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Neurosurgical services in the UK are organised regionally into 34 acute neuroscience centres. Brain injury, both traumatic and non-traumatic, is common, and patients often present to local hospitals requiring further treatment in a neuroscience centre. Between April 2014 and June 2015, 15 820 patients suffered a traumatic brain injury in the UK. Of these, 6258 were transferred directly to a neuroscience centre, 5880 were not admitted to a neuroscience centre and 3682 underwent a secondary transfer from the admitting hospital to a neuroscience centre.1 In addition to traumatic brain injury, indications for non-traumatic causes of brain injury requiring acute transfer to a neuroscience centre continue to increase.
Management strategies for pulmonary atresia with intact ventricular septum are variable and are based on right ventricular morphology and associated abnormalities. Catheter perforation of the pulmonary valve provides an alternative strategy to surgery in the neonatal period. We sought to assess the long-term outcome in terms of survival, re-intervention, and functional ventricular outcome in the setting of a 26-year single-centre experience of low threshold inclusion criteria for percutaneous valvotomy.
Methods and results:
Retrospective analysis of patients diagnosed with pulmonary atresia with intact ventricular septum from 1990 to 2016 at a tertiary referral centre, was performed. Of 71 patients, 48 were brought to the catheterisation laboratory for intervention. Catheter valvotomy was successful in 45 patients (94%). Twenty-three patients (51%) also underwent ductus arteriosus stenting. The length of intensive care and hospital stay was significantly shorter, and early re-interventions were significantly reduced in the catheterisation group. There were eight deaths (17%); all within 35 days of the procedure. Of the survivors, only one has required a Fontan circulation. Twenty-eight patients (74%) have undergone biventricular repair and nine patients (24%) have one-and-a-half ventricle circulation. Following successful valvotomy, 80% of patients required further catheter-based or surgical interventions.
A low threshold for initial interventional management yielded a high rate of successful biventricular circulations. Although mortality was low in patients who survived the peri-procedural period, the rate of re-intervention remained high in all groups.
Addressing inequalities between mental and physical healthcare in older adult healthcare is imperative for safe patient care. This evaluation of services at The Harbour mental health hospital, Blackpool, UK gives insight into parity of esteem and prompts investigation into the clinical decisions of doctors working in older adult mental healthcare.
Pulmonary valve stenosis is common in patients with Noonan’s syndrome. The response to balloon valvoplasty varies.
We assessed the correlation between re-intervention rate, immediate response, and the progress of the valve gradient over time after intervention.
This is a retrospective study conducted from 1995 to 2014.
Of 14 patients identified, seven had re-intervention 28±54 months (range 3–149, median 3.3) after valvoplasty. These patients did not have a significant decrease in gradient after intervention. Their gradient subsequently decreased during follow-up and then became static before increasing years after intervention. In contrast, the gradient of patients not requiring further intervention continually reduced over time. Demographics did not differ between these groups.
We could not identify predisposing factors for long-term success of pulmonary valvoplasty in Noonan’s patients, but the trajectory of gradients differs significantly between patients needing re-intervention from those who remain free from re-intervention.
We describe the successful use of recombinant factor VIIa (rFVIIa) in the control of massive haemoptysis in a 17-year-old patient with a Fontan circulation. The patient was intubated and ventilated in the ICU with deteriorating gas exchange. Conventional methods to control the haemoptysis were ineffective, and rFVIIa was successfully administered as a rescue therapy. rFVIIa is a powerful pro-thrombotic agent, which is only licensed in haemophiliacs with acquired inhibitors to anticoagulation. It has been used off-license in the treatment of massive haemorrhage, although a Cochrane review did not show any significant benefit; however, it may have a role as a rescue therapy where alternatives options have been exhausted after careful risk–benefit analysis.
This study extends the limited body of research exploring the association between psychological resources and performance under pressure. It was anticipated that participants’ general self-efficacy and resilience would positively influence skill acquisition rate more under high pressure, than low pressure. Eighty-one undergraduate students (Mage = 22.93; SD = 7.53; 50.6% female) participated in a learning task: to fly a flight simulator. The within-subjects variable was the participant's ability to steadily control the aircraft roll across six trials. Psychological pressure was manipulated between-subjects and general self-efficacy and resilience were measured moderator variables. Findings indicated that under high pressure, higher levels of general self-efficacy and perceived resilience predicted faster initial skill acquisition compared to those with lower levels of these resources. In contrast, in the low-pressure condition, the skill acquisition rate was the same irrespective of psychological resources. This research highlights the importance of psychological resources in pressured training contexts.
We aimed to compare the procedural and mid-term performance of a specifically designed self-expanding stent with balloon-expandable stents in patients undergoing hybrid palliation for hypoplastic left heart syndrome and its variants.
The lack of specifically designed stents has led to off-label use of coronary, biliary, or peripheral stents in the neonatal ductus arteriosus. Recently, a self-expanding stent, specifically designed for use in hypoplastic left heart syndrome, has become available.
We carried out a retrospective cohort comparison of 69 neonates who underwent hybrid ductal stenting with balloon-expandable and self-expanding stents from December, 2005 to July, 2014.
In total, 43 balloon-expandable stents were implanted in 41 neonates and more recently 47 self-expanding stents in 28 neonates. In the balloon-expandable stents group, stent-related complications occurred in nine patients (22%), compared with one patient in the self-expanding stent group (4%). During follow-up, percutaneous re-intervention related to the ductal stent was performed in five patients (17%) in the balloon-expandable stent group and seven patients (28%) in self-expanding stents group.
Hybrid ductal stenting with self-expanding stents produced favourable results when compared with the results obtained with balloon-expandable stents. Immediate additional interventions and follow-up re-interventions were similar in both groups with complications more common in those with balloon-expandable stents.
We present an update of the ‘key points’ from the Antarctic Climate Change and the Environment (ACCE) report that was published by the Scientific Committee on Antarctic Research (SCAR) in 2009. We summarise subsequent advances in knowledge concerning how the climates of the Antarctic and Southern Ocean have changed in the past, how they might change in the future, and examine the associated impacts on the marine and terrestrial biota. We also incorporate relevant material presented by SCAR to the Antarctic Treaty Consultative Meetings, and make use of emerging results that will form part of the Intergovernmental Panel on Climate Change (IPCC) Fifth Assessment Report.
Background: Cognitive Behavioural Therapy (CBT) is not primarily conceptualized as operating via affective processes. However, there is growing recognition that emotional processing plays an important role during the course of therapy. Aims: The Emotional Processing Scale was developed as a clinical and research tool to measure emotional processing deficits and the process of emotional change during therapy. Method: Fifty-five patients receiving CBT were given measures of emotional functioning (Toronto Alexithymia Scale [TAS-20]; Emotional Processing Scale [EPS-38]) and psychological symptoms (Brief Symptom Inventory [BSI]) pre- and post-therapy. In addition, the EPS-38 was administered to a sample of 173 healthy individuals. Results: Initially, the patient group exhibited elevated emotional processing scores compared to the healthy group, but after therapy, these scores decreased and approached those of the healthy group. Conclusions: This suggests that therapy ostensibly designed to reduce psychiatric symptoms via cognitive processes may also facilitate emotional processing. The Emotional Processing Scale demonstrated sensitivity to changes in alexithymia and psychiatric symptom severity, and may provide a valid and reliable means of assessing change during therapy.
The Foundation Programme is a 2-year programme in the UK which forms the bridge between medical school and specialist/general practice training. It provides trainees with a broad range of experiences enabling them to apply for specialty training at an earlier stage. J.K., consultant psychiatrist in old age psychiatry, tells us about the experiences of hosting a Foundation Year 1 (FY1) doctor for the first time and the first incumbent G.T. (FY1) adds his views.
The paper examines the effect of the bottom stress on the weakly nonlinear evolution of a narrow-band wave field, as a potential mechanism of suppression of ‘freak’ wave formation in water of moderate depth. Relying upon established experimental studies the bottom stress is modelled by the quadratic drag law with an amplitude/bottom roughness-dependent drag coefficient. The asymptotic analysis yields Davey–Stewartson-type equations with an added nonlinear complex friction term in the envelope equation. The friction leads to a power-law decay of the spatially uniform wave amplitude. It also affects the modulational (Benjamin–Feir) instability, e.g. alters the growth rates of sideband perturbations and the boundaries of the linearized stability domains in the modulation wavevector space. Moreover, the instability occurs only if the amplitude of the background wave exceeds a certain threshold. Since the friction is nonlinear and increases with wave amplitude, its effect on the formation of nonlinear patterns is more dramatic. Numerical experiments show that even when the friction is small compared to the nonlinear term, it hampers formation of the Akhmediev/Ma-type breathers (believed to be weakly nonlinear ‘prototypes’ of freak waves) at the nonlinear stage of instability. The specific predictions for a particular location depend on the bottom roughness ks in addition to the water depth and wave field characteristics.