Raigmore Hospital Research Articles

33. Positive mental health in women living with breast cancer across geographic locations of residence: A data linkage study using the Scottish Health Survey

S S27 BCNs have also found the experience rewarding, with an enhanced breast diseases awareness and patient communication. In conclusion, a BCN-led TRC is an efficient and appreciated way of communicating benign result. http://dx.doi.org/10.1016/j.ejso.2015.03.033 33. Positive mental health in women living with breast cancer across geographic locations of residence: A data linkage study using the Scottish Health Survey Janni Leung, Gill Hubbard, Richard Kyle, Deirdre McLaughlin, Russell Mullen, Iain Atherton 1 School of Population Health, The University of Queensland, Brisbane, Australia 2 School of Nursing, Midwifery and Health, The University of Stirling, Inverness, UK The Highland Breast Centre, Raigmore Hospital, Inverness, UK Aims: Breast cancer campaigns and support groups emphasize the importance for breast cancer patients to stay positive. However, existing research on mental well-being of breast cancer patients focuses on the negative aspects of mental health, such as psychological distress, depression, and anxiety. This study aims to compare levels of positive mental health across breast cancer survivors living in primary cities and the rest of Scotland by time since diagnosis. Methods: Drawn from the 2008 to 2011 Scottish Health Survey (SHeS), the sample included 295 breast cancer survivors and 11,960 women with no cancer. The sample was categorised into four groups: 1) No cancer; 2) Breast cancer diagnosed 1 to 4 years ago; 3) Breast cancer diagnosed 5 to 10 years ago; and 4) Breast cancer diagnosed over 10 years ago. Positive mental health was measured using The Warwick-Edinburgh Mental Well-being Scale (WEMWBS). Control variables included age, marital status, ethnicity, education, smoking, drinking, occupation, and self-assessed general health. Results: Contrary to expectations, linear regression results showed that compared to the no cancer group, women who were diagnosed with breast cancer 1 to 4 years ago (B 1⁄4 3.51, 95%CI1⁄4 0.70,6.32) or 5 to 10 years ago (B 1⁄4 4.40, 95%CI 1⁄4 1.29,7.51) reported significantly higher levels of positive mental health. This was observed in women who lived in primary cities, and not in women who lived in the rest of Scotland. Conclusions: Breast cancer patients living in primary cities in Scotland displayed higher levels of positive mental health in the first ten years of diagnosis. Further research is warranted to examine the disparities in positive mental health between breast cancer patients living in primary cities and the rest of Scotland. http://dx.doi.org/10.1016/j.ejso.2015.03.034 34. Clinical audit of the assessment of osteoporosis by axial DXA scanning and treatment/prevention of bone loss in post menopausal women, commenced on adjuvant treatment for breast cancer with aromatase inhibitors Mark Sibbering, Karen Ives-Smith, Veronica Rogers Derby Hospitals NHSFT, Royal Derby Hospital, Derby, Derbyshire, UK Patients starting an aromatase inhibitor (AI) with early invasive breast cancer should be offered a ‘baseline’ dual energy x-ray absorptiometry (DXA) scan within 3 to 6 months of starting treatment (National Institute for Clinical Excellence 2009 CG-80). The UK expert group (2008), NICE (CG-8

P001. Rural-urban differences in screening mammography uptake in Australia and Scotland

P001. Rural-urban differences in screening mammography uptake in Australia and Scotland

General practitioner views of an electronic high-risk medicine proforma to facilitate information transfer.

The potential of warfarin related harm is increased if clinicians lack the full patient specific information to make informed decisions-an e-proforma has been developed to communicate this information on hospital discharge. To determine the views of general practitioners (GPs) on a warfarin discharge e-proforma. A cross-sectional survey of all GPs (n = 272) within the Raigmore Hospital catchment area of NHS Highland, Scotland. The response rate was 39.3 % (107/272). 84 (78.5 %) noticed recent changes to information supplied on discharge for warfarin patients. 64 (59.8 %) respondents thought this would result in more informed prescribing with regards to dosing, while 65 (60.7 %) felt this would improve safety. Accurate completion, timely receipt of the e-proforma and a realistic date for subsequent INR tests were considered important by GPs. This study suggests the use of an e-proforma to communicate information about a high-risk medication, warfarin, to GPs on discharge optimises safe, informed prescribing and monitoring in primary care. The development of a discharge e-proforma for other high-risk medication as a patient safety improvement measure should be explored.

UK survey of management of paediatric localized scleroderma

8 BSPAR107 SCLERODERMATOUS GRAFT VS HOST DISEASE C. McVitty, J. Stevenson, N. Martin, B. Gibson, A. M. Ewins, L. Jones, D. Shanks, C. Grant, M. Berry, J. Duncan and J. E. Davidson Royal Hospital for Sick Children, Glasgow, Royal Hospital for Sick Children, Edinburgh and Raigmore Hospital, Inverness, UK. Correspondence to: C. McVitty. E-mail: catrionamcvitty@googlemail.com Introduction: Cutaneous graft-vs-host-disease (GVHD) is common post-haematopoietic stem cell transplantation (HSCT). Sclerodermatous GVHD is rare, with few paediatric reports. Aims: To describe three paediatric cases of scleradermatous GVHD. Method: Retrospective case note review. Results: A 7-year-old girl was referred 2 years after matched HSCT for ALL. She subsequently presented with severe scleroderma on her legs with reduced range of movement (ROM) of her ankles. The disease progressed, involving her thighs and left arm, with significant joint contractures. She was successfully treated with methylprednisolone, MTX and physiotherapy (PT). A 4-year-old girl was referred 3 years after having two matched HSCTs for MHC class 2 deficiency. She presented with worsening contractures affecting her hands and legs with swelling, erythema and skin tethering. She was successfully treated with PT, occupational therapy (OT) splinting, prednisolone and MTX. A 6-year-old girl with beta thalassaemia major was referred 2 years post-HSCT. Buccal GVHD was noted 4 months post-transplant, treated with steroids and ciclosporin before extra-corporeal photophoresis. Despite initial improvement, hand function deteriorated with reduced ROM and grip strength. She was treated with prednisolone, MTX, PT and OT. Conclusion: Sclerodermatous GVHD is rare in children but results in significant morbidity. In these cases severe joint contractures were seen. Monitoring for early contracture post-HSCT and raising awareness of this potential complication should facilitate earlier diagnosis and better outcomes. Disclosure statement: The authors have declared no conflicts of interest.

Reviving post-take surgical ward round teaching

Learning in the clinical environment is an important feature of medical education. Ward-round teaching leads to relevant, applied and lasting learning of knowledge, skills and attitudes; however, on fast-paced ward rounds in specialties such as general surgery, the student experience is often suboptimal, and teaching can be overlooked. Clinical teaching fellows (CTFs) are postgraduate doctors ranging from foundation year-2 (FY2) level through to specialty trainees, who have elected to spend up to 2 years out of the programme to teach medical undergraduates. This article explores whether CTFs can successfully support the regular delivery of undergraduate medical teaching on the busy post-take surgical ward round (PTSWR). The CTFs at Raigmore Hospital, Inverness, planned and facilitated weekly, structured teaching sessions to accompany the PTSWR. This educational intervention was evaluated using pre- and post-intervention student questionnaires. The questionnaires focused on student enjoyment and depth of learning using Likert scales and free-text components. Students were also asked about barriers to learning on typical PTSWRs. The consultant surgeons leading on these rounds were issued separate questionnaires, to gauge their evaluation of CTF support. The main barrier to effective undergraduate ward round teaching was a lack of time on the part of clinical staff. Ward rounds accompanied by CTF support significantly increased student enjoyment (p < 0.0001) and perceived learning (p < 0.0001). Consultant surgeons were supportive of the teaching initiative. Support from CTFs on busy PTSWRs optimised student satisfaction, and was welcomed by clinical staff. CTF support could be widened to other busy ward rounds, e.g. acute medical takes, to enhance student learning and reduce the teaching burden on clinical faculty staff.

Nurse-led PICC insertion: is it cost effective?

Repeated attempts to cannulate small veins can cause considerable distress for patients and expend substantial staff time.For longer term venous access, a peripherally inserted central catheter(PICC) may be used instead of a peripheral cannula. Previous studies indicate that insertion of a PICC costs three times more than a cannula but the lifespan is substantially longer. This study aimed to compare insertion cost, patient satisfaction, and infection rates of PICCs for the two main staff groups (trained nurses and radiologists) inserting these devices in a district general hospital. The study took place over 4 months in 2012-13.A questionnaire was attached to all identified PICCs in stock at Raigmore Hospital to collect details of the date of insertion, patient involved, time taken, attendant staff grade and experience level,consumables used and insertion success. The lead author's personal observation of PICC insertion by different staff groups allowed estimation of staff time, costs and success rates. Patient experience and satisfaction was assessed before and after insertion using a patient questionnaire. PICC longevity, infection rates and failures were assessed by review of patient notes. The radiologist group had a statistically significant (p< 0.01) increased cost (42%) over the nurse group. Patient satisfaction regarding explanation of treatment before insertion was higher in the nurse group. Insertion success and infection rates were higher in the radiologist group. The authors conclude that the majority of PICCs can be safely performed without x-ray screening in a ward-based environment. This is likely to be the most cost-effective solution for large volume services.

Improving cancer teaching through videoconferenced multidisciplinary team meetings

Medical EducationVolume 47, Issue 11 p. 1133-1134 Really Good Stuff Improving cancer teaching through videoconferenced multidisciplinary team meetings Ian M Thomas, Ian M ThomasSearch for more papers by this authorJohn L Duncan, John L DuncanSearch for more papers by this author Ian M Thomas, Ian M ThomasSearch for more papers by this authorJohn L Duncan, John L DuncanSearch for more papers by this author First published: 13 October 2013 https://doi.org/10.1111/medu.12346Citations: 5 Correspondence: Ian M Thomas, Department of General Surgery, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, UK. Tel: 00 44 1463 255073; E-mail: imthomas@ntlworld.com Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article.Citing Literature Volume47, Issue11November 2013Pages 1133-1134 RelatedInformation

Haemorrhoids: 21st‐century management

Colorectal DiseaseVolume 14, Issue 8 p. 917-919 Leading Article Haemorrhoids: 21st-century management N. P. Ross, N. P. Ross Department of Surgery, Raigmore Hospital, Inverness, UKSearch for more papers by this authorD. R. Hildebrand, D. R. Hildebrand Department of Surgery, Raigmore Hospital, Inverness, UKSearch for more papers by this authorJ. P. Tiernan, J. P. Tiernan Department of Surgery, Northern General Hospital, Sheffield, UKSearch for more papers by this authorS. R. Brown, S. R. Brown Department of Surgery, Northern General Hospital, Sheffield, UKSearch for more papers by this authorA. J. M. Watson, A. J. M. Watson Department of Surgery, Raigmore Hospital, Inverness, UKSearch for more papers by this author N. P. Ross, N. P. Ross Department of Surgery, Raigmore Hospital, Inverness, UKSearch for more papers by this authorD. R. Hildebrand, D. R. Hildebrand Department of Surgery, Raigmore Hospital, Inverness, UKSearch for more papers by this authorJ. P. Tiernan, J. P. Tiernan Department of Surgery, Northern General Hospital, Sheffield, UKSearch for more papers by this authorS. R. Brown, S. R. Brown Department of Surgery, Northern General Hospital, Sheffield, UKSearch for more papers by this authorA. J. M. Watson, A. J. M. Watson Department of Surgery, Raigmore Hospital, Inverness, UKSearch for more papers by this author First published: 31 May 2012 https://doi.org/10.1111/j.1463-1318.2012.03086.xCitations: 9Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Citing Literature Volume14, Issue8August 2012Pages 917-919 RelatedInformation

Diagnostic and Complication Rate of Image-guided Lung Biopsies in Raigmore Hospital, Inverness: A Retrospective Re-audit

Background: Suspected lung malignancies that are deemed inaccessible by bronchoscopic biopsy undergo image-guided biopsies to obtain samples for histological study. A previous audit performed in 2008 assessed the diagnostic and complication rate of computed tomography (CT)-guided lung biopsies. This retrospective re-audit aimed to reassess the lung biopsies done in 2010. Standards: British thoracic society guidelines for Radiologically guided lung biopsy. Materials and Method: All patients who underwent image-guided lung biopsies at Raigmore Hospital, Inverness, in 2010 were included in the study. The imaging was either CT or ultrasound (US) and either fine-needle aspirate or core-biopsy samples were collected. Information on diagnostic rate, complications such as pneumothorax and haemoptysis, age, sex, size and depth of lesion were collected. Results: 108 biopsies were obtained by image guided lung biopsies from 101 patients during 2010. 80 lesions were malignant, 19 were benign and 2 undiagnostic. 7 biopsies had to be repeated. Diagnostic accuracy was 91.7% (99 biopsies). 21 patients (19.4%) had pneumothorax. 19 suffered from small pneumothorax while 2 (1.9%) required chest drain. 7 patients (6.5%) developed minor haemoptysis. Only 3 out of 108 biopsies were done under US scan. Conclusion: The diagnostic and pneumothorax rates are well within British thoracic society guidelines, whilst the minor haemoptysis rate is slightly higher. Further large-scale studies are indicated to assess the possible role of ultrasound as a potential imaging method for pleural based lung biopsies. DOI: http://dx.doi.org/10.3126/njr.v1i1.6315 Nepalese Journal of Radiology Vol.1(1): 1-7

Highland surgical boot camp—an apprenticeship in a week

Surgical training has changed: the apprenticeship model of training is dead, but what has taken its place? NHS Highland has developed the Highland surgical boot camp to help tackle this challenge. The boot camp is aimed at trainees at the beginning of their careers: early years specialty or core trainees and surgically minded foundation doctors. My course had nine participants from foundation year 1 to core training year 2. The excellent new Centre for Health Sciences at Raigmore Hospital in Inverness is a new facility with state of the art wet labs, clinical simulators, and a mock ward. The course was developed and is led by the general surgeons Angus Watson and Kenneth …

How does a Northern trust with unique geographical challenges compare with Scottish National data for all cancers in keeping terminally ill upper GI cancer patients out of hospital – To die at home?

s / International Journal of Surgery 10 (2012) S53–S109 S94 ABSTRACTS or a mean excess percent BMI loss (EBL) of 7.4 kg/m2. At 1 year, the mean reduction in BMI was 11.1 [EBL of 33.6 kg/m2]. At 2 years, the mean reduction in BMI was 13.29 [EBL of 41.5 kg/m2]. Correlation between preoperative weight loss versus weight lost at 1 and 2 years was performed. At 1 year & 2 years post-operatively, the Spearman Rank Correlation was 0.154 [p 1⁄4 0.208] and 0.069 [p 1⁄4 0.573] respectively (no statistical significant correlation). Conclusion: In this study, pre-operative dietary weight loss does not correlate with better outcomes following laparoscopic adjustable gastric banding. 1046: HOW DOES A NORTHERN TRUST WITH UNIQUE GEOGRAPHICAL CHALLENGES COMPARE WITH SCOTTISH NATIONAL DATA FOR ALL CANCERS IN KEEPING TERMINALLY ILL UPPER GI CANCER PATIENTS OUT OF HOSPITAL – TO DIE AT HOME? Angharad Jones , Ron Coggins , Jen Godsman . Raigmore Hospital, Inverness, UK; NHS Highland, North of Scotland, UK Aim: To study end of life care for Upper GI cancer patients diagnosed within geographically diverse northern NHS Highland. Methods: Four national databases were searched using ICD10 codes for Upper GI cancer for years 2005-2010. For patients diagnosed in this region, place of death (home, hospital, hospice or ‘other institution') was recorded and compared with Scottish national data for all cancers. Results: 978 Upper GI cancer patients were diagnosed within the study period. 298were excludedas place of deathwasunknown.Of the remaining 680 patients 237 (34.9%) died at home, 295 (43.4%) died in hospital, 96 (14.1%) died in hospice and 49 (7.2%) died in another institution. Of 75522 cancerdeaths in Scotlandbetween2004-2008equivalent percentageswere 24.3% (home), 51.9% (hospital), 17.6% (hospice) and 6.2% (‘other'). Highly significant differences betweenNHSHighlandandnationaldatawere found in both ‘at home' and ‘in hospital' deaths (p<0.0001). Conclusions: Over half of cancer patients in Scotland die in hospital and a quarter die at home. In our study group, fewer patients die in hospital with over one third dying at home. Despite Highland geographical challenges, ability to deliver end of life care for Upper GI cancer patients is uncompromised. 1155: ONE-STOP CHOLECYSTECTOMY CLINIC: A WAY FORWARD FOR THE FUTURE? K. Siddique, Sameh el-abyed, Sanjoy Basu. Wirral University Hospital,

To cement or not to cement? Selective uncemented hemiarthroplasty in elderly patients with intracapsular hip fractures: The Highland experience

Current evidence suggests that we should be moving away from Thompson9s hemiarthroplasties for patients with intracapsular hip fractures. Furthermore, the use of cement when inserting these prostheses is controversial. This study aims to show the Inverness experience. We performed a retrospective review of all NHS Highland patients who underwent a hemiarthroplasty for an intracapsular neck of femur fracture over the last 15 years. Demographics and the use of cement were documented. Further analysis of this group was performed to identify any of these patients who required revision of their prosthesis. Patients requiring revision had their case-notes reviewed to identify the cause for further surgery. From 1996 until present 2221 patients from the Highland area had a hemiarthroplasty for an intracapsular neck of femur fracture. 1708 where female (77%) and 513 male (23%). The ages ranged from 28 years to 104 years (mean 80 years, median 81). 2180 of this group had their operations in Raigmore Hospital with the remaining 41 at various centres throughout Scotland. 623 (28%)had a cemented hemiarthroplasty, with the remaining 1578 (72%) having an uncemented Thompson9s hemiarthroplasty. The revision rate for the cemented group was 2% (13 of 623 patients). In the uncemented group it was 0.4% (6 of 1578). Reasons from revision included dislocation, periprosthetic fracture, infection and pain. Current evidence from some joint registers regarding the use of Thompson9s hemiarthroplasty in the elderly is discouraging. The use of bone cement in this group with multiple co-morbidities is not without it9s risks. Our data suggests that uncemented Thompson9s hemiarthroplasties in low demand elderly patients with multiple co-morbidities can yield excellent results with less risk to the patients.

Retrospective Analysis of the Quality of Urological Patient Handovers

Retrospective Analysis of the Quality of Urological Patient Handovers

A Comparison of Rural and Urban Rheumatoid Arthritis Populations

There is evidence to suggest that remote populations have poorer clinical outcomes in certain disease processes such as asthma and cancer. This study looks to identify any disparities in the management of patients with rheumatoid arthritis in the context of rurality. A retrospective observational study was performed on all 1314 patients with a diagnosis of rheumatoid arthritis who have been under the care of the principal rheumatologist at Raigmore Hospital, Inverness, between the years 1994 and 2004 inclusive. Rurality was defined according to the Scottish Household Survey. Populations were assessed in terms of age; sex; duration of diagnosis; number of years of Disease Modifying AntiRheumatic Drugs (DMARD) therapy, prednisolone use and the number of musculoskeletal practical interventions undertaken (eg joint aspiration or replacement). Two thirds of patients were considered rural dwellers. No significant difference was established between the populations with regards to management. DMARD therapy had been prescribed in 77% of rural patients vs 70% of their city counterparts for a mean 5.4 and 4.0 years respectively. The proportion of patients exposed to prednisolone therapy and who underwent musculoskeletal procedures were equivalent. Rural dwellers, with rheumatoid arthritis in the Highlands of Scotland, do not appear to be disadvantaged in regards to their disease management in comparison to the urban population.

A Comparison of xylometazoline (Otrivine) and phenylephrine/lignocaine mixture (Cophenylcaine) for the purposes of rigid nasendoscopy: a prospective, double-blind, randomised trial

To evaluate if phenylephrine-lignocaine mixture (Cophenylcaine) nasal spray performs better than xylometazoline (Otrivine) spray for the purposes of out-patient rigid nasendoscopy preparation. Prospective, double-blind, randomised trial comparing visual analogue scores for out-patients receiving either phenylephrine-lignocaine mixture or xylometazoline, prior to undergoing rigid nasendoscopy as part of their assessment. Seventy-three patients requiring rigid nasendoscopy as part of their assessment were recruited to the study from Raigmore Hospital's out-patient clinic. These patients were randomised to receive a nasal spray comprising either phenylephrine-lignocaine mixture or xylometazoline, 10 minutes prior to rigid nasendoscopy. Double-blinding was adopted. After the procedure, the patient and the doctor independently completed separate visual analogue score-based questionnaires regarding the pain of the procedure and the ease of the examination, respectively. Analysis of the data using standardised statistical methods demonstrated that the phenylephrine-lignocaine mixture did not perform better than xylometazoline, to any statistically significant extent. Phenylephrine-lignocaine mixture is considerably more expensive and has potentially more side effects than xylometazoline. These study findings suggest that it is difficult to justify the use of phenylephrine-lignocaine mixture over xylometazoline, for nasal preparation prior to rigid nasendoscopy.

Peri‐operative iv fluids in diabetic patients – don’t forget the salt

Peri‐operative iv fluids in diabetic patients – don’t forget the salt

Re: Effective visualisation of small and mildly radio‐opaque foreign bodies in the aero digestive tract: picture archiving and communication systems

Clinical OtolaryngologyVolume 33, Issue 3 p. 291-292 Re: Effective visualisation of small and mildly radio-opaque foreign bodies in the aero digestive tract: picture archiving and communication systems S.K. Ross, S.K. Ross ENT Department, Raigmore Hospital, Inverness, UK. E-mail: [email protected]Search for more papers by this authorP. Spielmann, P. Spielmann ENT Department, Raigmore Hospital, Inverness, UK. E-mail: [email protected]Search for more papers by this author S.K. Ross, S.K. Ross ENT Department, Raigmore Hospital, Inverness, UK. E-mail: [email protected]Search for more papers by this authorP. Spielmann, P. Spielmann ENT Department, Raigmore Hospital, Inverness, UK. E-mail: [email protected]Search for more papers by this author First published: 05 June 2008 https://doi.org/10.1111/j.1749-4486.2008.01692.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL No abstract is available for this article. Volume33, Issue3June 2008Pages 291-292 RelatedInformation

Re: Antimicrobial prophylaxis in otorhinolaryngology/head and neck surgery

Clinical OtolaryngologyVolume 33, Issue 2 p. 153-153 Re: Antimicrobial prophylaxis in otorhinolaryngology/head and neck surgery M. Dhiwakar, M. Dhiwakar Department of Otolaryngology, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, UK.E-mail: dhiwamahi@yahoo.comSearch for more papers by this authorW.S. McKerrow, W.S. McKerrow Department of Otolaryngology, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, UK.E-mail: dhiwamahi@yahoo.comSearch for more papers by this author M. Dhiwakar, M. Dhiwakar Department of Otolaryngology, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, UK.E-mail: dhiwamahi@yahoo.comSearch for more papers by this authorW.S. McKerrow, W.S. McKerrow Department of Otolaryngology, Raigmore Hospital, Old Perth Road, Inverness IV2 3UJ, UK.E-mail: dhiwamahi@yahoo.comSearch for more papers by this author First published: 18 April 2008 https://doi.org/10.1111/j.1749-4486.2008.01645.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume33, Issue2April 2008Pages 153-153 RelatedInformation

A pit containing an undecorated Beaker and associated artefacts from Beechwood Park, Raigmore, Inverness

In 2004 an archaeological evaluation prior to development at Beechwood Park, adjacent to Raigmore Hospital, Inverness, revealed a pit which was found to contain both an undecorated beaker and a plano-convex flint knife at the base, with later slag from iron smithing dispersed in the fill. These associations are discussed and placed in their local and national context. Separately authored contributions include

Development of a national Scottish diabetic ketoacidosis protocol

AbstractDiabetic ketoacidosis (DKA) is a common diabetic emergency often managed by general physicians. However, in contrast to its management in children, there was no national guideline/protocol for adults until the recent national protocol was issued for use throughout Scotland. This national protocol was developed from the audit activity described in this article.A prospective audit of the management of DKA and local protocol adherence was carried out at Raigmore Hospital, Inverness (April 2000 to March 2001). This showed deficiencies in the management of DKA with delay in intravenous fluid and insulin administration, and laboratory monitoring being undertaken less frequently than recommended by local guidelines.In addition, 14 DKA management protocols from 17 Scottish trusts were reviewed. The rate and volume of fluid replacement varied slightly between the trusts. There was general agreement within protocols on laboratory monitoring, potassium replacement, insulin administration and bicarbonate usage.The audit showed that there was scope for improvement in the management of DKA and that there were sufficient similarities in protocols used throughout Scotland to allow collaboration on a national protocol. It is anticipated that this will serve to enhance the profile of guidelines and facilitate standardisation and therefore improvement in patient care. Copyright © 2007 John Wiley &amp; Sons.