Online Publications [Epub]

                                                                                 

Scottish Universities Medical Journal - Electronically Published 2014
                              Volume 3 of EPub Articles

Article 3:03: February 3rd 2014
Assessment and Management of Pain in Older Adults: Current Perspectives and Future Directions

Professor Patricia Schofield (Professor of Nursing, Department of Acute & Continuing Care University of Greenwich)

Until recently our knowledge of the prevalence of pain in older persons, particularly the 
oldest old, was relatively poor. Pain tended to be considered as part of the ageing process 
and was rarely investigated in its own right. The evidence suggests that pain is a common 
problem for older people with chronic persistent pain affecting at least 50% of community 
dwelling older adults. Although, earlier work suggests that this number is even higher. When 
we consider the oldest and most vulnerable, such as those living in care homes, it is believed 
that the incidence of pain increases to 80%.  More recent work confirms the size of the 
ageing population in pain and it remains high. This article aims to discuss the assessment 
and management of pain in older adults. 

Cite this article as:

Schofield P (2014). Assessment and Management of Pain in Older Adults: Current 
Perspectives and Future Directions.
Scottish Universities Medical Journal. 3:03  

Article 3:02: January 10th 2014
Do we know how to manage Irritable Bowel Syndrome?

Anton Emmanuel (Consultant Gastroenterologist, University College Hospital London)

Symptoms related to irritable bowel syndrome (IBS) represent the most common cause of presentation to gastroenterologists, but also result in a significant burden at 
the primary care level.  Despite its high prevalence, diagnosis and management in 
these patients remains frustrating for both patients and health care professionals.  
This is due to the lack of an identifiable organic cause, specific diagnostic marker, but 
also  a  universally  agreed  treatment  algorithm.  This  article  reviews  some  of  the 
challenges we have with patients with ‘refractory’ IBS and how to manage it today 
by providing an outlook of approaches that may help to overcome them in the near 
future. 

Cite this article as:

Emmanuel A (2014). Do we know how to manage Irritable Bowel Syndrome? Scottish Universities Medical Journal. 3:02  

Article 3:01: January 6th 2014
Sexually transmitted infection proctitis, Inflammatory bowel disease and Sexual History

AML Morieux (Medical Student, University of Dundee), C Mowat (Department of Gastroenterology Ninewells), N Reynolds (Department of Gastroenterology Ninewells), JA Todd (Department of Gastroenterology Ninewells), A Meritsi (Department of Gastroenterology Ninewells), S Allstaff (Tayside Sexual & Reproductive Health Service) & M Groome (Department of Gastroenterology, Ninewells)

Background: In the UK and many other western countries there has been a sustained annual increase in the incidence of sexually transmitted infections (STIs) over the past decade1. Gonorrhea, chlamydia, syphilis and herpes infection can present with rectal symptoms and endoscopic features that can mimic inflammatory bowel disease (IBD). Traditionally patients who disclose having anal sexual intercourse and present with rectal symptoms are referred to the genitourinary service where a sexual history is taken and STI proctitis considered. Patients who do not disclose anal sex to the primary referrer are usually sent to a gastroenterology clinic where sexually transmitted causes are usually not considered and a sexual history is not routinely taken. The aim of this project was to assess the prevalence of anal sex in a population referred to an IBD clinic with rectal symptoms; and to determine if there were associations between sexual practice and rectal symptoms reported.

Methods: Prospectively a sexual health questionnaire was distributed to patients attending the IBD Clinics in a tertiary Teaching Hospital setting over a 6-week period. The questionnaire recorded age, sexual orientation, number of sexual partners, sexual sites, STI and rectal symptoms. Results were compared to the Scottish figures from The National Survey of Sexual Attitudes and Lifestyles 2 (NATSAL2) 2.

Results: Only 2 men disclosed having sex with men so analysis was limited to female patients. 170 females completed a questionnaire (age range 16-81). The incidence of receptive anal sex with men within the age group 17-44 (the age range in NATSAL2) was 23.5% compared with 13.4% in NATSAL2. Regarding chronic symptoms: Rectal pain was reported in 41.6% of those having anal sex versus 15% in those not (p<0.002), rectal bleeding was reported in 29.2% of those having anal sex versus 28% in those not (p=NS) and rectal discharge was reported in 25% of those having anal sex versus 11.6% in those not (p=0.076). These symptoms were reported on a chronic basis and were not related to discrete episodes of anal sex. Past STI rates were shown as 29.2% in those having anal sex versus 4.8% in those not (p<0.0001).

Conclusion: The prevalence of anal sex is higher in this cohort than the general population. A lack of routine sexual health questioning in an IBD clinic will fail to identify those at risk of rectal STIs. Chronic rectal pain was strongly associated with a history of anal sex and should trigger a thorough sexual history. When receptive anal sex is disclosed STI screening should be offered to this cohort. Further studies are planned in this high-risk group.
 

Cite this article as:

Morieux AML, Mowat C, Reynolds N, Todd JA, Meritsi A, Allstaff S & Groome M (2014). Sexually transmitted infection proctitis, Inflammatory bowel disease and Sexual History. Scottish Universities Medical Journal. 3:01  

 

Scottish Universities Medical Journal - Electronically Published 2013

                                        Volume 2 of EPub Articles

Article 2:06: December 29th 2013
Placenta Accreta: Overview and Case Study

Rachel Dickinson (Medical Student, University of Glasgow) & Roderick Hamilton (Southern General Hospital, NHS Glasgow)    

The human placenta is critical throughout intra‐uterine development; it has a direct impact 
on the efficacy of fetal development, as well as influencing the risks of developing many 
diseases in adult life, such as diabetes mellitus and obesity. Placental growth, differentiation 
and adaptation are influenced by maternal factors, such as stress, oxygen availability and 
maternal genetics.  The placenta itself then influences vascular resistance, fetal nutrition and 
fetal growth, which affect the consequent organ structure, metabolism and homeostasis of 
the fetus. Problems with placenta development can have major consequences upon fetal 
development,  ranging  from  low  birth  weight  to  mental  or  physical  growth  retardation 
through  to  fetal  death.  Placenta  accreta  is  a  devastating  abnormality  of  placental 
attachment to the uterus, which has serious consequences for both mother and fetus. The 
cause  of  this  condition  is  still  not  fully  understood.  Therefore,  risk  factor  identification, 
diagnosis and management are critical in the prevention of maternal and fetal death.

Cite this article as:

Dickinson R & Hamilton R (2013). Placenta Accreta: Overview and Case Study. Scottish Universities Medical Journal. 2:06  

Article 2:05: December 26th 2013
Sustainable Food & Medicine at the Royal Infirmary Edinburgh

Callum Cruickshank (2nd year MBChB, University of Edinburgh), Iain Savage (2nd year MBChB, University of Edinburgh), Greg Flowerdew (2nd year MBChB, University of Edinburgh), Fiona Cuthill (2nd year MBChB, University of Edinburgh), Dan Couchman (2nd year MBChB, University of Edinburgh), Ziyan Sheng (2nd year MBChB, University of Edinburgh), Eloise M Fenton (2nd year MBChB, University of Edinburgh) and John Seymour (2nd year MBChB, University of Edinburgh)     

Introduction: Nutritional quality is an essential element in the recovery and psychological care of patients. A group of Edinburgh University medical students attempted to determine whether the method of procurement of meals at the Royal Infirmary of Edinburgh (RIE) affects nutritional quality, whilst exploring their sustainability.

Methods: Interviews with several people involved in food production and procurement were carried out. A survey of patients was also conducted to assess their opinions regarding the sourcing of food for hospitals.

Results: Interviews with the catering manager and a patient representative revealed that patient meals are prepared in Trowbridge, England, transported to Glasgow where they are frozen for several weeks, before being transferred to the RIE; creating a substantial carbon footprint. The patients’ meals are NHS budget-limited; a contrast to the staff meals that are fresh, locally supplied and profit-based. 54.5% of the seventy-seven respondents rated the food as good/very good, and 5.2% rated it as very poor. A dietician stated that the food was nutritionally sound. 90% of patients would prefer locally sourced meals. A local organic farmer, who is very committed to sustainable local food, suggested that East Lothian could produce enough food for the hospital. Other hospitals who use local produce revealed that they have not only saved money but patient satisfaction had improved.

Discussion: Our results clearly show the appetite for and affordability of local procurement in hospitals. In addition, we have found that the current food provided at the RIE is generally well received by patients. The authors suggest that the current method of procurement at the RIE should be reviewed at the next opportunity and a more cost effective and sustainable method sought whilst maintaining patient satisfaction with provided food.

Cite this article as:

Cruickshank C, Savage I, Flowerdew G. Cuthill F, Couchman D, Sheng Z, Fenton EM & Seymour J (2013). Sustainable Food & Medicine at the Royal Infirmary Edinburgh. Scottish Universities Medical Journal. 2:05  

Article 2:04: October 6th 2013
Dundee's Hospitals Through The Ages

Graham Lowe (Consultant Dermatologist, Ninewells Hospital & Medical School ; Honorary Medical Curator at the Tayside Medical History Museum)  

The provision of healthcare has changed massively over the last hundred years. In order to provide this ever‐changing healthcare hospitals have had to change too. In this article, we are delighted to have Dr Graham Lowe (Honorary Medical Curator at the Tayside Medical History Museum) discussing the history of Dundee’s hospitals through the ages. 

Cite this article as:

Lowe G (2013). Dundee's Hospitals Through The Ages. Scottish Universities Medical Journal. 2:04  

 

Article 2:03: September 16th 2013
NHS Research Ethics for Medical Students/Novice Researchers - What to consider when developing your project  

Caroline Y Ackland (Scientific Officer, The East of Scotland Research Ethics Service) & Lorraine S Reilly (Senior Co‐ordinator, The East of Scotland Research Ethics Service)  

Clinical research is a very important aspect of developing clinical care and treatments. Over the last few decades, in part due to un‐ethical studies and trials, there are now strict codes and practices that are essential to safeguard patients involved in clinical research. However, NHS Research Ethics can be a confusing area for novice researchers to navigate their way through. This article, written by two members of the East of Scotland Research Ethics Service, provides information on research ethics and important things to bear in mind when developing projects. It forms the second part of the Scottish Universities Medical Journal ‘Clinical Research for Beginners’ series.

Cite this article as:

Ackland CY & Reilly LS  (2013). NHS Research Ethics for Medical Students/Novice Researchers  – what you should consider when developing your project. Scottish Universities Medical Journal. 2:03  

 

Article 2:02: September 16th 2013
The Art of Portfolios

Professor Patsy Stark (Emeritus Professor of Clinical Education; University of Leeds/   Director of Strategic Development; Association for the Study of Medical Education)

Portfolios are kept during undergraduate medical studies, in Foundation and Core training and now throughout  one’s medical career. However, they have a bad press and many people cannot understand the rationale and purpose of spending time keeping a portfolio up to date. In this short article I hope to explain why portfolios are useful and how to make the best use of them.

Cite this article as:

Stark P (2013). The Art of Portfolios. Scottish Universities Medical Journal. 2:02

 

Article 2:01: July 26th 2013
The Curious Concept of Ageing

Lloyd D Hughes (5th year MBChB, BSc)

Ageing  populations  are  causing  a  significant  impact  into  the  healthcare  and  political   landscapes of government decision making across the world. But why do we age? This   commentary piece sheds some light onto the interesting reasons behind why ageing occurs   universally to us all from an evolutionary genetics perspective. 

Cite this article as:

Hughes LD (2013). The Curious Concept of Ageing. Scottish Universities Medical Journal. 2:01

 

Scottish Universities Medical Journal - Electronically Published 2012

                              Volume 1 of EPub Articles

All EPub articles below have been accepted for publication in the SUMJ and will be indexed in CINAHL.

Please find below the list of EPub articles and their abstracts:

Article 1:17: December 19th 2012

The Liverpool Care Pathway - a personal perspective

Dr Hannah Lord (Consultant Clinical Oncologist, Ninewells Hospital and Medical School)

Dr Hannah Lord provides a personal persepctive on the recently debated Liverpool Care Pathway.

Cite this article as:

Lord H (2012). The Liverpool Care Pathway - a personal perspective. Scottish Universities Medical Journal. 1:17.

 

Article 1:16: October 12th 2012

Regulation of Alternative Medicine - why it doesn't work

Balancing Medical Matters Opinion Articles - Complementary Alternative Medicine

Professor  David  Colquhoun  (Previous  Hon.  Director  of  the  Wellcome   Laboratory for Molecular Pharmacology, Fellow of the Royal Society & Honorary Fellow of  University College London)

There are strong advocates and opponents to alternative medicine being widely available to  the general population, whether this is over the counter or through the NHS. Indeed, if  anything this area is increasingly becoming a major discussion point both medically and  socially,  especially  with  new  constraints  on  budgets.  In  this  balancing  medical  matters  opinion piece, Professor David Colquhoun outlines his concerns regarding the regulation of  this  industry  and  the  potential  dangers  and  problems  this  may  cause  patients  and  consumers. 

Cite this article as:

Colquhoun D (2012). Regulation of Alternative Medicine ‐ why it doesn’t work. Scottish Universities Medical Journal. 1:16

 

Article 1:15: October 12th 2012

Small but Intriguing - The Unfolding Story of Homeopathic Medicine

Balancing Medical Matters Opinion Articles - Complementary Alternative Medicine

Dr Russell Malcolm MBChB (Dundee) BA FFHom (Dean of the Faculty of Homeopathy) 

There are strong advocates and opponents to alternative medicine being widely available to   the general population, whether this is over the counter or through the NHS. Indeed, if   anything this area is increasingly becoming a major discussion point both medically and   socially,  especially  with  new  constraints  on  budgets.  In  this  balancing  medical  matters   opinion  piece,  Dr  Russell  Malcolm  outlines  the  unfolding  story  and  background  of   homeopathic medicine and suggests that the medical and scientific communities should be less resistant to some of these interventions. 

Cite this article as:

Malcolm R (2012). Small but Intriguing - The Unfolding Story of Homeopathic Medicine. Scottish Universities Medical Journal. 1:15

 

Article 1:14: September 30th 2012

Minimising Prescribing Errors in Paediatrics - Clinical Audit

Winner of the National Medical Student Paediatric Conference 2012 Poster Prize

Raquel Romero-Perez [5th year BMBS, BPharm, MRPharmS] & Dr Philippa Hildick-Smith [Consultant Paediatrician]

Background: Thousands of medicines are prescribed in the UK every day without any problem, but medication errors occur with potential for serious impact on patient safety.

Objectives: This study had three core objectives: 1) To measure the incidence and nature of prescribing errors in a children’s teaching hospital. 2) To explore the factors contributing to them. 3) Use clinician feedback to design an intervention to help reduce errors according to local needs and resources.

Methods: A prospective review of in-patient medication charts, out-patient prescriptions and electronic discharge summaries was carried out for two consecutive weeks to identify the incidence and types of prescribing errors. An online survey and questionnaire was sent amongst doctors, pharmacists and nurses to explore the perceived causes of prescribing errors. Suggested strategies from healthcare professionals in the online survey and questionnaire were used to devise a paediatric prescribing pocket guide that was given out to all prescribers.

Results: Prescribing mean error rates varied between written in-patient drug charts (56.8%), out-patient prescriptions (46.8%), and electronic discharge medication orders (19.0%). The three most common types of errors were unit dose missing (29.4%), valid period missing (23.4%) and administration times missing or incorrect (9.4%). Potentially serious errors were less common (6.4%) and almost all were intercepted before they could affect patients. The three most frequently suggested causes of errors were being busy/rushing (73.9%), being tired/not concentrating (47.8%) and not checking (45.7%). Errors were mostly thought to arise when starting a new post (56.5%), when on-call (47.8%), and at the end of a working day (39.1%). After review, a majority of positive views were collected regarding the design, content and usefulness of the paediatric prescribing pocket guide. This intervention would be subject to review and audit in due course.

Conclusions: This study reinforces the message that prescribing errors are common in secondary care paediatrics and more needs to be done to reduce such errors impacting patient care. Prescribing errors are often multifactorial and efforts to reduce them need to address multiple causes to be of some benefit. Future research will investigate the impact of the devised educational intervention in reducing local prescribing errors and improving clinical practice.

Cite this article as:

Romero-Perez R & Hildick-Smith P (2012). Minimising Prescribing Errors in Paediatrics - Clinical Audit. Scottish Universities Medical Journal. 1:14

 

Article 1:13: September 6th 2012

What's New In Dermatology

Dr Sally Ibbotson (Consultant Dermatologist)

A brief summary of the latest developments in dermatology important for medical students to know for placements and ward teaching.

Cite this article as:

Ibbotson S (2012). What's New In Dermatology. Scottish Universities Medical Journal. 1:13

 

Article 1:12: September 6th 2012

What's New In Opthalmology

Dr. Una O’Colmain (Specialist Registrar in Ophthalmology) Prof. Caroline J MacEwen 
(Ophthalmology Consultant)

A brief summary of the latest developments in ophthalmology important for medical students to know for placements and ward teaching.

Cite this article as:

O'Colmain U & MacEwen CJ (2012). What's New In Opthalmology. Scottish Universities Medical Journal. 1:12

 

Article 1:11: September 6th 2012

What's New In Inflammatory Bowel Disease

Dr Sandeep Shivananda Siddhi (Gastroenterology Registrar, NHS Tayside) 

A brief summary of the latest developments in inflammatory bowel disease important for medical students to know for placements and ward teaching.

Cite this article as:

Shivananda Siddhi S (2012). What's New In Inflammatory Bowel Disease. Scottish Universities Medical Journal. 1:11

 

Article 1:10: September 6th 2012

What's New In Hepatology (Hepatitis C)

Dr Timothy Heron (Gastroenterology Specialist Registrar, NHS Tayside) 

A brief summary of the latest developments in hepatology (hepatitis C) important for medical students to know for placements and ward teaching.

Cite this article as:

Heron T (2012). What's New In Hepatology (Hepatitis C). Scottish Universities Medical Journal. 1:10

 

Article 1:09: September 6th 2012

What's New In General Practice

 Dr Penny Lockwood (Senior Clinical Lecturer & ISS lead; General Practitioner) 

A brief summary of the latest developments in general practice important for medical students to know for placements and ward teaching.

Cite this article as:

Lockwood P (2012). What's New In General Practice. Scottish Universities Medical Journal. 1:09

 

Article 1:08: August 4th 2012

Psychosocial treatments for depression in UK Criminal Justice - A Review of the Evidence

Lloyd D Hughes (4th year MBChB, BSc)

Objective: To systematically review the clinical efficacy of psychosocial methods for managing depression in the prison population.

Search Strategy: Medline, Embase, CINAHL, Psych Info, Applied Social Sciences Index and Abstracts, Cochrane Library (CENTRAL) and Controlled Clinical Trials.com were searched. Government reports and tertiary sector advisory body publications on the prison service were hand-searched.

Selection Criteria: Randomized clinical trials (RCT) of non-drug interventions to treat unipolar depression in the prison population were included if available. In line with the expected low number of RCTs in this area, observational studies [cohort studies, case-control studies and case series] and epidemiological studies where the primary aim of the study was to assess the implementation of non-drug treatment were included.

Data Collection and Analysis: One independent reviewer assessed eligibility and trial quality and extracted published data.

Results: One study reviewed the current implementation of non-drug interventions in the prison population, concluding that current mental health provision was good. Seven studies reviewing a non-drug intervention for managing depression were included in this review. The form of psychosocial interventions evaluated included group and individual CBT (n=2), art therapy (n=2), group interpersonal therapy (n=1), Iyengar yoga (n=1) and Behavioral Activities Intervention (n=1). A total of 333 patients were included in these reviews in three countries (United States of America, United Kingdom and Iran). The quality of the studies was variable with several studies being pilot studies to investigate the feasibility of an intervention in the prison setting and thus did not have a control arm.

Conclusions: The prison population has by definition; a differing set of care and support needs for their depressive disorders. This review has highlighted that there is limited specific evidence for non-drug interventions for depression in the prison population, with only individual and group CBT having an adequate evidence base. However, the lack of evidence should not be assumed to equate with a lack of clinical efficacy. The author advocates further research and financial investment into this area of forensic psychiatry. Such investment will enable primary care physician and psychiatrists working with patients serving custodial sentences to make evidence based medical decisions tailored to their patients needs.

Cite this article as:

Hughes LD (2012). Psychosocial treatments for depression in UK Criminal Justice - A Review of the Evidence. Scottish Universities Medical Journal. 1:08

 

Article 1:07: July 18th 2012

Innovative ways hearing aids can be improved for clinical use - A Literature Review

Ravinder Grewal (4th year MBChB) & Dr. John Irwin (Consultant in Audiological Medicine)

Background: Hearing aids have been vastly improved since the introduction of digital technology. However, there are several areas exist where further development can take place. There is currently no literature review focusing upon these potential hearing aid developments for patients with hearing problems.

Objectives: To research aspects of hearing aids that can be further improved and evaluate the effectiveness of using head-related transfer functions by comparing headphone and sound-field standardised scores in terms of sound localisation.

Search strategy:  ‘MEDLINE’, ‘Web of Science’, a manual library search and reference lists of relevant articles were searched up to and including January 2011

Selection criteria: Studies were included if they were randomised control trials and included only human participants. Data collection and analysis: One author selected relevant trials, assessed methodological quality and extracted data with supervision.

Main results: A quantitative meta-analysis was deemed inappropriate due to heterogeneity in outcome measures. Seven papers featured evidence of potential further enhancements to hearing aids that included direct and indirect improvements. Localisation techniques to improve hearing aid testing were discussed which improve hearing aid use indirectly. Further improvement to wireless abilities, stronger yet smaller digital signal processors (DSP) chips, a greater number of channels and complex algorithms featured as direct hearing aid improvement techniques.

Conclusions: For innovated sound localisation techniques to be implemented clinically, it is essential that this area is researched further. Otherwise, hearing aid technology will develop and sound localisation techniques will be over-shadowed by more direct improvements despite the very real clinical and cost-effective improvements that localisation techniques may have upon patient hearing.

Cite this article as:

Grewal R & Irwin J (2012). Innovative ways hearing aids can be improved for clinical use - A Literature Review. Scottish Universities Medical Journal. 1:07

 

Article 1:06: July 8th 2012

Is the personal banking of umbilical stem cells justified?

Eilidh Stewart O'Connor (4th year MBChB; BMSc)

Hematopoietic stem cells (HSCs) are defined by their ability to repopulate all lineages of the blood system – they are multipotent with ten or eleven possible fates.  They can self renew, which is important for maintaining a pool of stem cells that can continually renew the bodies 
blood cells, which have a finite life span – with red cells surviving for around 120 days, 
platelets for 7 days and granulocytes for 7 hours – leading to a high turnover rate.  During 
fetal life there are multiple sites of hematopoiesis, but following birth – the bone marrow is 
the only site of new blood cell formation, so its continuing function is vital to life.  Umbilical 
cord  blood  has  a  high  concentration  of  hematopoietic  stem  cells.  However,  there  is 
considerable debate about how we should store these cells. This article aims to provide 
some information about the area of HSC regenerative medicine and outline some of the core 
areas of ethical debate.  

Cite this article as:

O'Connor ES (2012). Is the personal banking of umbilical stem cells justified? Scottish Universities Medical Journal. 1:06

 

Article 1:05: July 8th 2012

An Audit of Management of Acute Uncomplicated Lower UTI at a Health Centre in Central Scotland

Kirsten E Stewart (5th year MBChB)

Clinical audits are an important method of assessing quality improvement within the NHS 
and aims to improve patient care by reviewing certain outcomes against agreed proposed 
standards.  These can then be used in the implementation of change in the management of 
the assessed topic.  This audit aims to assess the management of Urinary Tract Infection 
(UTI) in Primary Care and will focus on women aged between 16‐65 years old in a Health 
Centre in Central Scotland over a 2‐month period.   

Cite this article as:

Stewart KE (2012). An Audit of Management of Acute Uncomplicated Lower UTI at a Health Centre in Central Scotland. Scottish Universities Medical Journal. 1:05

 

Article 1:04: June 26th 2012

Coronary Heart Disease Prevention For Diabetic Patients In Primary Care - An Audit of Clinical Practice

Mohammed F Jabir (5th year MBChB) & Dr Alan Begg (General Practitioner, NHS Tayside)

Background: Type 2 diabetes mellitus (T2DM) represents a state of increased cardiovascular risk with the prognosis of diabetic patients with cardiovascular disease (CVD) much worse. The imperative on physicians, principally those in primary care, is to focus on strategies to reduce cardiovascular risk factors in patients with established diabetes. The main risk factors for CVD are hypertension, dyslipidemia and hyperglycemia. This audit reviewed clinical practice at a GP surgery in the drug management of cardiovascular risk factors in diabetic individuals who had suffered a previous cardiovascular event. Current clinical practice was compared with the standards as set out in The Quality and Outcomes Framework (QOF) guidance 2011/12.

Methods: Analysis was carried out by collecting data from the general practice database system containing over 317 patients with a confirmed diagnosis of T2DM. Variables collected included patient demographic details, diagnostic data, previous coronary vascular interventions and most recent cardiovascular risk factor measurements (blood pressure, total cholesterol levels and glycaemic levels (HbA1c)). Multivariate analysis was performed to examine the relationship between a confirmed diagnosis of diabetes and cardiovascular sequelae. Patients were classed into 4 standards (gold, silver, bronze and none) as per defined by QOF guidance based on their cardiovascular risk factors.

Results: Patients were excluded if they had a confirmed diagnosis of type 1 diabetes mellitus (n=19) or had no diagnosed cardiovascular pathology secondary to diabetes including myocardial infarction, heart failure, angina or left ventricular systolic dysfunction (n=258). A total of 59 patients were thus included in the audit analysis. Multivariate analysis noted a clear relationship between a diagnosis of type 2 diabetes and cardiovascular disease sequelae (p-value= 0.002). Results demonstrated that 59% of patients fell within in gold standard, 3.3% of patients fell within the silver standard, 22% of patients fell within the bronze standard and 15.3% failed to meet any standard cardiovascular risk standard.

Conclusions: There is scope for improved management within the practice since 40.6% of diabetic patients have need for reduction in their cardiovascular risk factors to attain optimum control. Cardiovascular risk factors that primarily require treatment include improved treatment of glycaemic levels and blood pressure.

Cite this article as:

Jabir MF & Begg A (2012). Coronary Heart Disease Prevention For Diabetic Patients In Primary Care - An Audit of Clinical Practice. Scottish Universities Medical Journal. 1:04

 

Article 1:03: May 31st 2012

Commissioned Article : Public Health Special

Public Health and Dental Caries in Young Children in Deprived Communities in Scotland

Stephanie Chambers (Research Fellow, Oral Health Research Programme)

Dental  caries  is  the  most  prevalent  disease  worldwide,  and  is  caused  by  a  complex 
interaction of tooth susceptibility, nutrition and the oral environment.  In young children it 
can have a major impact on their quality of life, and is the main reason why Scottish children 
are admitted to hospital.  There have been dramatic improvements in Scottish children’s 
oral health.  This has been enabled through the introduction of Childsmile, the national oral 
health  programme  for  Scottish  children.    Nevertheless,  significant  challenges  exist  in 
reducing  oral  health  inequalities.  This  paper  calls  for  a  greater  emphasis  on  the  social 
determinants of health to ensure that all Scottish children have the benefit of good oral 
health. 

Cite this article as:

Chambers S (2012). Public Health and Dental Caries in Young Children in Deprived Communities in Scotland. Scottish Universities Medical Journal. 1:03

 

Article 1:02: May 29th 2012

Yellow Oleander Poisoning and Suicide in Sri Lanka

Shobitha Puvaneswaralingam (4th year MBChB, BMSc)

Intentional yellow oleander poisoning is a growing problem that is straining the health 
care services of Sri Lanka as it is a readily available method of suicide. The country remains 
to have one the highest suicide rates in the world, and the trend of oleander poisoning has 
been difficult to halt due to the lack of resources to manage the problem. As mental 
health issues are becoming a serious public health problem in Sri Lanka, it is timely to 
consider what efforts could be made to manage this unique phenomenon. 

Cite this article as:

Puvaneswaralingam S (2012). Yellow Oleander Poisoning and Suicide in Sri Lanka. Scottish Universities Medical Journal. 1:02

 

Article 1:01: April 18th 2012

How should healthcare students view addiction and substance abuse?

Lloyd D Hughes (4th year MBChB, BSc)

Addiction to alcohol, nicotine and illegal substances is both a major medical and 
social concern. It is a common presentation to primary care with subsequent medical 
complications  not  uncommonly  being  managed  by  secondary  care  services. 
Therefore, it is suggested by the National Institute for Drug Abuse that healthcare 
students develop an understanding of some of the biological and social debate in 
this area to aid clinical practice.  

Cite this article as:

Hughes LD (2012). How should healthcare students view addiction and substance abuse? Scottish Universities Medical Journal. 1:01