages of melanomagenesis to identify differentially expressed microRNAs (miRNAs). Differential expression was validated by qRT-PCR, and functional studies were carried out after transfection of miRNA precursors or inhibitors into melanoma cells to modulate miRNA expression. Results: In all, 20 miRNAs showed highly significant differential expression between benign naevi and either primary or metastatic melanomas, the majority being downregulated in melanoma, whereas only 2 miRNAs, namely miR-203 and miR-205, were differentially expressed between primary and metastatic melanomas. In functional in vitro assays, overexpression of miR-200c and miR-205 inhibited anchorage-independent colony formation and overexpression of miR-211 inhibited both anchorage-independent colony formation and invasion. Conclusion: We have identified a series of differentially expressed miRNAs that could be useful as diagnostic or prognostic markers for melanoma and have shown that three miRNAs (namely miR-200c, miR-205 and miR-211) act as tumour suppressors. © 2012 Cancer Research UK.
Farooq S.,Wolverhampton City Primary Care Trust |
Taylor M.,NHS Lothian
British Journal of Psychiatry | Year: 2011
Evidence concerning the superior efficacy and effectiveness of clozapine has not fully informed routine clinical practice. This is possibly because of the perception that clozapine is a dangerous therapeutic agent. Clozapine use may actually promote longevity, and earlier use of clozapine in adequate dosages represents a neglected therapeutic opportunity in this age of stagnated antipsychotic innovation. © 2011 The Royal College of Psychiatrists.