Volume 1 - Issue 2

Scottish Universities Medical Journal 2012 Volume 1- Issue 2

Please find below the list of articles and their abstracts. The full journal is available for download below in PDF format an can be viewed online using ISSUU. Individual articles can be downloaded from the links provided.

Download entire SUMJ Dundee Vol1 - Issue 2 as a PDF

 

 

Vol 1 - Issue 2 Overview of Articles:

Prisoner or Patient - The Challenges within Forensic Health Services

Catriona E Neil (4th Year MBChB, BMSc) University of Dundee

Abstract:

Offenders have very high rates of mental health problems with recent estimates suggesting that up to 90% of individuals serving custodial sentences have some form of diagnosable mental health condition. As a group, prisoners and forensic patients have specific healthcare needs that differ from the general population. The challenge for doctors is providing the best care to address complex psychiatric, medical and social needs within a challenging setting. Prisoners are vulnerable members of society and it is the doctor’s duty to make difficult decisions about treatment whilst keeping the patient’s best interests at heart.

Cite this article as:

Neil CE (2012). Prisoner or Patient - The Challenges within Forensic Health Services. Scottish Universities Medical Journal. 1 (2). p. 119-122
 

Your NHS - Myths Debunked and the Reforms Explained

Joshua Coats (5th Year MBChB, BMSc) University of Dundee & Benedict Warner  (5th Year MBChB, BMSc) University of Dundee.

Abstract:

By the time the Health and Social Care Bill passed into law, becoming an Act, on 20th March 2012, it had garnered almost universal condemnation, with unprecedented agreement between the medical Royal Colleges, the British Medical Association, the Royal College of Nursing, the Royal College of Midwives, and many others – not forgetting nearly 180,000 signatures on the ‘Drop the Bill’ Government e-petition (the second-most signed petition on the site). The Bill, from a government that had promised ‘no top-down reorganisations of the NHS’ at the last general election, represented a glaring democratic deficit. But how did such widespread opposition fall on deaf ears? Perhaps part of the failure of the opposition to the reforms was the difficulty in forming an adequate counter-argument to the huge variety of issues raised by the Health and Social Care Bill. In this article, we will outline the key policies of the reforms and some of their potential consequences as well as indicating how students and citizens may become more involved in the future direction of the NHS.

Cite this article as:

Coats J & Warner B (2012). Your NHS - Myths Debunked and the Reforms Explained. Scottish Universities Medical Journal. 1 (2). p. 123-127

Prediction of In-Hospital Mortality in Acute Exacerbations of COPD

Ross Archibald (5th Year MBChB, BSc (Hons)) University of Dundee; Dr James Chalmers (Respiratory Physician & Clinical Lecturer) University of Edinburgh, Dr Tom Fardon (Consultant Respiratory Physician) NHS Tayside et al.

Abstract:

Background: Physicians lack a robust and validated method of measuring severity or predicting poor outcome in patients with acute exacerbation of COPD (AECOPD). Such a predictive tool would allow optimisation of treatment plans for these patients, as well as best use of health care resources. 

Objective: To determine predictors of in-hospital mortality in AECOPD, and develop a predictive scoring system to identify patients at higher risk of in-hospital mortality.

Methods: Analysis of clinical patient data from the exacerbations of obstructive lung disease managed in UK Secondary care [EXODUS] study database, collected from 11 UK hospitals.

Results: A total of 1031 patients were included in the validation cohort. The in-hospital mortality rate was 5.2%. Independent predictors of mortality were identified and a new scoring system (“CAUDA70”), for prediction of in-hospital mortality in AECOPD was derived. The score incorporated 6 easily obtained clinical variables: acidosis, albumin, urea, the presence of confusion, MRC dyspnoea score and age. The score displayed strong discrimination, with an area under the receiver operating characteristic (ROC) curve of 0.84. This performance was reproduced in a further validation dataset of 312 patients. The discrimination of the new score exceeds that of existing scores validated for use in AECOPD (CURB65, CRB65 and BAP-65).

Conclusion: A new scoring system composed of six readily available clinical variables can accurately predict in-hospital mortality in AECOPD.

Cite this article as:

Archibald R, Chalmers J, Fardon T et al. (2012). Prediction of In-Hospital Mortality in Acute Exacerbations of COPD. Scottish Universities Medical Journal. 1 (2). p. 129-139

Pathogenesis and Management of Age-Related Macular Degeneration

Clare Porte (1st Year MBChB) University of Dundee

Abstract:

Age related macular degeneration (AMD) was responsible for 8.7% of all blindness worldwide in 2007, and this figure is expected to double by 2020 as a result of population ageing. Macular degeneration is defined by the NHS as a painless disease that leads to loss of central vision and is an umbrella term that denotes many eye-disorders which lead to loss of detailed vision, the most common being AMD. AMD is the most common cause of severe vision loss in industrialised countries, with more adult Americans being affected by AMD than cataracts and glaucoma combined. This article will outline the pathogenesis and discuss the clinical management of this common and serious ophthalmology condition.

Cite this article as:

Porte C (2012). Pathogenesis and Management of Age-Related Macular Degeneration. Scottish Universities Medical Journal. 1 (2). p. 141-153

Clinical Research for Beginners - The Importance of Planning

Dr Lynda Cochrane (Medical Statistician) Dundee Epidemiology and Biostatistics Unit; Shobitha Puvaneswaralingam (4th Year MBChB, BMSc) University of Dundee

Abstract:

While the identification of the individual who said “Failing to plan is planning to fail!” is in doubt, the wisdom of the words is not especially in the context of undertaking clinical research. There appears to be a view in some quarters that collecting a set of data, for example on people with a particular condition, and carrying out a series of analyses to try to find something of statistical significance constitutes a scientific investigation - it does not! A clinical research study must have a clearly defined aim with a comprehensive plan including a statement of the population of interest, which data are to be collected, how they will be measured, by whom, when and with what, as well as details of how subjects are to be allocated to interventions (if any). The purpose of this article is to give an introduction to some of the issues involved in constructing such a plan. It is by no means a definitive guide and further details can be found in the reference list.

Cite this article as:

Cochrane LA & Puvaneswaralingam S (2012). Clinical Research for Beginners - The Importance of Planning. Scottish Universities Medical Journal. 1 (2). p. 154-164

The Ethics of Acupuncture

Paul Connelly (5th Year MBChB) University of Dundee

Abstract:

Complementary and alternative medicine (CAM) incorporates a broad range of healthcare systems and therapeutic practices that are not traditionally associated with conventional medicine. The use of CAM has increased substantially in the last 20 years and it is believed as much as a fifth of the UK population utilize this form of healthcare in some form. This article discusses some of the principles that clinicians should think about when managing patients who use CAM practices themselves or when referring patients to NHS supported CAM therapy providers using a case study.

Cite this article as:

Connelly P (2012). The Ethics of Acupuncture. Scottish Universities Medical Journal. 1 (2). p. 165-169

Development of Minimally Invasive Surgical Treatment for Aortic Stenosis in Older Patients

Deepika Manoharan (4th Year MBChB, BSc (Hons)) University of St Andrews & Divya Manoharan (4th Year MBChB, BSc (Hons) University of St Andrews;

Abstract:

Aortic stenosis (AS) is the term used to describe the narrowing of the valve within the aorta (aortic valve). The restricted opening of the valve results in the obstruction of the left ventricular outflow leading to a reduced volume of blood entering the systemic circulation. Once patients develop symptoms, particularly of chest pain, breathlessness, syncope and heart failure, the prognosis becomes poor with drug treatments providing only symptomatic relief. Increasingly older patients with multi-morbidities are developing AS and as such the traditional open-heart surgical methods of treatment are less well tolerated or contraindicated. This article discusses some recent developments in less invasive surgical techniques for older patients with comorbid health problems which is hoped to improve outcomes for older patients with AS.

Cite this article as:

Manoharan D & Manoharan D (2012). Development of Minimally Invasive Surgical Treatment for Aortic Stenosis in Older Patients. Scottish Universities Medical Journal. 1 (2). p. 170-173

Clinical Anatomy Series - Lower Respiratory Tract Anatomy

John W Kennedy (5th Year MBChB) University of Dundee

Abstract:

As discussed in the previous article of this series, the necessity for a greater understanding of anatomy has never been more pertinent. This paper continues on from the cardiac anatomy covered in the last issue by staying in the thorax as the lower respiratory tract is reviewed and placed in a clinical context relevant to undergraduates and junior doctors. 

Cite this article as:

Kennedy JW (2012). Clinical Anatomy Series - Lower Respiratory Tract. Scottish Universities Medical Journal. 1 (2). p. 174-179

Telehealth - A Developing Field

Professor Brain McKinstry (Professor of Primary Care E-Health) University of Edinburgh

Abstract:

Telehealth makes use of information technology and telecommunication to help to provide clinical care over distances. This article outlines the potential for improving clinical care using these interventions, the current evidence base for tele-health programmes and the challenges to their efficacy.

Cite this article as:

McKinstry B (2012). Telehealth - A Developing Field. Scottish Universities Medical Journal. 1 (2). p. 180-183

Femoral Nerve Block - A Guide for Medical Students and Junior Doctors

Dr Andrew R Bogacz (Specialist Registrar in A&E Medicine) & Michael Jamison (5th Year MBChB) University of Dundee

Abstract:

A femoral fracture is a painful and distressing traumatic injury that is commonly encountered when working in an emergency department.  The incidence of femoral shaft fracture has been estimated at 1.0-1.3 per 10,000 of population.  The acute treatment of such an injury involves placement of the injured limb into a Thomas traction splint, which requires the provision of pain relief, commonly through use of a femoral nerve block.  A femoral nerve block is a specific regional anaesthetic technique used by doctors in emergency medicine to provide anaesthesia and analgesia of the affected leg, to allow relief of pain from the fracture and facilitate movement of the injured limb into a splint.  This article provides an educational overview of this practical procedure for junior doctors and medical students alike.  We describe the technique as traditionally performed, as well as highlighting an increasingly favoured method using ultrasound as an adjunct to improve the accuracy and safety of the procedure.

Cite this article as:

Bogacz A & Jamison M (2012). Femoral Nerve Block - A Guide for Medical Students and Junior Doctors. Scottish Universities Medical Journal. 1 (2). p. 185-191

Clinical Pathology - A Diagnostic Aid?

Professor Stuart Fleming (Professor of Cellular and Molecular Pathology) University of Dundee

Abstract:

Clinical pathology is now an essential component of high quality clinical care. Pathology tests are important to reaching a diagnosis in 85% of hospital patients.  Indeed in some areas including oncology, infection and transplantation medicine diagnosis and optimum treatment cannot be delivered without histopathological investigation.  Pathology testing is a core component of early cancer detection through screening for breast, bowel, cervix and prostate cancers.  In the last twenty years pathology has moved from a useful diagnostic aid to a clinical essential.

Cite this article as:

Fleming S (2012). Clinical Pathology - A Diagnostic Aid?. Scottish Universities Medical Journal. 1 (2). p. 192-198

Treatment of Idiopathic Pulmonary Fibrosis - An unmet clinical need

Dr Philip Short (Specialist Registrar in Respiratory Medicine) Royal Infirmary of Edinburgh & Dr Nik Hirani (Consultant in Respiratory Medicine)Royal Infirmary of Edinburgh

Abstract:

Idiopathic Pulmonary Fibrosis (IPF) is a progressive lung condition with no clear underlying definitive cause. This article will discuss previous landmark studies in IPF and review current and potential future treatment options.

Cite this article as:

Short P & Harani N (2012). The Treatment of Idiopathic Pulmonary Fibrosis - an unmet clinical need. Scottish Universities Medical Journal. 1 (2). p. 199-203