Scot Med J
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Assess and correlate the clinical presentation, cranial CT and lumbar puncture (LP) findings in patients presenting with acute headache, clinically suspicious of subarachnoid haemorrhage, from the Accident and Emergency (A/E) department of a main teaching hospital. ⋯ This study reviews the varying clinical presentations of SAH and the difficulty in clinically diagnosing SAH where headache is the only symptom. We review the wide differential diagnosis on cranial CT and on discharge of patients presenting with symptoms clinically suspicious of SAH. In addition this study identfies a high proportion of patients without detailed clinical notes and discharged without a diagnosis. The study reaffirms that a significant proportion of patients are diagnosed on LP and stress the importance of performing a LP in all cases with clinically suspected SAH with a negative CT This latter point requires highlighting in the medical literature as over half of eligible patients did not have a LP performed despite this being accepted diagnostic protocol.
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Rheumatoid Arthritis (RA) is a common inflammatory arthritis' with pain and loss of function among its most disabling symptoms. These are mostly secondary to inflammation or mechanical damage to the joints. However it is also important to consider disease complications as a cause of symptoms, especially when the response to treatment is suboptimal. We report an RA patient whose symptoms were resistant to standard therapy, and were actually due to peripheral neuropathy.
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Comparative Study
Admission proforma significantly improves the medical record.
The authors worked in a busy regional fracture unit, where it was noted that important data was being omitted from medical notes. In an attempt to improve on this, an admission proforma was formulated. ⋯ Notes were audited on two separate weeks, the first before, and the second after introduction of the proforma. The overall results demonstrate statistically significant improvements in documentation with a proforma, and concur with the limited previous literature in this area.
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Comparative Study
The impact of an extreme sports event on a district general hospital.
Extreme sports events are increasing in popularity, particularly in mountainous areas throughout Great Britain. Emergency medical care for these events is usually provided by voluntary organisations, providing event side first aid and referring patients to nearby District General Hospitals. The Fort William Mountain Bike Race is part of the UCI World Cup Series: 173 competitors racing in cross country, downhill and 4X events. The Belford Hospital provides year round medical care for the Lochaber community, which frequently swells during the tourist season. The hospital has 8300 new attendances per annum, 35 patient reviews per 24 hrs. ⋯ We believe that extreme sports events can have considerable impact on small district general hospitals. Additional triage and staffing resources should be utilised and event organisers should anticipate the additional problems they present to the local community. District General Hospitals continue to provide a substantial contribution to the provision of health care for extreme sports within the UK.