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.

Coconut water drink and the risk of hyperkalaemia in diabetes

Abstract: Coconut water is available as a substitute for table water and as a sports rehydrating drink. Because of the nature of its micronutrients, it may lead to biochemical changes that may not be beneficial for all groups of people. A patient with type 2 diabetes mellitus consumed daily around one litre of coconut water drink. As a result, there was a gradual increase in serum potassium. On cessation of beverage consumption, serum potassium decreased to within the reference interval. However, an increase in urea and creatinine concentration did not revert to the level seen prior to coconut water consumption. There was a decrease in serum alkaline phosphatase and zinc when consuming the beverage. Reduction occurred in diastolic blood pressure, estimated glomerular filtration rate, serum enzymes and zinc, while serum potassium concentration increased in this patient with type 2 diabetes. The observed changes resulted from consuming excessive quantities of coconut water drinks. In patients with diabetes and renal impairment and on potassium-retaining medication, there is a high risk of developing hyperkalaemia. Copyright © 2016 John Wiley & Sons.

G578(P) Potentially preventable unexpected term admissions to neonatal intensive care (nicu)

Abstract: Context/Problem Admission of babies to NICU for medical care involves the separation of mothers and babies. We questioned what proportion of term babies were admitted in our institution and what interventions they required. We hypothesised that a significant proportion of babies would have minimal intervention on admission and a number would have potentially avoidable and treatable causes that would lend themselves to quality improvement interventions. We aimed to identify causes of potentially preventable admissions as a key performance area to target. Assessment of problem and analysis of cause We retrospectively reviewed the NICU database to identify all babies ≥ 37 weeks gestation admitted to our tertiary level service over a 12-month period. We classified term admissions as “expected” when NICU admission was anticipated following an antenatal diagnosis or “unexpected” where there were no concerns. Study design Through Badgernet, demographic data were collected for all babies and the source of admission, diagnosis, interventions and length of stay (LoS) documented. For those infants in whom Badgernet data was incomplete or missing, retrospective case note analysis was undertaken. Results There were 5843 babies delivered over the 12 month period of whom 4900 (83.9%) were ≥ 37 weeks. There were 453 (9.2%) term babies admitted to NICU; 65 (14%) of these admissions were expected and 389 (86%) unexpected. We identified a number of babies who did not meet the recommended standard for achieving high-level neonatal care benchmarked against admission temperature and blood sugar level. Blood sugar level was documented in 174 babies (44.7%). Of these, 20 babies were identified as having a True Blood Glucose (TBG) 105 of 389 babies were discharged or transferred within 6 h of admission. 11/105 babies required medical intervention prior to transfer for cardiac or surgical management. The remaining 94 were discharged to the postnatal ward, 22 of 94 received IV antibiotics, no other interventions were required in the remaining 72. 72/389 (18.5%) of unexpected admissions at term required no medical interventions and were discharged to the postnatal ward within 6 h, representing 9.5% of all admissions to the unit. Measurement of improvement Commonest reasons for admission in this group were mild respiratory distress, hypothermia and hypoglycaemia. Following on from identifying these reversible causes we have implemented a quality improvement temperature bundle for use in labour ward, postnatal wards and NICU. This uses a visual cue to ensure both ambient temperature and infant temperatures are regularly checked. The introduction of this improvement bundle has enabled regular prospective audit of our temperature targets. Conclusion and lessons learnt 9.2% of term infants were admitted to NICU. A significant proportion of “unexpected” admissions had a brief NICU stay and received minimal intervention. These infants who had minimal interventions represent a substantial share of the workload and admissions to NICU. A concerning number of infants had hypothermia and hypoglycaemia on admission, a key area to target in implementation of quality improvement strategies. Provision of simple supportive interventions in a Transitional Care Unit or observation area could potentially have reduced unexpected term admissions by 9.5%.

Level of agreement between three-dimensional volumetric ultrasound and real-time conventional ultrasound in the assessment of synovitis, tenosynovitis and erosions in rheumatoid arthritis patients

Abstract: The aim of the study was to assess agreement between three-dimensional volumetric ultrasound (3D US) performed by inexperienced staff and real-time conventional ultrasound (2D US) performed by experienced rheumatologists in detecting and scoring rheumatoid arthritis (RA) lesions. Thirty-one RA patients underwent examination of seven joints by 2D and 3D US for synovitis and tenosynovitis in B and PD modes and erosions in B mode. A global score for synovitis and global counts for synovitis, tenosynovitis and erosions were also calculated for every patient. Agreement between 2D and 3D US was analysed for counts and scores at the patient level with the intraclass correlation coefficient (ICC) and for counts at the joint level with Cohen's kappa coefficient. B-mode synovitis was detected at a median of five joints in each patient, frequently in wrists and hand joints but less frequently in foot joints. PD-mode synovitis, tenosynovitis and erosions were detected less frequently. All ICCs for agreement between 2D and 3D US findings were significant. All kappa coefficients were significant for B- and PD-mode synovitis and for erosions (except PIP3), while those for tenosynovitis were only significant for MCP2 (B and PD modes) and PIP2 (B mode). Although the 3D US volumes were acquired by inexperienced operators, agreement between 2D and 3D US was acceptable in detecting and scoring synovitis. A higher level of agreement was attained for patient-level global scores and counts than for individual joints.

Heart failure in the new born; vein of Galen aneurysmal malformation.

Abstract: We narrate the case of a term baby who presented at 30 h of age in congestive cardiac failure due to vein of Galen aneurysmal malformation. A successful interventional radiology embolisation of the feeding vessels to the aneurysm was performed on day 5. Twenty hours following the procedure, the baby developed significant intraventricular haemorrhage with extension into the brain parenchyma; care was reoriented on day 7 of life after discussion with the parents. Vein of Galen aneurysmal malformation is a rare congenital vascular malformation. It usually manifests in the newborn period with high-output cardiac failure. The death rate is higher in those who present early in the neonatal period. The management of this condition requires a multidisciplinary approach.

Amputation and the diabetic foot: learning from a case study.

Abstract: Diabetic foot disease causes more amputations than any other lower limb disease. Management of the diabetic foot requires a thorough knowledge of the risk factors for ulceration and amputation, the most common of which are neuropathy, ischaemia and infection. Amputations are not inevitable, however; early detection and appropriate treatment of ulcers can prevent up to 85% of amputations. This has been demonstrated in the formation of multidisciplinary diabetic foot clinics, which have been shown to reduce the number of amputations across the world. Adherence to a systematic regime of organization, education, screening and intervention can improve communication between patients, GPs, community nursing and diabetes sub-specialists to facilitate appropriate treatment and prevention of complications. The case discussed here demonstrates how inadequate and disjointed management through lack of communication, education and knowledge of diabetic foot disease can lead to complications requiring amputation and deb...