The Ulster medical journal最新文献

Objectives: Whereas about 20% of emergency medical admissions in richer countries are neurological, the situation in poorer countries is less clear. To help clarify this we studied admissions data in a hospital in Nyala, Sudan and compared our findings with the results from a previous, methodologically similar study from Northern Ireland (NI).

Methods: Over three months the numbers of emergency medical admissions to Nyala Teaching Hospital were recorded, along with the percentage with neurological symptoms. The following information was also noted: diagnosis, mortality, the use of investigations, and referral to neurologists and neurosurgeons. The results were compared to a study from the Downe Hospital, NI carried out in 1987.

Results: Fifty-six (24%) of 234 medical admissions were neurological. Stroke (57%), infections (21%) and tumours (11%) made up 89% of neurological admissions, with epilepsy accounting for only 4%, a pattern quite different from the NI study. Mortality was 23% compared with 12% in the NI study. Referral to neurospecialists was similar.

Conclusion: Although emergency neurological admissions were slightly commoner, the most striking difference between Nyala and the NI study was the high proportion of stroke admissions in Nyala to the near exclusion of other neurological conditions. The first priority to improving neurological care in Nyala, (and by implication, sub-Saharan Africa), is a stroke prevention program.

Introduction: This study assesses the implementation of the introduction of an electronic healthcare record (EHCR) into the South Eastern Trust (SET) in Northern Ireland.

Aims: To address the effect of the introduction of EHCR on clinical efficiency, initial implications for patient care and staff wellbeing, and to provide guidance from lessons learnt for future implementation.

Method: Doctors employed and medical students on placement within the SET were asked to complete an electronic Likert survey during the system's initial three months of implementation.

Results: There were 151 responses across 25 specialties. Overall, 81% did not experience an improvement in working efficiency. 50% of respondents anticipated that inpatient efficiency would improve with time, while 19% did not. In the outpatient clinic environment, only 25% believe that efficiency will be improved with time and adaptation. Regarding administration, 45% believe that following introduction, administrative tasks placed on doctors are disproportionate to their clinical value for patient care. 67% stated that there was less time for medical education and training.

Conclusions: Despite an initial overall negative response towards EHCR participants have a positive attitude towards its potential to improve patient care. Concerns relating to system usability and administrative burden imposed by Epic on senior staff remain apparent throughout the study. 'A perfect system would have doctors freed up to do what we are trained to do'. Usability issues were identified as contributory to this dissatisfaction. Inadequate training was identified as a factor which made adaptation more challenging. This in particular is a consideration for those trusts yet to implement Epic.

Objective: To investigate timing and surgical approaches of multidisciplinary management of sinogenic subdural and extradural empyema in the paediatric population.

Methods: We performed a retrospective analysis of all cases of sinogenic subdural and extradural empyema at our tertiary referral centre over a 10-year study period from 1^st May 2012 to 1^st May 2022. Data on demographics, presenting features, surgical management, length of stay, radiological investigations, microbiology results and long-term morbidity was recorded in a spreadsheet for analysis.

Results: We identified 11 children (mean age 11.3 years ± 2.3). In this sample, 7 were male (63.6%) and 4 female (36.4%). There were 7 cases of subdural empyema (63.6%), 2 cases of extradural empyema (18.2%) and 2 cases with both subdural and extradural empyema (18.2%). There were significant underlying co-morbidities in 2 cases (18%). The frontal sinus was suspected source in 10 cases (91%). Endoscopic sinus surgery was performed in 10 cases (91%); with 9 of these cases (90%) as/with the initial operation or within 24 hours of initial operation. Craniotomy was required in 9 cases total (81%), with 5 cases (56%) as/with the initial operation or within 24 hours of initial operation. After initial craniotomy 4 cases (44%) required further neurosurgical evacuation of abscess. Additionally, 2 cases managed with initial burrhole later required craniotomy. All 3 cases of small volume subdural empyema without neurological deficit were initially managed with endoscopic sinus surgery only and all cases subsequently required craniotomy. All cases with subdural empyema required craniotomy (n=9) whereas all cases with isolated extradural empyema avoided craniotomy (n=2). There was a longer length of stay in those that presented with neurology or low GCS than those that did not (27 days ± 10 compared to 86 days ± 41, p= 0.009). Long term morbidity and repeated neurosurgical intervention were more common in those cases with subdural empyema than those without subdural empyema, (55% vs 0% and 67% vs 0% respectively) although only 2 patients did not have subdural empyema (no statistical analysis available given small numbers). A Streptococcus milleri group microbe was isolated in 82% of cases.

Conclusions: Endoscopic sinus surgery does not seem effective at preventing the need for craniotomy in cases of subdural empyema. It does have a role in aiding microbiological diagnosis. ESS may have a role in the treatment of extradural empyema and avoiding craniotomy. Subdural empyema has a higher morbidity and return to theatre rate than extradural empyema. Those that present with a neurological deficit or decreased GCS have a longer length of stay. Larger studies are required to assess the timing and extent of surgical interventions for subdural and extradural empyema.

It is a great privilege to assume the role of Honorary Editor of the Ulster Medical Journal from my predecessor, Professor David Armstrong. In doing so, it is important to mark his contribution to the Journal. During his tenure, David oversaw the publication of an eclectic mix of original papers, covering history, ethics and clinical medicine. His thought-provoking and erudite editorial pieces were crafted with literary flair. As I have recently come to appreciate, the role of editor involves considerable tenacity with regards to the independent peer-review process, a careful eye for detail and the skills of a diplomat. David is a busy clinician, and it could not have been easy to juggle an additional commitment as demanding as this one. The success of the UMJ flows, in no small part, from the wisdom of its Editorial Board. My colleague, Professor Peter Maxwell, opens a series of Guest Editorials, below, with a discussion on the challenges facing clinical academics in the workforce. I hope that policy makers will give careful consideration to the solutions that he proposes. A longstanding and steadfast supporter of this Journal, Professor John Hedley-Whyte, who is the David S. Sheridan Professor of Anaesthesia and Respiratory Therapy at Harvard University, has recently stepped down from the Editorial Board. His contribution as an author, particularly to the Medical History Section of this Journal, has been immense and continues in this Issue, on the subject of Hugh Percy, 10^th Duke of Northumberland. Professor Hedley-Whyte's colleagues on the Editorial Board have asked me to thank him for his many years of service and to wish him well for the future. My satisfaction in seeing this Issue of the Journal take shape over the summer was considerably tempered by the news of Professor Barry Kelly's death, in June. To describe Barry simply as a 'former editor' of this Journal hardly does justice to his contribution. I am grateful, therefore, to Professor Patrick Morrison, who has penned a fitting and moving obituary to a great thinker, whose loss will be felt far beyond his family, friends and colleagues.