Scottish Medical Journal最新文献

Background and AimsTo determine which factors were associated with and predictive of an advanced stage at diagnosis and emergency mode of presentation in colorectal cancer patients.Methods and ResultsA total of 587 consecutive patients discussed at multidisciplinary team meetings between January 2017 and December 2019 at an acute hospital in Scotland were included. The effect of predefined variables on stage and mode of presentation was analysed using logistic regression. 55.4% of patients had advanced disease and 19.7% of patients presented as an emergency: these were more likely to have advanced disease (odds ratio (OR) 1.64, 95% confidence interval (95%CI) 1.02-2.62, p = 0.04) compared to the 22.3% diagnosed at screening (OR 0.33, 95%CI 0.21-0.52, p < 0.001). Individuals with affected first-degree relatives were more likely to present with advanced disease (OR 2.39, 95%CI 1.06-5.40, p = 0.04). The association of deprivation and tumour site with advanced disease at presentation was significant (p = 0.04 and p = 0.013, respectively). The likelihood of presenting as an emergency increased with age (OR 1.03, 95%CI 1.01-1.05, p = 0.003) and with advanced disease (OR 2.15, 95%CI 1.37-3.38, p < 0.001). Again, the relationship between tumour site and emergency presentation was significant (p = 0.002).ConclusionFurther efforts are required to increase screening uptake, particularly amongst higher risk groups, to detect disease at an early stage and reduce the number of patients presenting as emergencies.

BackgroundThe aim of this study was to assess the efficacy of post-stroke rehabilitation and to determine the influence of differing rehabilitation program components on changes in quality of life (QoL).Methods120 patients diagnosed with stroke were included in this study. The sample comprised 53 males and 67 females, exhibiting a meantime since the event of 77.7 ± 70.5 days (range:30-365 days). Patient sociodemographic data, stroke characteristics, and received rehabilitation services were documented upon admission. Hemiplegic patients' motor development was assessed using the Brunnstrom stages. QoL was assessed using the stroke-specific quality of life scale (SS-QOL).ResultsInpatient rehabilitation lasted an average of 59.71 ± 19.56 days (range:30-70 days). A comparison of SS-QOL scale scores at admission and discharge among rehabilitation patients revealed improvements in both the overall mean and all subscales. Statistically significant improvements were found in all rehabilitation sub-dimensions. Cognitive rehab significantly improved patients' social, language, vision, cognitive, and personality functioning. Analysis revealed significant enhancements in mood and activity among subjects undergoing lower extremity robotic rehabilitation and balance laboratory treatment. Hand support showed significant improvement across all measured sub-dimensions.ConclusionsOur research facilitated a comprehensive assessment of stroke-induced impairments, demographic variables, and individualized treatment modalities influencing QoL, as measured by a dedicated SS-QOL scale.

BackgroundThe increasing prevalence of thyroid incidentalomas and their uncertain malignancy risk necessitates population-specific analyses. This study aimed to investigate the prevalence and characteristics of thyroid incidentalomas in patients at the University of Jordan.MethodsConducted at the Jordan University Hospital (JUH), the retrospective study reviewed Magnetic Resonance Imaging (MRI) reports. Patients aged 18-83 were included, and MRI findings were screened for thyroid incidentalomas. Further assessments included neck ultrasound (US) and serum thyrotropin (TSH) analysis to evaluate thyroid function.ResultsOf 194 images reviewed, 190 met inclusion criteria, with 128 (67.4%) showing thyroid incidentalomas. Subsequent ultrasound examinations in 28 patients confirmed findings consistent with MRI in 17 cases (60.7%). Of fine-needle aspiration biopsies performed, 38.89% were benign, while 11.11% were classified as atypia or follicular lesions of undetermined significance, ultimately diagnosed as papillary cancer.ConclusionThe study underscores the high prevalence of thyroid incidentalomas in imaging performed for unrelated conditions and highlights their potential malignancy risk. Increased awareness among medical professionals is crucial for timely identification and management. Incidental thyroid lesions on MRI warrant further evaluation to ensure appropriate clinical and diagnostic follow-up.

BackgroundIn an era where ENT educators face reduced teaching hours alongside a limited selection of interactive pedagogical tools, laryngeal anatomy remains a difficult topic to teach medical students. A comparative pilot study was performed to investigate the aptness of clay models as a teaching tool in the undergraduate ENT setting.MethodsSixteen medical students were recruited. Students were assigned to prosections (n = 8) or clay models (n = 8); and tasked to identify or model laryngeal structures. Participants were examined using a pre- and post-test multiple-choice questionnaire. Feedback was obtained via a 5-scale Likert questionnaire. To investigate the impact of student learning approaches on assessment, the ASSIST questionnaire was used.ResultsClay modelling students performed better on post-test than their prosection counterparts (mean: 14.37 vs 13.62; p = 0.67), whilst surface learners (n = 7) achieved higher scores on post-test compared to their strategic counterparts (n = 9; p = 0.87). Findings were not statistically significant. Feedback indicated higher levels of satisfaction in students allocated to clay models, whilst usefulness was perceived more by those in the prosection group.ConclusionClay modelling is an enjoyable teaching tool which yields comparable scores to prosections on assessment. Educators may use this tool to improve interactivity and accommodate for contact free teaching requirements.

ObjectiveThe aim of this paper was to look at the cost of the different non-antimicrobials available for the management of recurrent UTIs, and to compare these to the antimicrobials currently recommended for prophylaxis in the United Kingdom.MethodsFive non-antimicrobials (D-mannose, Probiotics/lactobacillus, Methenamine Hippurate, Oestrogens and Cranberry) and four antimicrobials (prophylactic dose Trimethoprim, Nitrofurantoin, Amoxicillin and Cefalexin) were included. The cost for 6 months of prophylactic treatment was calculated for each, with the median and range included for the non-prescription products.ResultsFor a 6-month duration, the median cost of Vaginal oestrogen, Cranberry, Methenamine Hippurate, Probiotics and D-mannose was £22.04, £55.95, £100.44, £139.5 and £158.40 respectively. Vaginal oestrogens were the cheapest non-antimicrobial management option with D-mannose being the most expensive. Trimethoprim was the cheapest of the antimicrobials for 6 months of prophylaxis (£5.08), followed by Cefalexin (£7.97), Amoxicillin (£10.71) and Nitrofurantoin (£16.32).ConclusionThe cost of antimicrobial management options for the prophylaxis of UTIs was found to be generally cheaper across the board, in comparison to non-antimicrobial products. However, the continuing public health crisis with regards to overprescribing of antimicrobials, growing resistance and the need for antimicrobial stewardship makes non-antimicrobials an ever-important consideration.