Scot Med J
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The Scottish Bowel Screening Programme aims to detect cancer in asymptomatic individuals. We aimed to measure the prevalence of lower gastrointestinal symptoms in faecal occult blood (FOB) screen-positive patients, to correlate the symptoms with neoplasia and to compare the predictive value of FOB screening with urgent symptomatic referrals in Ayrshire and Arran. ⋯ Half the FOB screen-positive patients had bowel symptoms. Symptoms in these patients had no correlation with an increased rate of neoplasia. The PPV for neoplasia is superior in symptomatic and asymptomatic screen-positive patients when compared to conventional urgent symptom-based referral.
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Prompt and accurate assessment of patients with chest pain likely of cardiac origin (of recent onset) is important and requires excellent coordination between the specialist cardiology services with general/emergency medicine and primary care physicians. The presence of clear guidelines helps streamline this process for all stakeholders, to meet the requirements set out in with the National Service Framework for managing coronary artery disease (CAD). However, the new guidance offered by NICE guideline 95 (March 2010)(1) for evaluation of patients in England and Wales with chest pain of recent onset, represent several major changes to its former guideline (NICE TA 73), and the Scottish Intercollegiate Guidelines Network (SIGN) guideline 96 (2007, which is based on recommendations from European Society of Cardiology(2)) currently guiding the management of such patient in Scotland. This is likely to cause confusion and lack of uniformity in assessing patients across the United Kingdom. ⋯ If the NICE guidance on chest pain of recent onset had been implemented in our study population, the need for change of the offer of specific first line tests (as discussed above) means that, a major re-organisation in both the services in RACPCs and the current process of referral to these specialists cardiac services from the primary care physicians will be required. Whilst acknowledging that regional variations may exist in the proportions of tests needed (depending on the incidence and prevalence of CAD and risk factors), these figures from our study represent a much higher level of need of these specialist tests for patients attending RACPCs than initially suggested by contemporary reviews. We therefore conclude that data from larger studies in many regions may be useful for understanding the degree of regional and national changes required for organising the structure and referrals to specialist cardiac services in Scotland, if an equitable service based on NICE guidance 95 is rolled out throughout United Kingdom in future.
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Advance warning of patients who are difficult to intubate may prevent an airway catastrophe but relies on effective communication between specialties. Anaesthetists aim to inform general practitioners whenever a difficult airway is encountered and expect general practitioners to include this information in subsequent referrals. We investigated how anaesthetists communicated with general practitioners, their knowledge of the Read Code (used by general practitioner computer systems) for difficult tracheal intubation, and how likely general practitioners were to pass the information on. ⋯ Communication between anaesthetists and general practitioners is currently poor, but could be improved by simplifying difficult airway letters and including the SP2y3 code and a statement of priority.
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Older people represent the fastest growing sector of society and a growing proportion of those undergoing elective surgery. Older people are at the highest risk of increased length of stay and postoperative complications. We evaluated the development of a nurse-led multidimensional preoperative assessment for older people. ⋯ Delays were reduced from 9.9% to 2.3% (P = 0.004) and fewer procedures were cancelled at pre-assessment (17.7% before, 5.2% after; P < 0.001). Serious postoperative complications were reduced from 8.5% to 2.3% (P = 0.01). Coordinated multidisciplinary preoperative assessment in the elderly may reduce complications and length of stay.
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The aim of this study was to determine the current clinical practice of UK stroke physicians with regard to the early management of blood pressure (BP) and arrhythmia detection following acute stroke. Postal service evaluation questionnaires were sent to the lead physicians for stroke in UK hospitals. Hospitals were identified by their inclusion in the 2008 Scottish Stroke Care Audit and the 2006 Royal College of Physicians Sentinel Stroke Audit. ⋯ Of all respondents, 87% expressed interest in participating in future trials of complex interventions for stroke. Current practice of UK stroke physicians regarding acute BP intervention is diverse, reflecting conflicting evidence. There is interest in the stroke community for further research aiming to answer these important clinical questions.