Wishaw General Hospital

About: Wishaw General Hospital is a healthcare organization based out in Wishaw, Scotland, United Kingdom. It is known for research contribution in the topics: Population & Medicine. The organization has 256 authors who have published 222 publications receiving 4324 citations.

Population‐based study of the sensitivity of axillary ultrasound imaging in the preoperative staging of node‐positive invasive lobular carcinoma of the breast

Abstract: Background: Preoperative staging of the axilla is important to allow decisions regarding neoadjuvant treatment and the management of the axilla. Invasive lobular carcinoma metastases are difficult to detect because of the infiltrative pattern of the nodal spread. In this study the sensitivity of preoperative axillary staging between invasive lobular (ILC) and ductal (IDC) carcinoma was compared. Methods: All women diagnosed with pure ILC or IDC in the West of Scotland in 2012–2014 were identified from a database maintained prospectively within the Managed Clinical Network. Pretreatment axillary ultrasound imaging (AUS), core biopsy and fine‐needle aspiration cytology (FNAC) results were compared between ILC and IDC. Results: Some 602 women with ILC and 4199 with IDC had undergone axillary surgery, of whom 209 and 1402 respectively had nodal metastases. Pretreatment AUS sensitivity was significantly lower in ILC than in IDC (32·1 versus 50·1 per cent respectively, P < 0·001; OR 0·47, 95 per cent c.i. 0·34 to 0·64). Core biopsy had equally high sensitivity of 86 per cent in both subtypes; however, FNAC was significantly less sensitive in both ILC (55 per cent; P = 0·003) and IDC (75·6 per cent; P = 0·006). Multivariable analysis revealed that cT3–4 status and symptomatic presentation were both significant in predicting nodal metastasis in patients with ILC and false‐negative AUS findings (OR 3·77, 95 per cent c.i. 1·69 to 8·42, P = 0·001; and OR 1·92, 1·24 to 2·98, P = 0·003, respectively). Conclusion: AUS is inferior in detecting axillary node metastasis in ILC compared with IDC. Women with cT3–4 lobular carcinoma may benefit from ultrasound‐guided axillary biopsy regardless of the ultrasonographic appearance of the nodes.

Implementation and role of modern musculoskeletal imaging in rheumatological practice in member countries of EULAR.

Abstract: Objectives To document the current training, implementation and role of modern musculoskeletal imaging techniques: ultrasound, magnetic resonance imaging, computed tomography and positron emission tomography, among rheumatologists in the member countries of the EULAR. Methods English-language questionnaires for each imaging modality developed by a EULAR task force were sent out to national and international scientific societies as well as imaging experts in the given modalities involved in research and/or training. The surveys were distributed via an online survey tool (SurveyMonkey). Simple descriptive and summary statistics were calculated from the responses. Results More than 90% of ultrasound (US) experts reported the availability of a US unit in their department. Suspicion of rheumatoid arthritis and spondyloarthritides were the main clinical indications for performing US for diagnostic purposes. Suspicion of sacroiliitis and degenerative spine disease were the most common indications to perform magnetic resonance imaging (MRI) or computed tomography (CT) for diagnostic purposes, while positron emission tomography was mainly performed to diagnose large vessel vasculitis and to investigate fever of unknown origin. The reported percentage of rheumatologists performing US was highly variable, ranging from more than 80% in 6% of countries to less than 10% in 15% of countries. The majority of experts (77%) reported that their national rheumatology societies organise musculoskeletal US courses, while courses in MRI or CT organised by the national rheumatology societies were less commonly reported (29% and 8%, respectively). Conclusions Rheumatologists in Europe utilise modern imaging techniques; however, access to the techniques and training offered is varied.

Changes in Plasma Itaconate Elevation in Early Rheumatoid Arthritis Patients Elucidates Disease Activity Associated Macrophage Activation.

Abstract: Changes in the plasma metabolic profile were characterised in newly diagnosed rheumatoid arthritis (RA) patients upon commencement of conventional disease-modifying anti-rheumatic drug (cDMARD) therapy. Plasma samples collected in an early RA randomised strategy study (NCT00920478) that compared clinical (DAS) disease activity assessment with musculoskeletal ultrasound assessment (MSUS) to drive treatment decisions were subjected to untargeted metabolomic analysis. Metabolic profiles were collected at pre- and three months post-commencement of nonbiologic cDMARD. Metabolites that changed in association with changes in the DAS44 score were identified at the three-month timepoint. A total of nine metabolites exhibited a clear correlation with a reduction in DAS44 score following cDMARD commencement, particularly itaconate, its derived anhydride and a derivative of itaconate CoA. Increasing itaconate correlated with improved DAS44 score and decreasing levels of C-reactive protein (CRP). cDMARD treatment effects invoke consistent changes in plasma detectable metabolites, that in turn implicate clinical disease activity with macrophages. Such changes inform RA pathogenesis and reveal for the first time a link between itaconate production and resolution of inflammatory disease in humans. Quantitative metabolic biomarker-based tests of clinical change in state are feasible and should be developed around the itaconate pathway.

Short migraine attacks of less than 2 h duration in children and adolescents

Abstract: We studied the duration of migraine attacks among children and adolescents who reported headache attacks lasting 2 h. Patient-based analysis of the headache diaries showed that only three children consistently had headache attacks lasting 2 h) attacks of headache can coexist in the same patient. The IHS diagnostic criteria of 1988 for migraine in children should therefore acknowledge such variation and allow reduction of the duration of migraine attacks to 1 h.

How we equip undergraduates with prioritisation skills using simulated teaching scenarios.

Abstract: Background: Goldacre et al. [Goldacre MJ, Lambert T, Evans J, Turner G. 2003. PRHO views' on whether their experience at medical school prepared them well for their jobs: National questionnaire survey. BMJ 326 (1):1011–1012.] undertook a study which showed that 40% of undergraduates felt under prepared for work by their undergraduate curriculum. Illing et al. [Illing J et al. 2008. A GMC report: Submitted to GMC.] demonstrated that one of four key areas, for which they felt least prepared, was prioritisation of tasks in the clinical setting.Aim: To equip undergraduates about to become Foundation year 1 with the prioritisation skills along with others highlighted by Illing in a very real yet safe environment.Methods: We devised a simulated teaching session ‘an evening on call'. Each individual student had a 45 min session, held on mock wards where they were given a handover task list, and like a de facto on call would be paged by the wards at varying intervals. Tasks ranged from prescribing night sedation,...