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PubMed1991

Medical training in clinical biochemistry (chemical pathology) in Scotland 1985-1989.

A questionnaire was sent to 35 doctors who were believed to have trained in clinical biochemistry in Scotland between 1 January 1985 and 31 December 1989. Thirty replies were received from 23 individuals who were still employed in the specialty (including seven consultants and nine senior registrars) and from seven individuals who had left. Twenty considered that training within the laboratories in which they were employed had not been satisfactory. The main emphasis of training was directed towards reporting duties, clinical liaison, research, teaching and outpatient clinics. Little training was provided for the development of analytical experience, personnel selection and laboratory management. Those surveyed identified poor training in laboratory management as the main aspect of training which required improvement.

Adult↗

PubMed1993

A pilot scheme for improving the accuracy of serum cholesterol measurement in Scotland and Northern Ireland.

The measurement of plasma cholesterol is subject to particularly stringent requirements of bias and imprecision because clinically important action limits lie within the bulk of the population distribution. A pilot scheme was conducted with the aim of improving the accuracy of the assay of cholesterol in 26 laboratories in Scotland and Northern Ireland. This involved the distribution of three sets of authentic human sera with varying cholesterol concentrations assigned by the reference Abell-Kendall method which was established and validated in a central laboratory. The precision (coefficient of variation) of cholesterol testing was 1.71% across all laboratories at the first distribution and this did not alter subsequently. Mean bias was initially 4.07% (median 4.14%) relative to the Abell-Kendall assigned values and this figure had fallen to 1.12% (median 0.92%) by the third distribution. We conclude that through a standardization scheme it is possible in a relatively short time to improve bias significantly and meet the criterion of < 2-3% bias required for optimum cholesterol measurement.

Bias↗

PubMed1996

Familial defective apolipoprotein B-100: a study of patients from lipid clinics in Scotland and Wales.

Familial defective apolipoprotein (apo) B-100 (FDB) is an autosomal codominant disorder, which may be associated with hypercholesterolaemia. The defect is caused by the substitution of glutamine for arginine at amino acid residue 3500 of apo B-100. A total of 357 hypercholesterolaemic patients, 48 with a clinical diagnosis of familial hypercholesterolaemia attending lipid clinics in Scotland and Wales, were screened for the presence of FDB. Seven unrelated individuals, five of whom had a family history of coronary heart disease, and a further 11 first-degree relatives, were shown to be heterozygous for the mutation. Pedigree analysis demonstrated the mutation to be present on a single haplotype, suggesting that in Britain it is inherited from a common ancestor. Treatment of 11 heterozygous individuals with lipid-lowering medication showed falls in total and low density lipoprotein cholesterol ranging from 11.6 to 38.8% and 5.3 to 49.5%, respectively. In view of the condition's association with coronary heart disease and hypercholester-olaemia, it may be worthwhile identifying carriers attending lipid clinics, so that affected siblings can be offered cholesterol-lowering treatment where necessary.

Adult↗

PubMed1991

Elderly suicides in the Lothian and borders region of Scotland, 1983-1988.

This study examined all the suicides in the over 60 age group in the Lothian and Borders region of Scotland during the period 1983-1988. The data was analysed according to a number of variables, primarily with the intention of identifying the characteristics of the elderly suicide population. With the exception of those persons who exhibit a history of previous attempts, it is concluded that no characteristics unique to that cohort exist. Hence the problem of an accurate and precise diagnosis and assessment of suicide risk is difficult and complex. Cases exhibiting recent contact with the medical profession illustrate the problems of preventive procedures once a valid initial assessment has been made. Medico-legal issues raised by these cases are noted. It is suggested that prevention must be considered as a general function of the care of the elderly rather than as a process appropriate to a 'high-risk' group.

Aged↗

PubMed1996

Deaths among drug abusers in south-east Scotland (1989-1994).

A survey of deaths of chronic drug abusers who came to medico-legal autopsy in the South-east of Scotland revealed a total of 179 fatalities in the six-year period between 1989 and 1994 inclusive. There was an almost linear increase in the number of such deaths reported to the Procurator Fiscal per year over this period, rising from 14 in 1989 to 45 in 1994. The majority of deaths (86%) were seen in males and the peak age at death was in the third decade of life. In the majority of cases (60%) death was deemed to be accidental and most were due to accidental drug overdoses, with methadone being the drug most commonly detected on toxicological analysis. The number of HIV-positive cases peaked in the years 1991 and 1992 with a decline over the subsequent two years.

Adolescent↗

PubMed1997

Alcohol and house fire fatalities in Scotland, 1980-1990.

The association between house fire fatalities and high blood-alcohol concentrations has been recognized as a particular problem in Scotland. Alcohol intoxication increases the risk of the outbreak of fire and decreases the intoxicated individual's ability to effect an escape. This survey investigates the reported blood-alcohol concentrations from all Scottish fire fatalities during the 11-year period 1980-90 and analyses the data by age, sex, year and geographical location. Alcohol intoxication in fires is shown both to be a national problem and one relevant to females as well as males. Fire prevention campaigns must continue to emphasize the risk of consuming excessive quantities of alcohol in the home whilst parallel efforts to reduce the objective risk should be encouraged.

Accidents↗

PubMed1998

Consultant psychiatrists' knowledge of mental health legislation in Scotland.

There has been increasing concern recently over an apparent lack of knowledge of mental health law among psychiatrists and other medical practitioners involved in its use. This has been particularly highlighted by the introduction of new and complex legislation intended to facilitate care in the community. As a result of findings from previous studies of other groups of medical practitioners in Scotland, a national survey of consultant psychiatrists working there was undertaken to determine their level of understanding of the statutory provision for the care of the mentally disordered. A purpose-designed instrument was used at interview with 72 consultants chosen at random from all psychiatric specialties. Their knowledge of even the most basic definitions and fundamental areas was limited, with only just over half being able to give the correct title of one relevant piece of legislation and only one in 10 being able to define mental disorder in terms of the Act. Otherwise knowledge was generally patchy. Greater emphasis should be placed upon training in mental health law for consultant psychiatrists in general, as the findings are unlikely to reflect purely localized patterns. Attitudes to the use of compulsory measures also need to be addressed.

Commitment of Persons with Psychiatric Disorders↗

PubMed2001

"And afterwards your body to be given for public dissection": a history of the murderers dissected in Glasgow and the west of Scotland.

Between 1752 and 1832, the bodies of hanged murderers were dissected or gibbeted. During this period, 38 murderers were executed in the West of Scotland. The bodies of at least 23 were dissected in Glasgow. The stories of these murders are recounted. Insight is also given into the attitudes of the public and the anatomists to dissection of executed murderers.

Anatomy↗

PubMed2001

The role of dihydrocodeine in causing death among drug users in the west of Scotland.

There has been a wealth of information relating to the role of methadone in fatalities over the past decade. However, a dearth exists in the literature of deaths involving dihydrocodeine, a substitute that is being increasingly prescribed by general practitioners for drug harm reduction purposes. Over the past five years in the Strathclyde region of Scotland there has been an increase in the number of drug related deaths involving dihydrocodeine with the largest increase occurring in the latter two years. This in combination with a general acceptance for this drug as a substitute for methadone amongst general practitioners highlights its potential abuse factor which is addressed in this paper. As the number of methadone deaths in relation to the total number of accidental drug related deaths per annum decrease, those related to dihydrocodeine are shown to be increasing.

Adolescent↗

PubMed2002

Three years experience of adults admitted to hospital in north-east Scotland with E. coli O157.

UNLABELLED: To describe the epidemiology, clinical features, treatment and outcomes of adults with E. coli O157 infection presenting to Aberdeen Royal Infirmary over a three year period. METHODS: A retrospective casenote review. RESULTS: Thirty-two confirmed cases of E. coli O157 infection were admitted between 1997 and 2000. The median age was 58 years (range 16-93). Ten patients (31%) were from the city of Aberdeen and 22 (69%) from surrounding rural areas. Twenty-seven patients (85%) presented between May and October. The source of infection was unknown or unconfirmed in all cases. Bloody diarrhoea was present in 30 (94%). Leucocytosis was present in 18 (63%) but only four patients (13%) had a fever. Six of the 32 patients (19%) developed Haemolytic-Uraemic Syndrome (HUS) of whom 2 died. Ten patients received antibiotics of whom two developed HUS. Twenty-seven of the 32 (85%) had made a full recovery by time of discharge, three (9%) had impaired renal function and two (6%) died in hospital. CONCLUSION: E. coli O157 infection tends to occur sporadically in rural areas in North East Scotland. It is not usually associated with fever. Infection occurs more commonly in the summer and autumn. HUS complicates infection in almost one fifth of patients.

Adult↗

PubMed2003

Endoscopic surveillance practice for Barrett' s oesophagus in Scotland and early experience in implementing local guidelines.

Management of columnar lined oesophagus (CLO; Barrett s oesophagus) is controversial. We prospectively audited surveillance practices in Scotland and prospectively assessed the impact of introducing local guidelines for Barrett s surveillance in Edinburgh. Most respondents were gastroenterologists. The majority take random, not four quadrant, biopsies from the CLO. In Edinburgh during 2000, 80 patients underwent surveillance. The guideline protocol was not followed in 30 (37.5%) patients. Follow up of patients without dysplasia generally conformed to the guidelines. Follow up of patients with low grade dysplasia was highly variable while management of those with high grade dysplasia followed the guidelines. Overall we found a wide variability in the management and surveillance of CLO. Early experience suggests that implementation of guidelines is helpful but there is still variation in practice.

Barrett Esophagus↗

PubMed2004

What does GP out of hours care cost? An analysis of different models of out of hours care in Scotland.

BACKGROUND: The changes to out of hours care provided by General Practitioners have led to wide variation in the types and costs of out of hours care across the country. AIM: To examine the costs of different models of service delivery for GP out of hours organisations. METHODS: This was a prospective cross-sectional survey of eight GP out of hours organisations and samples of their patients. A deputising service, rotas, and various types of GP co-operative across Scotland were surveyed. Information on the quantities of resources used by each organisation was combined with unit costs. Costs incurred by patients and other NHS costs subsequent to the out of hours contact were also calculated. RESULTS: Annual costs incurred by the GP out of hours organisation per 1,000 population ranged from pounds sterling 2,916 to pounds sterling 12,120. There was no relationship between costs and type and size of organisation. There was a three-fold variation in total costs per out of hours contact (pounds sterling 15 to pounds sterling 51). Costs per phone contact were lowest (pounds sterling 6 to pounds sterling 11), followed by cost per centre contact (pounds sterling 10 to pounds sterling 16) and cost per home contact (pounds sterling 21 to pounds sterling 60). Total costs per episode ranged from pounds sterling 78 to pounds sterling 136 for centre contacts, from pounds sterling 130 to pounds sterling 303 for home contacts, and from pounds sterling 70 to pounds sterling 553 for telephone contacts. Home contacts had the highest average cost per episode (pounds sterling 212), followed by telephone contacts (pounds sterling 117) and centre contacts (pounds sterling 85). CONCLUSIONS: There are wide variations in the costs of operating GP out of hours services, It is likely that the context in which organisations were set up and local geography infuence variations in costs, as well as the level of GP cover.

After-Hours Care↗

PubMed2004

The Scotland Leukaemia Registry audit of incidence, diagnosis and clinical management of new patients with chronic myeloid leukaemia in 1999 and 2000.

The management of CML has recently become increasingly complex. The Scotland Leukaemia Registry (SLR) sent questionnaires to all 26 Scottish haematology units, of which 18 (69%) responded. From January 1999 to December 2000, 64 new cases of CML were identified by the audit (incidence 0.64/100,00/yr), of which 46 were registered with the SLR. At diagnosis, all 18 units combined bone marrow examination with cytogenetics/FISH, but only 13 performed RT-PCR. Of four units that calculated the Hasford Score, only two used it to inform clinical decisions. 52% of patients entered clinical trials, 57% involving imatinib mesylate (IM). Of the 23 patients who were tissue typed, suitable donors were found for 18, 11 sibling, and 7 unrelated, representing 28% of the total patient population. Only 13/64 patients (20%) did not have a BMT donor identified or enter a clinical trial. Although 38% of units would consider reduced intensity allografting in patients > 60 years, no centres currently routinely tissue-type such patients. For first line therapy 56% of patients received hydroxyurea +/- interferon. Of the newer agents, 83% of units believed imatinib mesylate should be reserved for clinical trials, 83% would consider using oral ara-C and 89% pegylated-interferon.

Adult↗

PubMed2004

Chronic rhinosinusitis: a comparative study of disease occurrence in North of Scotland and Southern Caribbean otolaryngology outpatient clinics over a two month period.

A comparative study of the occurrence of chronic rhinosinusitis in clinics in the North of Scotland and Southern Caribbean was performed, to test the hypothesis that patients with chronic rhinosinusitis present more commonly in temperate climates than tropical climates. The data was collected prospectively over two month periods from outpatient clinics at both sites. A higher surgical trainee or consultant otolaryngologist made the diagnosis of chronic rhinosinusitis. Eight-hundred-and-seventy-two otolaryngology outpatients were studied 311 were from Trinidad and 561 from Aberdeen. The proportion of patients presenting with chronic rhinosinusitis in both samples is similar, 54 (9.6%) patients in Aberdeen and 29 (9.3%) in Trinidad. The proportion of chronic rhinosinusitis patients with a history of allergy is greater in Trinidad 79.3% (23) than in the Aberdeen sample 50% (27). Patients with chronic rhinosinusitis were seen as commonly in otolaryngology clinics in a tropical setting as in a temperate setting.

Caribbean Region↗

PubMed2004

Suspending tonsillectomy: the effects on primary and secondary acute care in Scotland.

For the first six months of 2001, tonsillectomy operations were effectively suspended in Scotland. This was due to concern regarding the potential transmission of vCJD prions by surgical instruments, and the subsequent gradual introduction of disposable instruments. The number of patients awaiting tonsillectomy therefore increased and theoretically there should have been an increase in the number of tonsillitis episodes in the community, or even in the number of tonsillitis-related complications seen in secondary care. We examined for these effects using available national data sources which record primary and secondary care activity. No increases in the incidences of acute tonsillitis or tonsillitis-related complications were found for this period. The reasons and implications are discussed.

Creutzfeldt-Jakob Syndrome↗

PubMed1978

Tourist hepatitis in the West of Scotland.

During the 6-year period (1971-76) 971 patients were admitted with acute viral hepatitis to different infectious units in the West of Scotland. Of these, 30 (3%) patients had tourist hepatitis. The majority (80%) acquired the infection in the subcontinents of Africa and India or other tropical countries. The clinical spectrum of the illness in these patients ranged from mild to fulminant hepatitis. Fifteen patients were specifically asked about their immunisation history prior to their travel and none had immunoglobulin prophylaxis against hepatitis. Normal human immunoglobulin prevents clinical hepatitis A and should be given to all prospective travellers to Third World countries. In order to formulate a rational policy for prophylaxis, more data about the risk of contracting hepatitis in different countries is needed.

Adult↗

PubMed1981

Neonatal screening for hypothyroidism in Scotland: results of a pilot study.

We have assessed the feasibility of screening for neonatal hypothyroidism based on thyroxine (T4) or thyrotrophin (TSH) assays on dried blood spots collected for the phenylketonuria (PKU) screening programme in Scotland. The TSH assay was both more sensitive and specific than T4 in detecting primary hypothyroidism and was sufficiently rugged and rapid for routine application. Using a labelled antibody assay for TSH, 99.7 per cent of the first 30,000 babies tested had values less than 25 mU/l, and 0.24 per cent had values between 25 and 50 mU/l. Of the 11 suspected positives (TSH greater than 50 mU/l), nine were confirmed on serum specimens as primary hypothyroidism (prevalence 1:3,300) and the two false positives (0.007% of total) were explicable by inappropriate time of sampling. No false negatives have so far been identified. The median time to detection by blood spot assay was 16 days (range 6 to 22 days). Five of the nine cases were not suspected clinically at the time of screening. It is concluded that TSH fulfils most of the criteria for an ideal screening test for primary hypothyroidism and a screening programme based on blood spot TSH will allow therapy to be commenced within one month of birth.

Congenital Hypothyroidism↗

PubMed1982

Health care accommodation in Scotland.

The Medical and Nursing Advisers of the Scottish Health Service, Common Services Agency, Building Division, advise upon the planning of health care accommodation. The overall spread of beds by function is given in a review of existing health care buildings in the year 1981. The numbers of hospital beds and of various groups of staff in the hospital and community services are calculated per 100,000 population so that any unusual disparity can be ascertained. One of the parameters for health building planning is fiscal control and so the cost per hospital in-patient week is tabulated for eight groups of specialities. The appropriate responsibilities of the Regional Councils in Scotland in 1979 are considered along with the responsibilities of Health Boards because part of each Social Work Department's work is the provision of accommodation and social care for those in need as opposed to the National Health Service responsibility for the health care of those in hospital and in the community. An overall view of residential accommodation for those requiring medical treatment or social care is presented in tabular form. The views expressed are not necessarily those of the Common Services Agency.

Financing, Government↗