JRSM short reports最新文献

A systemic inflammatory response causing multi-organ failure and requiring multiple amputations was refractory to all treatments except Anakinra, and the cause remains unclear.

Objective: To look for a relationship between the maternal age-specific incidence of complete molar pregnancy and the age-specific mid-follicular levels of circulating follicle stimulating hormone and luteinizing hormone.

Design: Calculation of correlation coefficients between the incidence of complete mole and the circulating levels of follicle stimulating hormone and luteinizing hormone using the method of least squares.

Setting: England and Wales.

Participants: All mothers between 23 and 49 years delivering in England and Wales between 2000 and 2009 inclusive and a sample of women between 23 and 49 years from Sheffield (1987).

Main outcome measures: The bivariate correlation coefficients between the incidence of complete mole and the mid-follicular plasma levels of the pituitary gonadotrophins.

Results: Exponential correlation between the incidence of complete mole and mid-follicular plasma follicle stimulating hormone, r = 0.965, r (2 )= 0.932. Linear correlation between the incidence of complete mole and mid-follicular plasma luteinizing hormone, r = 0.972, r (2 )= 0.944. Multivariate exponential regression between the incidence of complete mole and the combination of follicle stimulating and luteinizing hormones. This does not improve the prediction of the incidence of complete mole and it shows that luteinizing hormone is not a significant predictor of the incidence of complete mole in the presence of follicle stimulating hormone.

Conclusions: There is a strong positive exponential correlation between the maternal age-specific incidence of complete mole in England and Wales and the age-related mid-follicular levels of follicle stimulating hormone in a sample of English women.

Objective: Unsuspected idiopathic intracranial hypertension (IIH) is found in a significant minority of patients attending clinics with named headache syndromes, if it is specifically sought out. Chronic fatigue syndrome is frequently associated with headache. Could the same be true of chronic fatigue? Moreover, there are striking similarities between the two conditions. Could they be related? Attempting to answer these questions, we describe the results of a change in clinical practice aimed at capturing patients with chronic fatigue who might have IIH.

Design: Cross-sectional.

Setting: Hospital outpatient and radiology departments.

Participants: Patients attending a specialist clinic with chronic fatigue syndrome and headache who had lumbar puncture to exclude raised intracranial pressure.

Main outcome measures: Intracranial pressure measured at lumbar puncture and the effect on headache of cerebrospinal fluid drainage.

Results: Mean cerebrospinal fluid pressure was 19 cm H2O (range 12-41 cm H2O). Four patients fulfilled the criteria for IIH. Thirteen others did not have pressures high enough to diagnose IIH but still reported an improvement in headache after drainage of cerebrospinal fluid. Some patients also volunteered an improvement in other symptoms, including fatigue. No patient had any clinical signs of raised intracranial pressure.

Conclusions: An unknown, but possibly substantial, minority of patients with chronic fatigue syndrome may actually have IIH. An unknown, but much larger, proportion of patients with chronic fatigue syndrome do not have IIH by current criteria but respond to lumbar puncture in the same way as patients who do. This suggests that the two conditions may be related.

Objectives: To determine current evidence-based medicine skills and practice among trainees.

Design: Questionnaire study.

Setting: Electronic survey was sent to all obstetrics and gynaecology trainees in East Midlands South Deanery, and responses collected were anonymous.

Participants: All obstetrics and gynaecology trainees in East Midland South Deanery.

Main outcome measures: Self-reported attitude, skills and knowledge in various components of evidence-based medicine.

Results: 69 trainees were included in the study of which 35 responded. Among all respondents, almost 72% of trainees use non-evidence-based methods to find answers for their clinical questions, whereas only 18% use appropriate evidence-based medicine practice for such queries. Just 35% of trainees have minimum skills of literature searching. Most of the trainees struggle to understand various components of evidence-based medicine. Nearly 80% of trainees do not have formal education or training with regard to evidence-based medicine.

Conclusions: This study highlights the inadequacy of evidence-based medicine skills among trainees and urges that evidence-based medicine be incorporated in formal training along with specialty study modules.

Objectives: Provision of person-centred generalist care is a core component of quality primary care systems. The World Health Organisation believes that a lack of generalist primary care is contributing to inefficiency, ineffectiveness and inequity in healthcare. In UK primary care, General Practitioners (GPs) are the largest group of practising generalists. Yet GPs fulfil multiple roles and the pressures of delivering these roles along with wider contextual changes create real challenges to generalist practice. Our study aimed to explore GP perceptions of enablers and constraints for expert generalist care, in order to identify what is needed to ensure health systems are designed to support the generalist role.

Design: Qualitative study in General Practice.

Setting: UK primary care.

Main outcome measures: A qualitative study - interviews, surveys and focus groups with GPs and GP trainees. Data collection and analysis was informed by Normalisation Process Theory.

Design and setting: Qualitative study in General Practice. We conducted interviews, surveys and focus groups with GPs and GP trainees based mainly, but not exclusively, in the UK. Data collection and analysis were informed by Normalization Process Theory.

Participants: UK based GPs (interview and surveys); European GP trainees (focus groups).

Results: Our findings highlight key gaps in current training and service design which may limit development and implementation of expert generalist practice (EGP). These include the lack of a consistent and universal understanding of the distinct expertise of EGP, competing priorities inhibiting the delivery of EGP, lack of the consistent development of skills in interpretive practice and a lack of resources for monitoring EGP.

Conclusions: WE DESCRIBE FOUR AREAS FOR CHANGE: Translating EGP, Priority setting for EGP, Trusting EGP and Identifying the impact of EGP. We outline proposals for work needed in each area to help enhance the expert generalist role.

Objectives: To estimate the frequency of symptoms of obesity hypoventilation syndrome (OHS) in patients with obstructive sleep apnoea (OSA) and to evaluate comorbidities associated with OHS.

Design: Retrospective study based on patients' medical records and on further sleep tests performed in the study centre during the inclusion visit.

Setting: Respiratory Care Unit and Sleep Disorder Centre of the Zayed Military Hospital United Arab Emirates.

Participants: All patients referred to the study centre for a suspicion of sleep-disordered breathing.

Main outcome measures: Prevalence of OSA and OSA + OHS and comorbidities in patients with OSA and OHS.

Results: A total of 212 adult patients participated in the study. Of these, 107 patients (50.5% [43.8-57.1% CI 95%]) fulfilled diagnostic criteria for OSA, and the majority were men (79.4%). Among patients with OSA, 18 patients (16.8% [10.8-25.1% CI 95%]) fulfilled diagnostic criteria for OHS. In this group, women were more frequently affected than men (31.8% [7/22] vs. 12.9% [11/85], respectively; p = 0.03) and tended to be older than affected men, with a mean age of 55 ± 10.6 years versus 46 ± 13 for men. After adjustment for gender, OHS was significantly associated with hypertension (OR = 3.5; p = 0.03), diabetes mellitus (OR = 4.6; p = 0.02), ischaemic heart disease (OR = 5.1; p = 0.04) and pulmonary hypertension (OR = 16.1; p = 0.001).

Conclusion: OHS is a common condition in obese patients in the UAE and is associated with an increased risk of cardiovascular comorbidities and diabetes.