Scot Med J
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Clinical Trial Controlled Clinical Trial
Setting up a pain management programme. The Ayrshire experience.
A controlled trial of an outpatient cognitive behavioural pain management programme for sufferers of non-cancer chronic pain is described. A multidisciplinary team set up a programme of ten half day sessions for groups of ten to fourteen patients aiming to improve activity levels and control over pain; to reduce maladaptive pain behaviours and drug intake; to mitigate negative mood; to modify unhelpful beliefs and to maintain treatment gains by operant and cognitive methods. ⋯ Fifty-eight patients entered the study group and 39 patients completed the programme and initial follow up with further attrition in long term follow up. There were no changes in the waiting list control group of twelve subjects but the study group made significant short and long term improvements in pain severity, activity levels, mood, coping and experienced fewer catastrophizing thoughts.
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Comparative Study
Disparities in the geographical distribution of authorship between invited and peer reviewed papers.
Fifty issues of the British Medical Journal (BMJ), The Lancet, The British Journal of Psychiatry and Psychological Medicine were scrutinized. Papers were designated as invited or peer reviewed and the geographical location of the first author was recorded. For UK-based authors, the latitude and longitude of the host institution was noted and was allocated to one of the UK regions. ⋯ For individual Journals, the Lancet and the British Journal of Psychiatry showed fewer regional disparities in authorship than the BMJ and Psychological Medicine. These disparities may lead to nationalism and parochiality in the content of invited papers. Journal editors may wish to review selection practices for authorship of invited papers.
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A postal survey of all senior anaesthetists with routine commitment to an acute trauma list in 13 Scottish hospitals was conducted to delineate contemporary anaesthetic practice for hip fracture surgery. Almost equal use of general and regional anaesthesia was reported, however the techniques used for general anaesthesia were different from those described in previous literature in this group. ⋯ However these conclusions relate to techniques and drugs which are now rarely used during general anaesthesia for hip fracture surgery. Further work to assess the impact of new techniques and agents on outcome for this group of patients may be required.
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Fingertip and nailbed trauma caused by doors is common in children, occurring when fingers are either shut in the door itself or are trapped in the hinge as the door is closed. An audit was carried out over five months of all fingertip and nailbed injuries due to trauma from a door. One hundred and eighty eight children, 2% of all attendances in this period, had sustained such trauma, 39% of these occurring in children under four years of age. ⋯ Avulsion of the nail from the nailbed or amputation of part of the fingertip and 29 (15%) of all the cases required a general anaesthetic for exploration, cleaning and repair. The Plastic Surgery department followed up these 29 children and 71 Accident & Emergency follow-up appointments were generated by the remaining injuries. The incidence of significant injury was higher than expected and caused considerable distress to both the children and their parents, It is suggested that home safety protocols should feature advice on how to avoid these injuries.
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In a previous paper on mortality audit we reported on the use of treatment limiting decisions (TLDs) in a neurosurgical unit in the year 1988. In this paper we compare the findings of a similar audit for 1997. It appears that our unit's policy of openly discussing all TLDs in patients who die had led to such decisions being made at a more appropriate stage in the patient's illness. Regular review of TLDs is probably helpful in increasing the confidence of clinicians to make these difficult decisions openly and timeously.