Isebrook Hospital

This study investigates the relationship between tinnitus and psychological morbidity using a cross-sectional survey design from patients of an outpatient audiology department in a typical District General Hospital. The results suggest that a significant number of tinnitus patients suffer from psychological problems both during and more unfortunately after routine treatment for their tinnitus. Anxiety was found to be the main psychological problem. In conclusion, this study suggests that, while further research is needed, many tinnitus patients require psychological treatment and this has implications for the staffing of audiology units in District General Hospitals.

Traditional cross-couplings require stoichiometric organometallic reagents. A novel nickel-catalyzed cross-coupling reaction between aldehydes and aryl halides via hydrazone intermediates has been developed, merging the Wolff-Kishner reduction and the classical cross-coupling reactions. Aromatic aldehydes, aryl iodides and aryl bromides are especially effective in this new cross-coupling chemistry.

SUMMARY One hundred and sixty seven children on 0‐200 μg/day of inhaled steroid with asthma symptoms and sub‐optimal peak flow values (less than 90% of that predicted for their height) were randomly allocated either 400 μg once daily (nocte with placebo o.m.) or 200 μg twice daily of budesonide Turbohaler® for 8 weeks. Bronchodilator usage and symptoms were reduced in both groups at 4 and 8 weeks compared with baseline. There was a significant increase within both groups in morning and evening PEF after 4 and 8 weeks. The increase in evening PEF after 8 weeks was greater in the once‐daily group than in the twice‐daily group but there were no other significant differences between the groups (morning: +24.6 l/min vs 15.2 l/min, p=0.059; evening: +19.7 l/min vs +8.3 l/min; p=0.013). Budesonide Turbohaler® 400 μg once daily is therefore as effective as 200 μg twice daily in achieving asthma control in children.

BACKGROUND: Anxiety related to dental treatment is a common phenomenon that has a significant impact on the provision of appropriate dental care. The aim of this case series was to examine the effect of acupuncture given prior to dental treatment on the level of anxiety. METHODS: Eight dentists submitted 21 case reports regarding the treatment of dental anxiety. The level of anxiety was assessed by the Beck Anxiety Inventory (BAI). Only patients with moderate to severe anxiety (BAI score > or =16) were included. The remaining 20 patients, 16 women and 4 men, with a mean age of 40.3 years, had a median BAI score of 26.5 at baseline. The BAI score was assessed before and after the acupuncture treatment. All patients received acupuncture treatment for 5 min prior to the planned dental treatment using the points GV20 and EX6. RESULTS: There was a significant reduction in median value of BAI scores after treatment with acupuncture (26.5 reduced to 11.5; p<0.01), and it was possible to carry out the planned dental treatment in all 20 cases after acupuncture treatment. Previously this had only been possible in six cases. CONCLUSION: Acupuncture prior to dental treatment has a beneficial effect on the level of anxiety in patients with dental anxiety and may offer a simple and inexpensive method of treatment. However, the present results need to be tested in a larger randomised clinical trial in order to evaluate the effectiveness of the acupuncture treatment in patients with dental anxiety.

This paper is a review of a clinical audit conducted on the elderly care wards of a National Health Service (NHS) Trust hospital in the East Midlands. The audit examined current discharge planning arrangements and their effectiveness on elderly care wards, community nursing services and client satisfaction. Sixty sets of nursing notes were examined, 27 community nurses received a questionnaire and 60 patients and 26 carers or significant others were interviewed in the patient's place of residence. The audit findings revealed that, of the 60 sets of notes examined, only 10% of patient discharge plans commenced on admission. Liaison between ward and community nursing staff to discuss the needs of patients being discharged was minimal. Only 50% of community nurses believed they were adequately informed about, and 40% adequately involved in, patient discharge. Little consultation between ward staff, patients and their carers occurred during the discharge planning phase. The majority of patients (63%) and carers (81%) interviewed said that the patient's needs were not discussed prior to discharge home. The report ended by formulating a list of 11 recommendations which includes a thorough review of current policies, procedures and standards. A multidisciplinary steering group has been formed to assist in the implementation of the recommendations.

Assessment of risk of violence is essential in the management of patients with schizophrenia admitted to secure hospitals. The present study was conducted to test the validity of actuarial measures and psychotic symptoms in the prediction of further violence and offending in this group. The H-10 scale of the HCR-20, Violence Risk Appraisal Guide and Psychopathy Checklist-Revised were scored retrospectively. Symptom severity was rated at interview and persistence from notes. Outcome was measured using criminal records and recorded incidents of aggression over an 8-10 year period. Seventy-six percent of patients were involved in more than 1800 incidents defined as physical contact with a victim or damage to property, and 28% in a serious incident defined as injury to a victim requiring hospital treatment, a contact sexual incident or fire setting. Fifteen percent of patients were convicted of any offense and 5% of a violent offense. The risk scales had moderate to high predictive accuracy for offenses and violent offenses but failed to predict incidents or serious incidents. Symptom severity and persistence predicted incidents but not offenses. Violence within this population is common. Actuarial measures of risk assessment are valid predictors of offending and violent offending but psychotic symptoms are more relevant to the prediction of violent incidents. Assessments of likely inpatient aggression must emphasize symptoms.

Summary Community learning disability nursing has been faced with considerable changes over recent years. In the early part of the 1990s, some commentators believed that it was a specialism in decline. The aim of the present study was to describe the way in which community nurses, learning disabilities (CNLDs), work within National Health Service (NHS) trusts in England, the other professionals whom they relate to, the client group whom they serve, their qualifications and their working practices. A postal questionnaire enquiring about these themes was returned by CNLD managers from 136 out of the 170 NHS trusts which were identified (81%).

PURPOSE: Severe bilateral leg spasticity can cause severe symptoms and reduced quality of life in affected individuals. It is often unresponsive to treatment. The objective of this study was to review the effectiveness of intrathecal phenol in the treatment of severe bilateral leg spasticity. METHOD: A retrospective case notes review of patients treated with intrathecal phenol by a rehabilitation service was performed. A simple rating scale based on comments in the case notes was used to identify changes in spasticity and treatment goals. RESULTS: Forty patients were identified as having been treated with intrathecal phenol over a 10-year period. All patients had improvements in their spasticity, 34 of which were rated as substantial or excellent. All patients (in whom the effect was documented), except one, had short-term improvement in the goals for treatment, 31 having substantial or excellent improvement. The effect was long lasting in many of the patients. Seven patients required repeat injections with similar outcomes. Seven patients experienced temporary side-effects. CONCLUSION: Intrathecal phenol is a useful alternative in treating selected patients with chronic severe bilateral leg spasticity that is unresponsive to other treatments.

Aims and Method To investigate the recording of Mental State Examination (MSE) findings by psychiatric trainees as well as dating, timing and signing of entries into the clinical record. Data were collected from randomly selected case notes in three acute psychiatric units. Results There was an initial decline of MSE recording from 69% to 58% in the first re-audit. Introduction of a standardised format and involvement of consultant trainers in the supervision of MSE recording led to an improvement to 83% in the secondre-audit. Adherence to medico-legal standards also improved. Clinical Implications The introduction of an MSE format and consultant supervision of records improved the standard of MSE recording as well as basic medico-legal requirements by psychiatric trainees.

Infection with methicillin-resistant Staphylococcus aureus is a familiar problem in hospital patients and has been a global issue since the 1960s. Control of this organism is expensive both financially and in terms of human resources. This article is an attempt to review the epidemiological evolution and our understanding of the organism and bring together possible solutions.

OBJECTIVE: To analyze the differences of coronary artery anomalies between Han and Tibetan nationality living in middle and high altitude. METHODS: A total of 7 028 adults living in the Qinghai Plateau(1 800-7 720 m altitude), who underwent coronary CT angiography in Qinghai Cardio-cerebro-vascular Disease Special Hospital between 2010 to 2015, were included in this study.There were 6 391 cases of the Han nationality and 637 cases of the Tibetan nationality. The differences of coronary artery anomalies between Han and Tibetan nationality were analyzed retrospectively. RESULTS: (1) Incidence of coronary artery anomalies was lower in Han nationality than in the Tibetan nationality (1.596%(102/6 391)vs. 4.239%(27/637), P<0.001). (2) There was 64.7%(66/102) male residents with coronary artery anomalies in Han nationality, and 74.1% (20/27) male residents with coronary artery anomalies in Tibetan nationality(P=0.359). (3) Left side coronary artery anomalies in Han nationality was similar as in Tibetan nationality (64.4%(67/104) vs. 55.6%(15/27), P=0.396). (4) Incidence of benign coronary artery anomalies was significantly lower in Han nationality than in Tibetan nationality (0.720%(46/6 391) vs. 2.200%(14/637), P<0.001). Incidence of potentially dangerous coronary artery anomalies was also significantly lower in Han nationality than in Tibetan nationality (0.876%(56/6 391) vs. 2.041%(13/637), P=0.004). (5)Ten kinds of coronary artery anomalies were found in this study. There were significant differences between Han and Tibetan nationality in left coronary artery originated from right coronary sinus(0.046%(3/6 391) vs. 0.471%(3/637), P=0.012), in left circumflex branch originated from right coronary sinus(0.046%(3/6 391)vs. 0.471%(3/637), P=0.012), and opening of right coronary artery in left coronary sinus or left anterior descending(0.704%(45/6 391)vs. 1.570%(10/637), P=0.018). CONCLUSION: The incidences of coronary artery anomalies and benign coronary artery anomalies were significantly lower in Han nationality residents than that of the in Tibetan nationality residents living in middle and high altitude.

Clinical governance, primary care groups and trusts and budget limitations all impact on which dressings can be prescribed in the community. Marilyn Edwards discusses some of the ethical and budget issues prescribers have to address