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PubMed1987

A survey, in Scotland, of measures to prevent infection following orthopaedic surgery.

The current use of methods, in Scotland, to prevent infection following orthopaedic surgery was established by postal questionnaire. Thirty-five per cent of surgeons used antibiotic cement routinely for total hip replacement. Ultraclean air facilities were provided for only 19%. Ninety-one per cent of surgeons used prophylactic parenteral antibiotics during total hip replacement, 75% in the management of open fractures, but only 12% for metal implants. Most chose an appropriate antibiotic. Only one-third of surgeons used an antibiotic regimen of appropriate duration and timing for total hip replacement or when employing metal implants.

Anti-Bacterial Agents↗
PubMed1988

Survey of antibiotic prophylaxis in gastrointestinal surgery in Scotland--5 years on.

The results of a 5-year follow-up survey of the use of prophylactic antibiotics in gastrointestinal surgery in Scotland are reported. There have been significant increases in the routine use of prophylactic antibiotics during elective cholecystectomy (21% to 53% of surgeons; P less than 0.001) and appendicectomy (49% to 79% of surgeons; P less than 0.001). In addition a substantial number of surgeons used prophylactic antibiotics in selected high risk patients undergoing biliary tract surgery and gastroduodenal surgery.

Anti-Bacterial Agents↗
PubMed1989

Student assessment in basic nursing education in Scotland.

This paper presents some of the findings of a 4-year-study of the examination system for student nurses entering basic nursing courses offered by all Colleges of Nursing and Midwifery in Scotland. These modular courses, first implemented in 1982, involve students in a series of internal (college) assessments and two external (national) examinations. Results for 2742 students on 16,764 written assessments were analysed. The hypotheses that there would be high correlation between different modular results in internal assessments, and between results in internal assessments and external examinations were not supported. Implications for possible changes in the examination system are discussed.

Curriculum↗
PubMed1989

A qualitative analysis of examination questions set for students of nursing in Scotland.

The construction of essay-type questions for inclusion in nursing examination papers is a time consuming task for teachers. In this paper, the findings of the qualitative analysis of the examination systems in basic nursing education in Scotland are discussed, with specific reference to questions set in internal and external formal examinations. The form and type of questions which seemed to create difficulties for students are identified and discussed. Several issues are raised, including coverage of the syllabus content, the science base for nursing, and determining levels of question difficulty. The paper concludes with recommendations concerning the format of assessment, especially if the NBS were to delegate more responsibility to colleges and when the proposals on curriculum reform evisaged in Project 2000, are implemented.

Curriculum↗
PubMed1990

An analysis of mandibular fractures in Dundee, Scotland (1977 to 1985).

A retrospective study was undertaken to assess mandibular fractures presenting over the period 1977-1985 in Dundee, Scotland. The data collected included age, sex, aetiology, month in which injury occurred, anatomical site of fracture, associated maxillofacial trauma and treatment modalities. The majority of fractures were sustained by males in the age group 20 to 29 years. Assault was the major cause of trauma followed by falls and road traffic accidents. The posterior body region was found to be the most common fracture site in the mandible. The level of such trauma has more than doubled, since a similar study was undertaken between the years 1961 to 1970.

Accidental Falls↗
PubMed1992

Incidence of nerve damage following third molar removal: a West of Scotland Oral Surgery Research Group study.

A survey was carried out to record both initial and longterm effects on the lingual and inferior alveolar nerves following third molar removal. Eight hundred and twenty five patients were included from eight West of Scotland Oral Surgery Units, and had 1339 third molars removed. Changes in sensation were recorded by direct questioning at 6 to 24 h and 7 to 10 days, and by postal questionnaire at 12-18 months. The incidence of lingual nerve damage was found to be 15% of operated sides at 6 to 24 hours, 10.7% at 7 to 10 days, and 0.6% after 1 year. The incidence of inferior alveolar nerve damage was 5.5% of operated sides at 6 to 24 h, 3.9% at 7 to 10 days, and 0.9% after 1 year. These results are proposed as an indication of the likely incidence of nerve damage complicating third molar removal in the general circumstances of current United Kingdom practice and are presented as a basis for discussion of patient information and current prudent practice. Since one in four patients suffered at least temporary sensory deficit, we believe the case for effective warning of all patients undergoing impacted third molar removal is overwhelming.

Adolescent↗
PubMed1994

Smoking, alcohol and oral cancer in south east Scotland: a 10-year experience.

OBJECTIVE: To examine the relationship of oral carcinoma to tobacco and alcohol consumption in patients referred over a 10-year period. DESIGN: Analysis of records obtained for the age of presentation, the tobacco and alcohol intake, the site and type of carcinoma. SETTING: All patients with carcinoma of the mouth and associated structures referred to the Joint Onocology/Maxillofacial Clinic at Edinburgh Royal Infirmary by General Medical and Dental Practitioners together with hospitals and hospital departments within South East Scotland. SUBJECTS: A total of 454 patients, with a mean age of presentation for males of 63.8 years, for females 68.0 years. RESULTS: 58% of those with carcinoma had a smoking history, with 24% drinking more than 20 units of alcohol per week. 60% of patients with oral tumours smoked. The tongue and floor of mouth were the most common sites, and over 95% of tumours here were squamous cell carcinoma. A high proportion of patients with floor of mouth tumours had a smoking history (79%) with a higher than average alcohol consumption (41% drank over 20 units). CONCLUSION: It is suggested that these two carcinogens, smoking and alcohol, could be site specific in the oral cavity, and have an additive role. In public health terms the Scottish people need to reduce the intake of both in order to adequately reduce their risk of having oral carcinomas.

Adolescent↗
PubMed1991

A numerical prognostic index for clinical use in identification of poor-risk patients with Hodgkin's disease at diagnosis. Scotland and Newcastle Lymphoma Group (SNLG) Therapy Working Party.

The aim of this study was to assess the feasibility of using objective data obtained at diagnosis of Hodgkin's disease to predict those patients who were likely to die of progressive disease within 4 years of diagnosis. 92 consecutive patients from one centre (Newcastle upon Tyne) were used to construct a numerical index based on disease stage (Ann Arbor), age, haemoglobin and absolute lymphocyte count. Weight was assigned according to a predictive value in univariate and multivariate analyses based on survival. The index produced was then validated on a separate patient set (455) from other centres within the Scotland and Newcastle Lymphoma Group (SNLG) on whom the same prospective information was available. The index produced provided a useful separation of those patients destined to die of disease. Of 101 patients with index higher than 0.5, 62 (61.4%) were dead at 4 years, whereas with index lower than 0.5, 61 (18%) of 336 patients were dead at 4 years. The index includes Ann Arbor stage but possesses additional practical prognostic value which allows identification of patients with early stage destined to die of disease. Of 149 patients with stage IA and IIA disease 15 patients had index higher than 0.5, and 10 (60%) have died, whereas the remaining patients had survival of 90% and 85% respectively. This numerical index is applicable to all patients at diagnosis and in the SNLG population gives better predictive survival at 4 years than stage alone, and provides a basis for selecting patients for more aggressive therapy.

Adolescent↗
PubMed1990

Social class and health in youth: findings from the west of Scotland twenty-07 study.

The assumption that social class inequalities in health are a persistent feature of the life-course has been questioned in a recent issue of this journal. On the evidence of mortality and chronic illness, the pattern in youth in Britain appears to be characterised by the lack of class differentials, a striking contrast to early adulthood where the familiar picture of health inequalities is observed. The possibility that this finding of relative equality in youth is a consequence of the limited, and potentially inappropriate, health indicators used has now been tested on a cohort of 15-year-olds in the West of Scotland. On a range of indicators, from subjective assessments to objective physical measures, very little evidence of class variation in health is found. The possible transience of the youth pattern is, however, indicated by findings from a cohort of 35-year-olds in the same study, among whom marked class gradients in health are apparent. Possible explanations for the transformation of a pattern of relative class equality in youth into one of inequalities in adulthood are discussed.

Adolescent↗
PubMed1992

Provision of domiciliary dental care for the older person by general dental practitioners in Scotland.

The databank at the Scottish Dental Practice Board (SDPB) was explored to determine the domiciliary care provided, for those patients over 70 years of age, by general dental practitioners under the National Health Service in one year. Three thousand nine hundred and forty-three (3943) courses of treatment were provided, via domiciliary visits to patients in this age category, by 38 per cent (1012) of dentists registered to provide dental care under the National Health Service. Whereas 34 per cent of dentists under 40 years of age provided domiciliary care, 46 per cent of those over 40 years provided such a service (P less than 0.001). In Scotland, approximately 1 per cent of 70-79-year-old patients and 2 per cent of patients over 80 years received domiciliary dental care over a 1-year period. For those elderly people who received such care, the mean percentage doubled for every 5-year increase in patient age.

Aged↗
PubMed1994

The causative rhythm in out-of-hospital cardiac arrests witnessed by the emergency medical services in the Heartstart Scotland Project.

Out-of-hospital defibrillation has been shown to improve survival in out-of-hospital cardiac arrests. The maximum performance of defibrillation-based systems is dependent on the proportion of cardiac arrests due to tachyarrhythmias. We reviewed 4248 reported arrests in the Heartstart Scotland database. We identified 3489 arrests due to cardiac or unknown cause. From this group we selected 258 cases known to be conscious on arrival of the crew. We were able to retrieve electrocardiographic data on the period within 2 min of the arrest in 106 cases. The first recorded rhythm at the arrest was ventricular fibrillation in 64%, ventricular tachycardia 4%, bradycardia in 28% and electromechanical dissociation in 4%. Defibrillatory shocks were delivered to 96% of patients in ventricular fibrillation and 60% of these patients survived. None of the patients with bradycardic arrests survived. Preceding chest pain was noted in 79% of patients subsequently developing ventricular fibrillation as the cause of arrest compared to only 37% of those suffering bradycardic arrests. It would appear that public awareness of the importance of early contact with the emergency services after the onset of chest pain could substantially improve the survival from out-of-hospital arrests.

Aged↗
PubMed1994

The performance of ultrasound physiotherapy machines in Lothian Region, Scotland, 1992.

Eighty-five ultrasound therapy machines in use in Lothian Region, Scotland were tested for performance and their recalibration was expedited where necessary. The performance characteristics reported are the temporal average acoustic output power, the treatment frequency, pulse timing and treatment timer accuracy. Consideration is also given to the performance of the wide dynamic range radiation force balance that was used to make acoustic power measurements. Of the machines tested, 69% had power outputs that differed by more than 30% from the expected values. The results of power measurements are analysed according to continuous and pulsed output, single and dual frequency treatment heads and year of manufacture. Therapy machines more than 10-12 years old and modern dual frequency treatment heads performed particularly badly. This study suggests that the performance of ultrasound therapy machines has improved little in the last 20 years despite the introduction of IEC 601-2-5 in 1984.

Calibration↗
PubMed1986

Electrical burns--incidence and prognosis in Western Scotland.

A 10-year review of all patients admitted to the West of Scotland Regional Burns Unit with serious electrical burns indicated an incidence of only 2.6 cases per million of the population served by the Unit per year. Injuries following electrocution or electric flash, but excluding injuries caused by grasping the hot heating element of an electric fire, were suffered by 70 patients, 52 of whom sustained electrocution which was not immediately fatal. Ninety-one per cent of the patients were male. The patients who died in hospital did so as a result of sepsis rather than as a direct result of the electrical injury. All those patients who had ECG changes on admission recovered completely. In view of the very deep injuries, the amputation rate was high with 12 out of 52 patients (23 per cent) with electrocution injury requiring one or more amputations. The events preceding the serious electrical injury in our patients suggest that, 57 per cent of all the injuries could have been prevented, and in patients under 20 years of age this percentage rose to 91.

Adolescent↗
PubMed1995

Burns in the elderly in the south east of Scotland: review of 176 patients treated in the Bangour Burns Unit (1982-91) and burn inpatients in the region (1975-91).

One hundred and seventy-six patients aged 65 years and above, treated in Bangour Burns Unit during a 10-year period between 1982 and 1991 were studied in detail. Annual number of burn cases treated as inpatients in the South East of Scotland, within or outwith the Bangour burns unit, and all deaths due to burns, during the period from 1975 to 1991, among the estimated population were analysed to assess the trend in incidence and rates of burns in elderly persons in the community.

Aged↗
PubMed1996

Abstaining and carousing: substance use among adolescents in the Western Isles of Scotland.

An account is presented of a survey of self-reported substance use among 839 adolescents in the Western Isles (Outer Hebrides) of Scotland. The study group was aged 13-16. The drinking habits of those surveyed were extremely polarised. Results showed that while only 81.2% had ever used alcohol, nearly 40% of males and a third of females reported having consumed at least 11 units of alcohol on their last drinking occasion. Levels of tobacco and illicit drug use were less striking: 21.4% considered themselves current smokers, while fewer than one-quarter had ever used illicit drugs or solvents. Results are related to recent UK surveys of adolescents and to the distinctive culture of the study area. It is concluded that the polarisation of youthful drinking in the Western Isles poses special problems in relation to the provision of alcohol education.

Adolescent↗
PubMed1992

A coronary primary prevention study of Scottish men aged 45-64 years: trial design. The West of Scotland Coronary Prevention Study Group.

This paper describes the design of the West of Scotland Coronary Prevention Study (WOSCOPS) which is a primary prevention trial involving men aged 45-64 yr with raised plasma cholesterol levels. The principal aim is to test the hypothesis that reduction of serum cholesterol by treatment with pravastatin [a competitive inhibitor of 3-hydroxy-3-methylglutaryl coenzyme A (HMG CoA) reductase--a regulatory enzyme in cholesterol synthesis] over an average period of 5 yr will lead to a reduction in fatal and non-fatal myocardial infarction. A trial population of approx. 6500 men have been randomized in equal numbers to treatment with placebo or pravastatin. At the time of randomization, these men have no evidence of previous myocardial infarction. All subjects are given smoking and dietary advice throughout the study. The principal endpoints are: (i) coronary heart disease death plus non-fatal myocardial infarction, (ii) coronary heart disease death, and (iii) non-fatal myocardial infarction.

Cholesterol↗
PubMed1995

Computerised record linkage: compared with traditional patient follow-up methods in clinical trials and illustrated in a prospective epidemiological study. The West of Scotland Coronary Prevention Study Group.

Computerised record linkage systems have great potential for enhancing or even replacing traditional methods of adverse event reporting based on active patient follow-up, both in clinical trials and in epidemiological studies. However, these methods must be evaluated. The West of Scotland Coronary Prevention Study (WOSCOPS) is a randomised double-blind clinical trial of pravastatin versus placebo in the primary prevention of coronary heart disease, with coronary heart disease death plus nonfatal myocardial infarction as its primary end point. Adverse event reporting is based on active patient follow-up at routine trial visits. In parallel with this approach, we have obtained computer records of all deaths, incident cancers, and hospitalisations for our subjects by linking their names, dates of birth, and postcodes of their home addresses with a Scottish national database operated by the Scottish Record Linkage system. The results of this comparative study, based on follow-up of the 6595 men ages 45-64 randomised in WOSCOPS, demonstrate minor flaws in both systems, show that follow-up based on computerised linkage alone can be as effective as reporting based on direct contact with the patients, and show that a system based on both approaches provides a direct cross-validation of the two approaches to adverse event reporting while minimising the frequency of unreported events. Preliminary results are reported for a prospective epidemiological study of 80,184 men, ages 45-64 years, who were screened for coronary heart disease risk factors as part of WOSCOPS. This study is based solely on computerised linkage reporting of events on these subjects. This provides an indication of the number of events in various categories that will be available for analysis in future reports. The associations between death rates and standard risk factors such as age, blood pressure, total cholesterol level, and smoking status mirror those reported in other studies.

Adverse Drug Reaction Reporting Systems↗
PubMed1995

Second cancers occurring after cancers of the mouth and pharynx: data from three population-based registries in Australia, Scotland and Slovenia.

Data over at least 20 years from three large population-based registries in Europe and Australasia have been used to assess the risk of second primary tumours occurring after a cancer of the mouth or pharynx. These patients have previously been shown in clinical series to be at a particularly high risk of subsequent tumours, while data from cancer registries have shown conflicting results on the magnitude of the risk. In this study, patients were found to have between a 2-fold (Scotland and New South Wales) and 4-fold (Slovenia) increase in risk of a subsequent tumour over that in the population, although the actual risk in each centre was similar (between 2.8 and 3.1 per 100 person years). The risk remained for 10 years after diagnosis of the original tumour and was primarily in the upper aerodigestive tract. The most elevated risks (approximately 10-fold) were for tumours in the oral cavity and oesophagus. These data provide higher estimates of risk than previously reported from European cancer registries for second primary tumours and emphasize the need for close follow-up of patients who may represent an appropriate population in which to assess possible new chemopreventive agents.

Digestive System Neoplasms↗