Scottish Hospital Research Articles

Association between suicidal symptoms and repeat suicidal behaviour within a sample of hospital-treated suicide attempters.

BackgroundSuicidal behaviour is the end result of the complex relation between many factors which are biological, psychological and environmental in nature. Network analysis is a novel method that may help us better understand the complex association between different factors.AimsTo examine the relationship between suicidal symptoms as assessed by the Beck Scale for Suicide Ideation and future suicidal behaviour in patients admitted to hospital following a suicide attempt, using network analysis.MethodSecondary analysis was conducted on previously collected data from a sample of 366 patients who were admitted to a Scottish hospital following a suicide attempt. Network models were estimated to visualise and test the association between baseline symptom network structure and suicidal behaviour at 15-month follow-up.ResultsNetwork analysis showed that the desire for an active attempt was found to be the most central, strongly related suicide symptom. Of the 19 suicide symptoms that were assessed at baseline, 10 symptoms were directly related to repeat suicidal behaviour. When comparing baseline network structure of repeaters (n=94) with the network of non-repeaters (n=272), no significant differences were found.ConclusionsNetwork analysis can help us better understand suicidal behaviour by visualising the complex relation between relevant symptoms and by indicating which symptoms are most central within the network. These insights have theoretical implications as well as informing the assessment and treatment of suicidal behaviour.Declaration of interestNone.Copyright and usage© The Royal College of Psychiatrists 2017. This is an open access article distributed under the terms of the Creative Commons Non-Commercial, No Derivatives (CC BY-NC-ND) license.

The Lazarus phenomenon: spontaneous cardioversion after termination of resuscitation in a Scottish hospital

A 66-year-old man suffered a ventricular fibrillation cardiac arrest after an episode of chest pain. Despite advanced life support, his condition deteriorated; the situation was considered irrecoverable and resuscitation was...

39th ANNUAL CARRELL-KRUSEN NEUROMUSCULAR SYMPOSIUM, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 23–24, 2017

The Annual Carrell-Krusen Neuromuscular Symposium is a unique conference attended by more than 200 each year at the Texas Scottish Rite Hospital for Children. Its name honors Dr. Brandon Carrell who retired as physician-in-chief at Texas Scottish Rite Hospital in 1978 and Dr. Ed Krusen who organized the first Muscular Dystrophy Association clinic in Dallas. This Symposium began in 1978 under the leadership of Dr. Jay Cook as a Muscular Dystrophy Clinic Directors' meeting and is now jointly sponsored by the hospital, the Muscular Dystrophy Association, Childrens' Medical Center of Dallas, and the University of Texas Southwestern Medical Center. The Symposium has grown to be the most popular clinical meeting for neuromuscular specialists in the country. During the 2 day meeting, attendees participate in lively discussions while meeting interesting and challenging patients. Attendees are invited to contribute interesting electrodiagnostic and histopathologic cases to review with the group. The visiting professor, the recipient of the Carrell-Krusen Award, gives the keynote lecture. Currently, the Program Director is Dr. Susan T. Iannaccone and Co-Directors Dr. Jaya Trivedi and Dr. Diana Castro.

A qualitative study of determinants of patient behaviour leading to an infection related hospital admission.

Objectives To describe and understand the determinants of patients' behaviours surrounding admission to hospital for an acute infective episode Method Patients admitted to the infection or acute medicine admission units of a major Scottish teaching hospital and commenced on antibiotic therapy after admission were included. Semi-structured face-to-face interviews were conducted using a pre-piloted interview schedule guide that focused on gathering information about patient behaviours and experiences prior to admission to hospital with an acute infection. Interviews were audio-recorded, transcribed verbatim and analysed using the Framework Approach. Emerging themes were matched to the Theoretical Domains Framework of behavioural determinants. Results Twenty-one patients consented to participate and 18 transcripts were suitable for analysis. The most common infections were those of the skin, soft tissue and respiratory tract. From the patients' perspectives, behavioural determinants that appeared to impact their admission to hospital were principally their knowledge, beliefs of consequences, the environmental context and resources (mainly out-of-hours services), social influences and their own emotions. Determinants such as knowledge of the signs and symptoms, beliefs of consequences and environmental context were facilitators of health seeking behaviours. The main barriers were a lack of awareness of consequences of infection potentially leading to delayed admission impacting infection severity, stay in secondary care and resource utilisation. Conclusions This study has shown that any initial patient-centred intervention that is proposed to change patient behaviour needs to be based on behavioural determinants emerging in this research. The intervention may include aspects such as patient education on resources available out-of-hours and ways to access the healthcare system, education on recognising signs of infection leading to prompter treatment and positive reinforcement for patients who present with recurrences of infection.

Mental hospital life in the 50s.

The recollections of a retired psychiatrist concerning his time as a house doctor in a 1952 Scottish mental hospital. These pertain to early days of the National Health Service. He describes the routines and practices of those times, and he refers to some of his reactions to his experiences.

Evaluating the effectiveness, impact and safety of live attenuated and seasonal inactivated influenza vaccination: protocol for the Seasonal Influenza Vaccination Effectiveness II (SIVE II) study

IntroductionSeasonal (inactivated) influenza vaccination is recommended for all individuals aged 65+ and in individuals under 65 who are at an increased risk of complications of influenza infection, for example, people...

Emergency Department redirection to primary care: a prospective evaluation of practice.

Background and aim Non-urgent Emergency Department presentations contribute to overcrowding, which can adversely affect patient care. Redirecting patients to a more appropriate service is an option to help address this. We conducted a prospective evaluation of a major Scottish hospital's Emergency Department redirection policy to assess its safety. Methods and results Over two months, 620 patients triggered senior assessment for redirection with 444 (72%) redirected to primary care. Information on presentation was collected with subsequent management and outcome of redirection provided by the patient's general practitioner. Those who required admission within seven days of redirection triggered review. This was carried out independently by an Emergency Department Consultant and a GP Principal to assess the incidence of sub-optimal care or harm as a consequence of redirection. Most patients presented during daytime hours with no significant variation between days. 'Patient factors' accounted for 74% of presentations with 'convenience' (20%) cited as the most common reason. Twenty-two patients were subsequently admitted, with one case of sub-optimal care (incidence 0.23%) and no cases of harm. Conclusions Our redirection policy provides a safe and effective means of directing patients to more appropriate care. The authors believe this to be in the patient s best interest as Emergency Department clinicians are not specifically trained to manage primary care issues.

To 'take their place among the productive members of society': Vocational rehabilitation of WWI wounded at Erskine

In 1916, the foundation of the Princess Louise Scottish Hospital for Limbless Sailors and Soldiers (still in existence today as Erskine), on the banks of the River Clyde in Scotland, was a direct response to the need for specialised medical facilities to deal with the unprecedented number of injured service personnel returning from the Great War. At the hospital, the West of Scotland medical and industrial communities came together to mend broken bodies with prosthetic technology, as well as physical and mental rehabilitation to prepare the limbless to re-enter the job market. This paper explores the establishment of manual therapy workshops at Erskine and how such programmes of vocational rehabilitation were culturally informed by the concerns and anxieties of both the military and civilian populations of the First World War-era.

Ethnic Variations in Liver- and Alcohol-Related Disease Hospitalisations and Mortality: The Scottish Health and Ethnicity Linkage Study.

Aims Preventing alcohol-related harms, including those causing liver disease, is a public health priority in the UK, especially in Scotland, but the effects of ethnicity are not known. We assessed liver- and alcohol-related events (hospitalisations and deaths) in Scotland using self-reported measures of ethnicity. Methods Linking Scottish NHS hospital admissions and mortality to the Scottish Census 2001, we explored ethnic differences in hospitalisations and mortality (2001–2010) of all liver diseases, alcoholic liver disease (ALD) and specific alcohol-related diseases (ARD). Risk ratios (RR) were calculated using Poisson regression with robust variance, by sex, adjusted for age, country of birth and the Scottish Index of Multiple Deprivation (SIMD) presented below. The White Scottish population was the standard reference population with 95% confidence intervals (CI) calculated to enable comparison (multiplied by 100 for results). Results For all liver diseases, Chinese had around 50% higher risks for men (RR 162; 95% CI 127–207) and women (141; 109–184), as did Other South Asian men (144; 104–201) and Pakistani women (140; 116–168). Lower risks for all liver diseases occurred in African origin men (42; 24–74), other White British men (72; 63–82) and women (80; 70–90) and other White women (80; 67–94). For ALD, White Irish had a 75% higher risk for men (175; 107–287). Other White British men had about a third lower risk of ALD (63; 50–78), as did Pakistani men (65; 42–99). For ARD, almost 2-fold higher risks existed for White Irish men (182; 161–206) and Any Mixed Background women (199; 152–261). Lower risks of ARD existed in Pakistani men (67; 55–80) and women (48; 33–70), and Chinese men (55; 41–73) and women (54; 32–90). Conclusions Substantial variations by ethnicity exist for both alcohol-related and liver disease hospitalisations and deaths in Scotland: these exist in subgroups of both White and non-White populations and practical actions are required to ameliorate these differences.

To 'take their place among the productive members of society': Vocational rehabilitation of WWI wounded at Erskine

In 1916, the foundation of the Princess Louise Scottish Hospital for Limbless Sailors and Soldiers (still in existence today as Erskine), on the banks of the River Clyde in Scotland, was a direct response to the need for specialised medical facilities to deal with the unprecedented number of injured service personnel returning from the Great War. At the hospital, the West of Scotland medical and industrial communities came together to mend broken bodies with prosthetic technology, as well as physical and mental rehabilitation to prepare the limbless to re-enter the job market. This paper explores the establishment of manual therapy workshops at Erskine and how such programmes of vocational rehabilitation were culturally informed by the concerns and anxieties of both the military and civilian populations of the First World War-era.

Routine histological examination of epidermoid cysts; to send or not to send?

BackroundThe diagnosis of epidermoid cyst is seldom in doubt, and associated malignancy extremely rare, yet it is commonplace for the lesion to be sent to the pathology laboratory for analysis. The aim of this study was to evaluate our current practice with regards to diagnostic accuracy among clinicians, and assess risk of not routinely sending suspected epidermoid cysts for histological examination. Potential cost savings were also estimated and calculated.MethodsRetrospective analysis of clinical and pathology data on all suspected epidermoid cysts excised from a Scottish district general hospital over a 5-year period between January 2011 and October 2015.ResultsFive hundred and thirty-six suspected epidermoid cysts were excised during the study period. Three hundred and ninety-six were sent for histological examination which confirmed a diagnosis of epidermoid cyst in 303 (76.5%) cases. There was good agreement between preoperative suspicion and final histological diagnosis: 80.8% (257/318) among referring clinicians, 81.9% (289/353) among reviewing surgeons, and 88.4% (243/275) where there was preoperative agreement between both. There were no malignant lesions. An average of 80 clinically apparent epidermoid cysts were excised and sent for histology each year at a cost of £4800 per annum.ConclusionThere was close agreement between clinical and final histological diagnosis of epidermoid cyst. Where a characteristic, odorous, toothpaste-like material is present on transection intra-operatively, the diagnosis is confirmed and the lesion can be discarded. We argue that significant cost savings can be achieved by adopting this approach.

'Heading up a blind alley'? Scottish psychiatric hospitals in the era of deinstitutionalization.

This article examines Scottish provision of psychiatric care in the 1960s and 1970s. It demonstrates that institutional services did not rapidly disappear across the UK following the Ministry of Health's decision to shut down psychiatric hospitals in 1961, and highlights Scotland's distinctive trajectory. Furthermore, it contends that psychiatric hospitals developed new approaches to assist patients in this era, thereby contributing towards the transformation of post-war psychiatric practice. Connecting a discussion of policy with an analysis of provision, it examines the Department of Health for Scotland's cautious response to the Ministry's embrace of deinstitutionalization, before analysing Glasgow's psychiatric provision in the 1970s. At this point the city boasted virtually no community-based services, and relied heavily on its under-resourced and overburdened hospitals. Closer analysis dispels any impression of stagnation, revealing how ideologies of deinstitutionalization transformed institutional care.

New institutionalisation following acute hospital admission: a retrospective cohort study

Backgroundinstitutionalisation following acute hospital admission is common and yet poorly described, with policy documents advising against this transition.Objectiveto characterise the individuals admitted to a care home on discharge from an acute hospital admission and to describe their assessment.Design and settinga retrospective cohort study of people admitted to a single large Scottish teaching hospital.Subjects100 individuals admitted to the acute hospital from home and discharged to a care home.Methodsa single researcher extracted data from ward-based case notes.Resultspeople discharged to care homes were predominantly female (62%), widowed (52%) older adults (mean 83.6 years) who lived alone (67%). About 95% had a diagnosed cognitive disorder or evidence of cognitive impairment. One-third of cases of delirium were unrecognised. Hospital stays were long (median 78.5 days; range 14–231 days) and transfers between settings were common. Family request, dementia, mobility, falls risk and behavioural concerns were the commonest reasons for the decision to admit to a care home. About 55% were in the acute hospital when the decision for a care home was made and 44% of that group were discharged directly from the acute hospital.Conclusionscare home admission from hospital is common and yet there are no established standards to support best practice. Decisions should involve the whole multidisciplinary team in partnership with patients and families. Documentation of assessment in the case notes is variable. We advocate the development of interdisciplinary standards to support the assessment of this vulnerable and complex group of patients.

Blood sampling - Two sides to the story

This study aimed to investigate why there is variability in taking blood.A multi method Pilot study was completed in four National Health Service Scotland hospitals. Human Factors/Ergonomics principles were applied to analyse data from 50 observations, 15 interviews and 12-months of incident data from all Scottish hospitals. The Functional Resonance Analysis Method (FRAM) was used to understand why variability may influence blood sampling functions.The analysis of the 61 pre blood transfusion sampling incidents highlighted limitations in the data collected to understand factors influencing performance. FRAM highlighted how variability in the sequence of blood sampling functions and the number of practitioners involved in a single blood sampling activity was influenced by the working environment, equipment, clinical context, work demands and staff resources.This pilot study proposes a realistic view of why blood sampling activities vary and proposes the need to consider the system's resilience in future safety management strategies.

Is it worth screening elective orthopaedic patients for carriage of Staphylococcus aureus? A part-retrospective case–control study in a Scottish hospital

BackgroundWith recent focus on methicillin-resistant Staphylococcus aureus (MRSA) screening, methicillin-susceptible S. aureus (MSSA) has been overlooked. MSSA infections are costly and debilitating in orthopaedic surgery.MethodsWe broadened MRSA screening to include...

Keeping “Small Talk” Small in Health-Care Encounters: Negotiating the Boundaries Between On- and Off-Task Talk

ABSTRACTHealth-care interactions often involve social, relational, small-talk, or “off-task” sequences that are largely topically distinct from the institutional business of the setting. In this article we examine data from preoperative assessment sessions in a Scottish hospital in order to explore the transitions between on- and off-task talk. In the majority of instances, the movement between social and medical talk is routine and unproblematic, and both nurse and patient orient to the boundaried nature of off-topic talk. However, occasionally patients’ social talk evolves into personal disclosure and troubles telling that may disrupt the institutional agenda and that can lead to difficulties in the negotiation of sequence closure. Data are in British English.

Measuring performance change in Scottish hospitals: a Malmquist and times-series approach

We applied a Malmquist approach to assess levels and change of efficiency and technology in Scottish hospitals. The biased corrected Malmquist index, the efficiency change index, and the technology change index appear to vacillate improving and regressing over the four time intervals with the overall indices (2003–2007). We did not detect steady movement in these measures in one way or another, but we have advanced the literature by employing a time-series trend analysis to gauge changes without the obfuscation by white noise. By using regression, we found a definite and statistically significant trend of improvement, from the first period as it affects the final period of the performance measures. This lends some encouragement to Scottish hospital management that they are doing more with less—which is particularly relevant in times of more austerity in government spending but without a decrease in demand. A longer time period would be necessary in order to ascertain if improvements would be achieved, overall, even with increases and decreases in performance during intervening time periods.

Not just a matter of size: a hospital-level risk factor analysis of MRSA bacteraemia in Scotland.

BackgroundWorldwide, there is a wealth of literature examining patient-level risk factors for methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia. At the hospital-level it is generally accepted that MRSA bacteraemia is more common in larger hospitals. In Scotland, size does not fully explain all the observed variation among hospitals. The aim of this study was to identify risk factors for the presence and rate of MRSA bacteraemia cases in Scottish mainland hospitals. Specific hypotheses regarding hospital size, type and connectivity were examined.MethodsData from 198 mainland Scottish hospitals (defined as having at least one inpatient per year) were analysed for financial year 2007-08 using logistic regression (Model 1: presence/absence of MRSA bacteraemia) and Poisson regression (Model 2: rate of MRSA bacteraemia). The significance of risk factors representing various measures of hospital size, type and connectivity were investigated.ResultsIn Scotland, size was not the only significant risk factor identified for the presence and rate of MRSA bacteraemia. The probability of a hospital having at least one case of MRSA bacteraemia increased with hospital size only if the hospital exceeded a certain level of connectivity. Higher levels of MRSA bacteraemia were associated with the large, highly connected teaching hospitals with high ratios of patients to domestic staff.ConclusionsA hospital’s level of connectedness within a network may be a better measure of a hospital’s risk of MRSA bacteraemia than size. This result could be used to identify high risk hospitals which would benefit from intensified infection control measures.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-016-1563-6) contains supplementary material, which is available to authorized users.

Ethnic Variations in Liver- and Alcohol-Related Disease Hospitalisations and Mortality: The Scottish Health and Ethnicity Linkage Study.

Preventing alcohol-related harms, including those causing liver disease, is a public health priority in the UK, especially in Scotland, but the effects of ethnicity are not known. We assessed liver- and alcohol-related events (hospitalisations and deaths) in Scotland using self-reported measures of ethnicity. Linking Scottish NHS hospital admissions and mortality to the Scottish Census 2001, we explored ethnic differences in hospitalisations and mortality (2001-2010) of all liver diseases, alcoholic liver disease (ALD) and specific alcohol-related diseases (ARD). Risk ratios (RR) were calculated using Poisson regression with robust variance, by sex, adjusted for age, country of birth and the Scottish Index of Multiple Deprivation (SIMD) presented below. The White Scottish population was the standard reference population with 95% confidence intervals (CI) calculated to enable comparison (multiplied by 100 for results). For all liver diseases, Chinese had around 50% higher risks for men (RR 162; 95% CI 127-207) and women (141; 109-184), as did Other South Asian men (144; 104-201) and Pakistani women (140; 116-168). Lower risks for all liver diseases occurred in African origin men (42; 24-74), other White British men (72; 63-82) and women (80; 70-90) and other White women (80; 67-94). For ALD, White Irish had a 75% higher risk for men (175; 107-287). Other White British men had about a third lower risk of ALD (63; 50-78), as did Pakistani men (65; 42-99). For ARD, almost 2-fold higher risks existed for White Irish men (182; 161-206) and Any Mixed Background women (199; 152-261). Lower risks of ARD existed in Pakistani men (67; 55-80) and women (48; 33-70), and Chinese men (55; 41-73) and women (54; 32-90). Substantial variations by ethnicity exist for both alcohol-related and liver disease hospitalisations and deaths in Scotland: these exist in subgroups of both White and non-White populations and practical actions are required to ameliorate these differences.

38th ANNUAL CARRELL-KRUSEN NEUROMUSCULAR SYMPOSIUM, Texas Scottish Rite Hospital for Children, Dallas, Texas, February 25–26, 2016

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