Res Medica (E-Journal)
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Audit into the Appropriateness of CT Cervical Spine Scan Requesting in the Emergency Department
Get PDFIntroduction: The use of computed tomography (CT) imaging of the cervical spine (CS) is now the recommended primary screening modality for suspected CS injuries following trauma. The aim of this audit is to review the appropriate use of CS CT imaging in the emergency department (ED) and assess compliance with the National Institute for Health and Care Excellence (NICE) head injury clinical guidelines.Methods: Charts were reviewed for the last 50 trauma patients to receive a CS CT scan following a request from the ED at University Hospital Limerick between 10 July 2013 and 19 December 2013. The NICE clinical guideline 176 on head injury was used as the standard of care. These data were used to perform a retrospective audit to assess patients who satisfied NICE criteria to qualify for a CS CT scan.Results: 45 patients who had undergone a CS CT scan were identified, this group had a mean age of 42 years and 71% of them were male. At least one of the NICE guideline criteria was fulfilled in 100% of patients who had a CS CT, with 2.64 of the criteria fulfilled on average. Plain-film X-ray radiography (PF) was inadequate for diagnosis in 20 (44.4%) patients.Discussion: ED consultants appropriately refer patients for CS CT scans following CS trauma and adhere to NICE head injury clinical guidelines.Conclusion: Having guidelines in place in the ED and adopting CS CT imaging as an initial screening modality following CS injury may reduce time to definitive care and improve resource implications
Research Topic: Distribution of Sexually Transmitted Diseases in the City of Edinburgh
Get PDFThe main aim of this research study was seen as a prototype to test the feasibility of a possible large scale project whose results could be used as a planning tool for provision of future facilities for the treatment and care of patients with sexually transmitted diseases. If fully developed, regular, possibly monthly figures might be produced which would aid the correlation of venereal disease incidence with that of other diseases and environmental factors, although ideas on these lines are at present essentially tentative
The Rectal Examination
Get PDFDIGITAL EXAMINATIONThe use of the observer\u27s eyes and forefinger with the initial chant of, “Now just turn over on your left side facing away from me and draw your knees up”, so realistically caricatured by O ’Grady (1963) is the first step in the “rectal” .Whatever the selected patient position, ensure that you have a good light on the perianal area and provide an intermittent commentary for the patient’s benefit. Part the buttocks and make a thorough visual examination of the anal area for evidence of trauma, sore patches of skin, lichenification, ulcers, thread worms, blood or mucous, “piles” and skin tags, fissures and fistulae, pilonidal sinus, the highly contagious syphilitic condylomata (warts) or other signs of anal sexual contact, or a prolapse of piles, anal canal or uterus, and note whether the anus is withdrawn or patulous
The Pineal Gland
Get PDFAlthough the pineal gland (epiphysis cerebri) has been noted in medical writings for at least 2,000 years its possible physiological role remains unresolved. Early Greek anatomists, including Herophilus and his disciples, believed that the cerebral ventricles were the seat of the mind and that the pineal body or conarium had a sphincteric function to regulate the flow of thought. This concept was refuted by Galen who concluded that the pineal was probably a gland, similar to the lymph glands. Belief in a thought sphincter persisted and Galen ascribed this function to the cerebellar vermis.In the seventeenth century Descartes established the idea that this organ was the seat of the soul. It is an awe-inspiring reflection of the power of Cartesian authority that, three centuries later, this is still the first association in the minds of many when the pineal gland is mentioned. His opinions were not accepted by everyone. Thomas Gibson, for example, in his descriptions of the anatomy of the brain in 1763 returned to the genital analogies of the early anatomists with respect to the pineal body.“The first is Glandula pinealis, or Penis; because it representeth the Pine-nut, or a Man’s Yard. It is seated in the beginning of that Pipe, by which the third and fourth Ventricles are united . . . This Gland des Cartes thinks to be the primary seat of the Soul, and that all animal operations draw their origine from it. But Bartholin has sufficiently confuted that opinion; for it seems to be but of the same use as other glands, and particularly the GlanduIa pituitaria placed near to it, viz. to separate the Lympha from the Arterial blood; which Lympha is resorbed by the Veins . . . Near to this on both sides of this third ventricle four round bodies appear. The two upper are lesser and are called Testes: the two greater are lower, and are called Nates. The chink between the Nates is called Anus”
The Defence Mechanism on Malignant Disease
Get PDFFrom a dissertation read before the Society on November 6th, 1968.The original suggestion implicating immunological factors in the natural history of malignant disease has been ascribed to Paul Ehrlich (1). Confirmation of this concept has waited fifty years for developments in knowledge and technique but its application allows not only some understanding of observed phenomena, but speculation on a rational approach to treatment and on a scientific establishment of the aetiological factors involved.Traditional teaching defines this group of conditions by the type of tissue change involved, the degree of differentiation and extent of spread. From these a prognosis is assessed and the clinical picture tends to be one of steady progression, interrupted by therapeutic endeavour, but culminating in the death of the patient. Variations on this picture are seen in clinical practice
Contraception
Get PDF“ Every Child a Wanted Child” — this was the stated ambition of a campaign launched by the Family Planning Association in June, 1969. Few enlightened people would disagree with this ideal, yet the majority give little thought as to how it can be achieved and most are quite unaware of how difficult it is for women, especially among the lower social groups, to obtain advice on contraception. Millions of pounds are spent each year in anattempt to stop the world population explosion, but in Great Britain, one of the most densely populated countries in the world and one which boasts of its Welfare Services, free Family Planning advice is available to only a small percentage of women. It is estimated that in Scotland as few as 25-35% of pregnancies are planned. One in three of babies born to mothers under the age of 20 are conceived before marriage. The illegitimacy rate is rising steadily. Add to these the number of abortions which are induced therapeutically or illegally each year and a dismal picture of unplanned pregnancy emerges
Auto-immunity Fact or Fiction
Get PDFRead before the Society Wednesday 14th January 1970.The recognition that the mammalian organism is capable of developing an immune response against its own normal tissue components has aroused interest in the implication of auto-immune reactions in human disease.This interest may, however, be too widely applied, and the label “auto-immune” may be applied to a particular clinical entity with a complete disregard for the rather exacting criteria which this aetiology demands; indeed one might say that the word auto-immune is almost synonymous with the word idiopathic, in the clinician’s dictionary.Some definitions first. By auto-immune disease it is widely understood that there is a failure at some point for the body to differentiate between its own tissue components and those of a foreign material; it can no longer distinguish, if one likes to put it in more crude terms, between “self” and “non-self” . Consequently the host launches an immunological response towards its tissue components, with the resulting pathological changes and clinical manifestations
Pulmonary Insufficiency in the Critically Ill
Get PDFIn recent years clinicians concerned with intensive care have become increasingly aware that pulmonary insufficiency may develop shortly after the apparently successful immediate resuscitation of the critically ill. The incidence of this complication is high, a figure between 30% and 50% being generally accepted (1). In its initial stages respiratory tract infection does not appear to play a part though bronchopneumonia may later supervene.The impact of this adult respiratory distress syndrome (ARDS) on surgeons dealing with extensive trauma, sepsis, burns and haemorrhagic shock has been dramatic and since 1968, when the first conference devoted to the pulmonary effects of nonthoracic trauma was held (2), investigation into the problem has been energetic. Essentially two opposing viewpoints have evolved to account for the occurrence of ARDS. That they are interrelated should become clear in the following discussion
Teviot Place now:— The Edinburgh Medical School in 1978
Get PDFIn the history of every Medical School there are periods of calm and times of intense activity. Some of the medical teachers in Edinburgh have already experienced three very active phases. First there was 1939 when there occurred the trauma and disruption of World War II. Seven years later came the immediate post-war period, when new members of staff were being recruited, former teachers were returning, and the intake included a large number of \u27mature\u27 students. The third peak of activity, which overlapped with the second, was in 1948 when the National Health Service was introduced and the teachers in general found themselves becoming employees either of the University or the N.H.S., not always being allotted to the employer of their own choice. Some would say that a fourth time of unusual activity was in 1963 when a new curriculum was introduced
The Edinburgh Medical Curriculum A Personal View
Get PDFStudents who are now studying Medicine in Edinburgh are obviously unable to compare the current curricular arrangements with those that preceded the changes which took place in 1977. It may therefore be useful to recall the major defects of the previous medical course as they were identified in the Fourth Report of the Review Committee set up by Faculty in 1973. The purpose in doing so is not so much to indulge in nostalgia but more to try to assess the extent to which the present curriculum has succeeded in remedying the flaws that were then seen. It may also help the new generation of students to see the direction in which future changes may be desirable