The Effect of Increasing Two-Week Wait Referrals for Head and Neck Cancer in East Kent

In 1998 the UK government published its white paper The New NHS: Modern and Dependable, in which it first suggested that patients being referred with a suspicion of cancer should have a maximum wait of two weeks to see a specialist. The rationale for this was that outcomes for late-stage disease are significantly worse when compared with outcomes for early-stage disease (Table 1). It was assumed that reducing the wait to see a specialist would reduce the stage of disease at presentation.

Atosiban in the Management of Preterm Labour

The purpose of this review was to look at the evidence available for the use of atosiban as a tocolytic in cases of threatened preterm labour. A Royal College of Obstetricians and Gynaecologists Green Top Guideline concluded that there was no clear evidence to show a benefit to tocolysis in reducing perinatal and neonatal morbidity and mortality. Using a systematic literature search, we summarise the evidence available on the use of atosiban for the prevention of preterm birth and compare it with other commonly used tocolytic agents in terms of efficacy, patient preference and drug safety. We conclude that although atosiban appears to be the tocolytic of choice, a clear benefit of using tocolysis in all cases of threatened preterm labour remains to be justified and clinical management should be tailored according to individual needs.

Nursing sisters' satisfaction with the pharmacy service — a survey

A questionnaire was sent to all nursing sisters in Hammersmith and Queen Charlotte's special health authority, a provider of specialist hospital services in London. They were asked for their overall impression of the pharmacy service and staff, for their opinions of specific services and for suggestions for improving the service. Eighty-six per cent of respondents thought the service was good, very good or excellent and 92 per cent thought the service was either the same or better than that of other hospitals in which they had worked.

Just under half the suggestions received were for service improvements related to supply of drugs stocked on the ward. The other main areas commented on were drug delivery, discharge medication and the pharmacy on-call service. The survey provided useful information about the pharmacy service and has enabled the department to implement some of the changes suggested as well as look at the feasibility of other improvements. It is intended to repeat this survey annually.

Fabrication And Characterization of Thermoelectric Generators From SiGe Thin Films

Thermoelectric materials are being important due to their application in both thermoelectric power generation and microelectronic cooling. The thermoelectric power generations convert the heat change to electricity. The waste of heat could be useful if the thermoelectric power generation is applied. Effective thermoelectric materials have a low thermal conductivity and a high electrical conductivity. A high thermal conductivity causes too much heat leakage through heat conduction. The performance of the thermoelectric materials and devices is shown by a dimensionless figure of merit, ZT = S2σT/K, where S is the Seebeck coefficient, σ is the electrical conductivity, T is the absolute temperature and K is the thermal conductivity. ZT can be increased by increasing S, increasing σ, or decreasing K. In this study, we prepared thermoelectric generator devices of SiGe at the thickness of 112 nm using the ion beam assisted deposition (IBAD) system. Rutherford Backscattering Spectrometry (RBS) analysis was used for the elemental analysis. The 5 MeV Si ion bombardment was performed using the AAMU Pelletron ion beam accelerator to make quantum clusters in the film to decrease the cross plane thermal conductivity, increase the cross plane Seebeck coefficient and electrical conductivity. To characterize the thermoelectric generator devices before and after Si ion bombardment we measured the cross plane Seebeck coefficient, electrical conductivity by Van der Pauw method, and thermal conductivity by 3w method for different fluences.

Epidemiology of multiple pregnancy and the effect of assisted conception

Multiple pregnancy is one of the greatest perinatal challenges facing clinicians today. In a society of rising expectations among fertility and maternity service users, the potential for adverse outcomes associated with multiple pregnancy is a source of concern. This article examines the impact of assisted conception on the incidence of multiple pregnancies and associated complications. It explores some of the reasons for the strong association between assisted reproductive technology and multiple pregnancies and suggests possible ways of addressing this continuing problem.

Recurrence risk of stillbirth in a second pregnancy

OBJECTIVE

To examine the risk of recurrence of stillbirth in a second pregnancy.

DESIGN

Retrospective cohort study.

SETTING

Scotland, UK.

POPULATION

All women who delivered their first and second pregnancies in Scotland between 1981 and 2005.

METHODS

All women delivering for the first time between 1981 and 2000 were linked to records of their second pregnancy using routinely collected data from the Scottish Morbidity Returns. Women who had an intrauterine death in their first pregnancy formed the exposed cohort, whereas those who had a live birth formed the unexposed cohort.

MAIN OUTCOME MEASURE

Stillbirth in a second pregnancy.

RESULTS

After adjusting for confounding factors, the odds of recurrence of stillbirth in a second pregnancy were found to be 1.94 (99% CI 1.29-2.92) compared with women who had had a live birth in their first pregnancy. Other factors associated with recurrence of stillbirth in a second pregnancy included placental abruption (adjusted OR 1.96; 99% CI 1.60-2.41), preterm delivery (adjusted OR 7.45; 99% CI 5.91-9.39) and low birthweight (adjusted OR 6.69; 99% CI 5.31-8.42). A Bayesian analysis using minimally informative normal priors found the risk of recurrence of stillbirth in a second pregnancy to be 1.59 (99% CI 1.10-2.33).

CONCLUSIONS

Women who have stillbirth in their first pregnancy have a higher risk of recurrence in their next pregnancy.

Automatic spike sorting for neural decoding

While various automated spike sorting techniques have been developed, their impact on neural decoding has not been investigated. In this paper we extend previous Gaussian mixture models and expectation maximization (EM) techniques for automatic spike sorting. We suggest that good initialization of EM is critical and can be achieved via spectral clustering. To account for noise we extend the mixture model to include a uniform outlier process. Automatically determining the number of neurons recorded per electrode is a challenging problem which we solve using a greedy optimization algorithm that selects models with different numbers of neurons according to their decoding accuracy. We focus on data recorded from motor cortex and evaluate performance with respect to the decoding of hand kinematics from firing rates. We found that spike trains obtained by our automated technique result in more accurate neural decoding than those obtained by human experts.

Measuring laparoscopic operative skill in a video trainer

BACKGROUND

Laparoscopic surgery requires a unique set of technical skills. More experienced laparoscopic surgeons perform certain tasks more efficiently in a video trainer than less experienced laparoscopic surgeons. The presumption is that the experienced surgeon possesses more of the skill required to complete the task. This study sought to determine the degree to which previous laparoscopic operative experience influenced the performance of selected video trainer tasks of varying complexity.

METHODS

In this study, 19 general surgery residents with varying levels of laparoscopic operative case experience (as defined by operative case logs) were timed performing five tasks in a video trainer. The tasks were rope pass, peg drop, peg exchange, needle pass, and knot tie. All the residents watched a video demonstration of each skill before testing. None of the residents had previous exposure to video trainers, and no practice was allowed before testing. A composite score for all tasks was calculated for each resident as a measure of overall performance.

RESULTS

There was a strong correlation between operative experience and time required for successful completion of each task, with the exception of the rope pass. The magnitude of correlation increased with tasks of increasing complexity. Composite scores were correlated with operative experience. Significant interval improvements in performance were observed for increasing experience up to a level of approximately 100 previous laparoscopic cases.

CONCLUSIONS

Overall composite scores and time required for the completion of each individual video trainer task (with the exception of the rope pass) may be an accurate reflection of laparoscopic surgical skill acquired in the operating room. A resident may need as many as 100 laparoscopic cases for full development of a basic skill set in the operating room. A more efficient and safe method of training, such as a validated skills curriculum conducted in a dry lab, is a desirable alternative to developing skill exclusively in the operating room.

Drug related deaths amongst Glasgow city hostel dwellers

The problems of homelessness and drug misuse are every day issues encountered in today's society. Over the past 2 years the number of hostel residents overdosing within their rooms in the city of Glasgow was shown to increase. Approximately three-quarters of deaths involved heroin, of which 56% also involved at least one benzodiazepine. This paper demonstrates a dearth in the literature relating to drug misuse amongst the homeless population, highlighting an area in need of address by the appropriate authorities.

The impact of past alcohol use on treatment response rates in patients with chronic hepatitis C

BACKGROUND

Studies have shown that past alcohol consumption reduces response rates in patients with chronic hepatitis C treated with interferon monotherapy.

AIM

To clarify the importance of alcohol consumption on response rates in patients undergoing treatment with pegylated interferon and ribavirin.

METHODS

In a single centre, prospective study, median daily alcohol consumption (determined by previously validated method) and quartiles of alcohol consumption were calculated. Univariate and binary logistic regression analyses were performed using treatment response status as the dependent variable.

RESULTS

Overall, in an intention-to-treat analysis, 34 of 115 patients (30%) responded to treatment. In univariate analysis, black patients, especially those with hepatitis C virus genotype 1, high viral load and low alanine aminotransferase were significantly less likely to respond. Predictors of response by regression analysis included alcohol <30 g/day (OR=3.02, 95% CI: 1.02-8.93; P=0.04), non-genotype 1 status (OR=1.98, 95% CI: 1.03-3.80; P=0.04) and non-black race (OR=2.79, 95% CI: 1.33-5.85; P=0.006).

CONCLUSIONS

Median daily alcohol use >30 g/day is associated with failure to respond to pegylated interferon and ribavirin for treatment of hepatitis C. Past alcohol use should be evaluated when considering treatment for hepatitis C.

Number II Pemphigus vulgaris

Pemphigus is a group of potentially life-threatening autoimmune diseases characterized by cutaneous and/or mucosal blistering. Pemphigus vulgaris (PV), the most common variant, is characterized by circulating IgG antibodies directed against desmoglein 3 (Dsg3), with about half the patients also having Dsg1 autoantibodies. There is a fairly strong genetic background to pemphigus with linkage to HLA class II alleles and ethnic groups such as Ashkenazi Jews and those of Mediterranean and Indian origin, are especially liable. Oral lesions are initially vesiculobullous but readily rupture, new bullae developing as the older ones rupture and ulcerate. Biopsy of perilesional tissue, with histological and immunostaining examination are essential to the diagnosis. Serum autoantibodies to either Dsg1 or Dsg3 are best detected using both normal human skin and monkey oesophagus or by enzyme-linked immunosorbent assay. Before the introduction of corticosteroids, PV was typically fatal mainly from dehydration or secondary systemic infections. Current treatment is largely based on systemic immunosuppression using corticosteroids, with azathioprine or other adjuvants or alternatives but newer therapies with potentially fewer adverse effects, also appear promising.

Number 1Epithelial biology

The oral mucous membrane has features similar to skin but also differs in several ways. This paper reviews the aspects of epithelial biology necessary for an understanding of the vesiculoerosive disorders.

Non-traumatic forensic neuropathology

The practicing Forensic Pathologist is likely to encounter case material in which either the cause of death or a major contribution to the cause of death is underlying damage to or disease of the central nervous system. While it is good practice in many instances to have a working relationship with a Department of Neuropathology, from which advice and practical help can be sought, there may be instances when the Forensic Pathologist needs to proceed on a basis of a working knowledge of Forensic Neuropathology up to and including how to examine the specimen and take tissue blocks for processing and subsequent histological examination. Some of the more common conditions of the central nervous system such as damage consequent to hypoxia-ischaemia, hypoglycemia and epilepsy, the encephalopathies associated with altered sodium concentration, deficiency due to Vitamin B(1) and various neurodegenerative diseases that manifest as dementia and include Alzheimer's disease, cortical Lewy body disease and the prion disorders, are outlined in this article.