Publications by authors named "Angus K McFadyen"

27 Publications

  • Page 1 of 1

Evaluating collaborative practice within community-based integrated health and social care teams: a systematic review of outcome measurement instruments.

J Interprof Care 2021 Jul 5:1-15. Epub 2021 Jul 5.

AKM-Stats, Glasgow, UK.

Collaborative practice is a workforce priority for integrated health and social care systems internationally, requiring robust outcome measurement instruments (OMIs) to enable team development and good quality research. In this systematic review, we appraised self-administered OMIs that could be used to measure team-based collaborative practice within integrated health and social care teams in community settings. The most important measurement properties when selecting between OMIs are content and structural validity and internal consistency. The COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) systematic review method was modified to evaluate each OMI. For each measurement property, the methodological quality of individual studies and quality of each parameter were rated, and the level of evidence graded. A search strategy applied to 19 bibliographic databases identified 7 instruments that met eligibility criteria. A total of 6 development studies, 6 content validity studies, 8 studies for structural validity, and 10 for internal consistency were included. Only the shortened version of the Assessment of Interprofessional Team Collaboration Scale (ATICS-II) was rated as Sufficient for each measurement property with Very Low or Moderate quality evidence. Further validation of each OMI for use by community integrated teams is needed; studies evaluating relevance, comprehensibility and comprehensiveness are a priority.
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July 2021

Facial changes related to brachycephaly in Cavalier King Charles Spaniels with Chiari-like malformation associated pain and secondary syringomyelia.

J Vet Intern Med 2020 Jan 5;34(1):237-246. Epub 2019 Nov 5.

School of Veterinary Medicine, Faculty of Health & Medical Sciences, Daphne Jackson Road, Guildford, Surrey, GU7 Q22, United Kingdom.

Background: Recent studies including an innovative machine learning technique indicated Chiari-like malformation (CM) is influenced by brachycephalic features.

Objectives: Morphometric analysis of facial anatomy and dysmorphia in CM-associated pain (CM-P) and syringomyelia (SM) in the Cavalier King Charles Spaniel (CKCS).

Animals: Sixty-six client-owned CKCS.

Methods: Retrospective study of anonymized T2W sagittal magnetic resonance imaging of 3 clinical groups: (1) 11 without central canal dilation (ccd) or SM (CM-N), (2) 15 with CM-P with no SM or <2 mm ccd (CM-P), and (3) 40 with syrinx width ≥4 mm (SM-S). Morphometric analysis assessed rostral skull flattening and position of the hard and soft palate relative to the cranial base in each clinical group and compared CKCS with and without SM-S.

Results: Sixteen of 28 measured variables were associated to SM-S compared to CM-N and CM-P. Of these 6 were common to both groups. Predictive variables determined by discriminant analysis were (1) the ratio of cranial height with cranial length (P < .001 between SM-S and CM-N) and (2) the distance between the cerebrum and the frontal bone (P < .001 between SM-S and CM-P). CM-P had the lowest mean height of the maxillary area.

Conclusions And Clinical Importance: CKCS with CM-P and SM-S have cranial brachycephaly with osseous insufficiency in the skull with rostral flattening and increased proximity of the hard and soft palate to the cranial base. Changes are greatest with CM-P. These findings have relevance for understanding disease pathogenesis and for selection of head conformation for breeding purposes.
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January 2020

Behavioral and clinical signs of Chiari-like malformation-associated pain and syringomyelia in Cavalier King Charles spaniels.

J Vet Intern Med 2019 Sep 9;33(5):2138-2150. Epub 2019 Jul 9.

School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Surrey, United Kingdom.

Background: Diagnosis of Chiari-like malformation-associated pain (CM-P) or clinically relevant syringomyelia (SM) is challenging. We sought to determine common signs.

Animals: One hundred thirty client-owned Cavalier King Charles spaniels with neuroaxis magnetic resonance imaging (MRI) and diagnosis of CM-P/SM. Dogs with comorbidities causing similar signs were excluded with exception of otitis media with effusion (OME).

Methods: Retrospective study of medical records relating signalment, signs, and MRI findings. Dogs were grouped by SM maximum transverse diameter (1 = no SM; 2 = 0.5-1.99 mm; 3 = 2-3.9 mm: 4 = ≥4 mm). Differences between all groups-groups 1 versus 2-4 and groups 1-3 versus 4-were investigated. Continuous variables were analyzed using 2-sample t-tests and analysis of variance. Associations between categorical variables were analyzed using Fisher's exact or chi-square tests.

Results: Common signs were vocalization (65.4%), spinal pain (54.6%), reduced activity (37.7%), reduced stairs/jumping ability (35.4%), touch aversion (30.0%), altered emotional state (28.5%), and sleep disturbance (22%). Head scratching/rubbing (28.5%) was inversely associated with syrinx size (P = .005), less common in group 4 (P = .003), and not associated with OME (P = .977). Phantom scratching, scoliosis, weakness, and postural deficits were only seen in group 4 (SM ≥4 mm; P = .004).

Conclusions And Clinical Importance: Signs of pain are common in CM/SM but are not SM-dependent, suggesting (not proving) CM-P causality. Wide (≥4 mm) SM is associated with signs of myelopathy and, if the dorsal horn is involved, phantom scratching (ipsilateral) and torticollis (shoulder deviated ipsilateral; head tilt contralateral).
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September 2019

An exploration of the experiences and utility of functional electrical stimulation for foot drop in people with multiple sclerosis.

Disabil Rehabil 2020 02 9;42(4):510-518. Epub 2018 Oct 9.

School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.

Functional electrical stimulation (FES) is effective in improving walking in people with multiple sclerosis (MS) with foot drop. There is limited research exploring people's experiences of using this device. This study aims to explore the utility, efficacy, acceptability, and impact on daily life of the device in people with MS. An interpretative phenomenological approach was employed. Ten participants who had used FES for 12 months were interviewed. Transcripts were analysed, and emergent themes identified. Nine participants continued to use the device. Three relevant super-ordinate themes were identified; , , and Participants reported challenges using the device; however, all reported positive physical and psychological benefits. Intrinsic and external influences such as; access to professional help, the influence of others, an individual's ability to adapt, and experiences using the device, influenced their decisions to continue with the device. A thematic model of these factors was developed. This study has contributed to our understanding of people with MS experiences of using the device and will help inform prescribing decisions and support the continued, appropriate use of FES over the longer term.Implications for RehabilitationPeople with multiple sclerosis using functional electrical stimulation report benefits in many aspects of walking, improved psychological well-being and increased engagement in valued activities.A number of challenges impact on functional electrical stimulation use. Factors such as; a positive experience using the device, access to professional help, the influence of others, a strong sense of personal autonomy and an individual's ability to adapt, influence an individual's decision to continue using functional electrical stimulation.Clinicians prescribing functional electrical stimulation should be aware of these factors so that the right support and guidance can be provided to people with multiple sclerosis, thus improving outcomes and compliance over the long term.
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February 2020

Pre-diagnostic delays caused by gastrointestinal investigations do not affect outcomes in pancreatic cancer.

Ann Med Surg (Lond) 2018 Oct 10;34:66-70. Epub 2018 Sep 10.

AKM-stats, Glasgow, UK.

Background: Pancreatic ductal adenocarcinomas are poor prognostic cancers accounting for 3% of all cancer cases in the UK. They often present late in the course of the disease process with non-specific symptoms, including gastro-intestinal(GI) symptoms. Delays in diagnosis occur when investigations are carried out in a primary care setting for GI symptoms. The aim of this study was to assess delays in pancreatic cancer diagnosis when patients were referred for GI investigations and evaluate its effect on survival.

Methods: Retrospective cohort study of all patients diagnosed with pancreatic adenocarcinoma in a Scottish district general hospital over a seven year period from January 2010 to December 2016. Patients were divided into two groups, those who had a GI investigation 18 months prior to the pancreatic cancer diagnosis and those who did not have GI investigations. Data on demographics, symptoms on referral, stage of disease at diagnosis, treatment undergone and length of survival collected and analysed.

Results: One hundred and fifty-three patients were diagnosed with pancreatic cancer in the study period. Forty (26%) of the 153 underwent gastrointestinal investigations in the 18 months prior to diagnosis. The remaining 113 (74%) had no gastro-intestinal investigations in the same time period. Demographic data were comparable. Significant delays occurred from referral to diagnosis in the GI investigated group compared to those who did not have GI investigations. (64.5days vs 9 days, p = 0.001). No difference was noted in disease stage or treatments undergone between the groups. There was no difference in the average survival after diagnosis between the two groups with median of 108 days for those who underwent GI investigations to 97 days for those who did not.(U = 2079.5, p = 0.454).

Conclusion: Delays caused by pre-diagnostic GI investigations do not appear to contribute to the poor prognosis of pancreatic cancer. Recently updated NICE Guidelines recommends early ultrasound or CT in patients with GI symptoms and weight loss which may reduce delays in diagnosis. Screening tests in future may become cost effective and diagnose this condition at a curable stage which in turn may improve survival rates.
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October 2018

A comparison of the initial orthotic effects of functional electrical stimulation and ankle-foot orthoses on the speed and oxygen cost of gait in multiple sclerosis.

J Rehabil Assist Technol Eng 2018 Jan-Dec;5:2055668318755071. Epub 2018 Feb 2.

2School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK.

Background: Foot drop affects walking in people with multiple sclerosis (pwMS). This study compares the initial orthotic effects of two treatments for foot drop: ankle-foot orthoses (AFO) and functional electrical stimulation (FES), on the speed and oxygen cost of walking in MS.

Method And Materials: Seventy-eight pwMS were randomised to receive AFO or FES (ODFS PACE (OML, Salisbury, UK)). Participants completed the 25-ft walk test (25ftWT) and 5-min self-selected walk test (5minSSWT), from which oxygen cost was determined, with and without their device. Between-, within- and sub-group analyses (based on baseline walking speed of <0.8 m/s (slow) or ≥0.8 m/s (fast)) were undertaken.

Results: No significant differences between baseline measures were observed. The AFO group walked significantly slower than the FES group (5minSSWT,  = 0.037, 0.11 m/s). The AFO group walked significantly slower with than without AFO (25ftWT,  = 0.037), particularly in the fast-walking group (  = 0.011). The slow-walking FES group walked significantly faster with FES than without (25ftWT;  = 0.029, 5minSSWT;  = 0.037). There were no differences in the fast-walking FES group or in the oxygen cost for either device.

Conclusion: AFO reduced walking speed, particularly in fast walkers. FES increased walking speed in slow, but not fast walkers.
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February 2018

MRI characteristics for "phantom" scratching in canine syringomyelia.

BMC Vet Res 2017 Nov 16;13(1):340. Epub 2017 Nov 16.

School of Veterinary Medicine, Faculty of Health & Medical Sciences, Daphne Jackson Road, Guildford, Surrey, GU2 7AL, UK.

Background: A classic sign of canine syringomyelia (SM) is scratching towards one shoulder. Using magnetic resonance imaging (MRI) we investigate the spinal cord lesion relating to this phenomenon which has characteristics similar to fictive scratch secondary to spinal cord transection. Medical records were searched for Cavalier King Charles spaniels with a clinical and MRI diagnosis of symptomatic SM associated with Chiari-like malformation (CM). The cohort was divided into SM with phantom scratching (19 dogs) and SM but no phantom scratching (18 dogs). MRI files were anonymised, randomised and viewed in EFILM ™. For each transverse image, the maximum perpendicular dimensions of the syrinx in the dorsal spinal cord quadrants were determined. Visual assessment was made as to whether the syrinx extended to the superficial dorsal horn (SDH).

Results: We showed that phantom scratching appears associated with a large dorsolateral syrinx that extends to the SDH in the C3-C6 spinal cord segments (corresponding to C2-C5 vertebrae). Estimated dorsal quadrant syrinx sizes based on the perpendicular diameters were between 2.5 and 9.5 times larger in dogs with phantom scratching, with the largest mean difference p-value being 0.009.

Conclusion: SM associated phantom scratching appears associated with MRI findings of a large syrinx extending into the mid cervical SDH. We hypothesise that damage in this region might influence the lumbosacral scratching central pattern generator (CPG). If a scratching SM affected dog does not have a large dorsolateral cervical syrinx with SDH involvement then alternative explanations for scratching should be investigated.
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November 2017

Increasing physical activity in older adults using STARFISH, an interactive smartphone application (app); a pilot study.

J Rehabil Assist Technol Eng 2017 Jan-Dec;4:2055668317696236. Epub 2017 Apr 5.

Institute for Health and Wellbeing, College of Social Sciences, University of Glasgow, UK.

Background: Increasing physical activity in older adults has preventative and therapeutic health benefits. We have developed STARFISH, a smartphone application, to increase physical activity. This paper describes the features of STARFISH, presents the views of older users on the acceptability and usability of the app and reports the results of a six week pilot study of the STARFISH app in older adults.

Methods: The operationalisation of the behaviour change techniques (BCTs) within the STARFISH app was mapped against the BCT Taxonomy of Michie et al. Sixteen healthy older adults (eight women and eight men; age 71.1 ± 5.2 years) used the app, in groups of four, for six weeks. Focus groups explored the user experience and objective measure of steps per day recorded.

Results: Participants were very positive about using the STARFISH app, in particular the embedded BCTs of self-monitoring, feedback and social support (in the form of group rewards). Objective step data, available for eight participants, showed that step counts increased by an average of 14% ( = 0.077,  = 0.56).

Conclusion: The STARFISH app was acceptable and straightforward to use for older adults. STARFISH has potential to increase physical activity in older adults; however, a fully powered randomised controlled trial is required.
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April 2017

Use of Morphometric Mapping to Characterise Symptomatic Chiari-Like Malformation, Secondary Syringomyelia and Associated Brachycephaly in the Cavalier King Charles Spaniel.

PLoS One 2017 25;12(1):e0170315. Epub 2017 Jan 25.

School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom.

Objectives: To characterise the symptomatic phenotype of Chiari-like malformation (CM), secondary syringomyelia (SM) and brachycephaly in the Cavalier King Charles Spaniel using morphometric measurements on mid-sagittal Magnetic Resonance images (MRI) of the brain and craniocervical junction.

Methods: This retrospective study, based on a previous quantitative analysis in the Griffon Bruxellois (GB), used 24 measurements taken on 130 T1-weighted MRI of hindbrain and cervical region. Associated brachycephaly was estimated using 26 measurements, including rostral forebrain flattening and olfactory lobe rotation, on 72 T2-weighted MRI of the whole brain. Both study cohorts were divided into three groups; Control, CM pain and SM and their morphometries compared with each other.

Results: Fourteen significant traits were identified in the hindbrain study and nine traits in the whole brain study, six of which were similar to the GB and suggest a common aetiology. The Control cohort had the most elliptical brain (p = 0.010), least olfactory bulb rotation (p = 0.003) and a protective angle (p = 0.004) compared to the other groups. The CM pain cohort had the greatest rostral forebrain flattening (p = 0.007), shortest basioccipital (p = 0.019), but a greater distance between the atlas and basioccipital (p = 0.002) which was protective for SM. The SM cohort had two conformation anomalies depending on the severity of craniocervical junction incongruities; i) the proximity of the dens (p <0.001) ii) increased airorhynchy with a smaller, more ventrally rotated olfactory bulb (p <0.001). Both generated 'concertina' flexures of the brain and craniocervical junction.

Conclusion: Morphometric mapping provides a diagnostic tool for quantifying symptomatic CM, secondary SM and their relationship with brachycephaly. It is hypothesized that CM pain is associated with increased brachycephaly and SM can result from different combinations of abnormalities of the forebrain, caudal fossa and craniocervical junction which compromise the neural parenchyma and impede cerebrospinal fluid flow.
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August 2017

Craniometric Analysis of the Hindbrain and Craniocervical Junction of Chihuahua, Affenpinscher and Cavalier King Charles Spaniel Dogs With and Without Syringomyelia Secondary to Chiari-Like Malformation.

PLoS One 2017 25;12(1):e0169898. Epub 2017 Jan 25.

School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, Surrey, United Kingdom.

Objectives: To characterize and compare the phenotypic variables of the hindbrain and craniocervical junction associated with syringomyelia (SM) in the Chihuahua, Affenpinscher and Cavalier King Charles Spaniel (CKCS).

Method: Analysis of 273 T1-weighted mid-sagittal DICOM sequences of the hindbrain and craniocervical junction from 99 Chihuahuas, 42 Affenpinschers and 132 CKCSs. The study compared 22 morphometric features (11 lines, eight angles and three ratios) of dogs with and without SM using refined techniques based on previous studies of the Griffon Bruxellois (GB) using Discriminant Function Analysis and ANOVA with post-hoc corrections.

Results: The analysis identified 14/22 significant traits for SM in the three dog breeds, five of which were identical to those reported for the GB and suggest inclusion of a common aetiology. One ratio, caudal fossa height to the length of the skull base extended to an imaginary point of alignment between the atlas and supraoccipital bones, was common to all three breeds (p values 0.029 to <0.001). Associated with SM were a reduced occipital crest and two acute changes in angulation i) 'sphenoid flexure' at the spheno-occipital synchondrosis ii) 'cervical flexure' at the foramen magnum allied with medulla oblongata elevation. Comparing dogs with and without SM, each breed had a unique trait: Chihuahua had a smaller angle between the dens, atlas and basioccipital bone (p value < 0.001); Affenpinschers had a smaller distance from atlas to dens (p value 0.009); CKCS had a shorter distance between the spheno-occipital synchondrosis and atlas (p value 0.007).

Conclusion: The selected morphometries successfully characterised conformational changes in the brain and craniocervical junction that might form the basis of a diagnostic tool for all breeds. The severity of SM involved a spectrum of abnormalities, incurred by changes in both angulation and size that could alter neural parenchyma compliance and/or impede cerebrospinal fluid channels.
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August 2017

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

Ann Med Surg (Lond) 2017 Jan 19;13:24-28. Epub 2016 Dec 19.

Department of Surgery, Dumfries and Galloway Royal Infirmary, Dumfries, UK.

Backround: The 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.

Methods: Retrospective 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.

Results: Five 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.

Conclusion: There 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.
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January 2017

Increasing physical activity in stroke survivors using STARFISH, an interactive mobile phone application: a pilot study.

Top Stroke Rehabil 2016 06 8;23(3):170-7. Epub 2016 Jan 8.

a School of Medicine , University of Glasgow , Glasgow , UK.

Background: Following stroke, people are generally less active and more sedentary which can worsen outcomes. Mobile phone applications (apps) can support change in health behaviors. We developed STARFISH, a mobile phone app-based intervention, which incorporates evidence-based behavior change techniques (feedback, self-monitoring and social support), in which users' physical activity is visualized by fish swimming.

Objective: To evaluate the potential effectiveness of STARFISH in stroke survivors.

Method: Twenty-three people with stroke (12 women; age: 56.0 ± 10.0 years, time since stroke: 4.2 ± 4.0 years) from support groups in Glasgow completed the study. Participants were sequentially allocated in a 2:1 ratio to intervention (n = 15) or control (n = 8) groups. The intervention group followed the STARFISH program for six weeks; the control group received usual care. Outcome measures included physical activity, sedentary time, heart rate, blood pressure, body mass index, Fatigue Severity Scale, Instrumental Activity of Daily Living Scale, Ten-Meter Walk Test, Stroke Specific Quality of Life Scale, and Psychological General Well-Being Index.

Results: The average daily step count increased by 39.3% (4158 to 5791 steps/day) in the intervention group and reduced by 20.2% (3694 to 2947 steps/day) in the control group (p = 0.005 for group-time interaction). Similar patterns of data and group-time interaction were seen for walking time (p = 0.002) and fatigue (p = 0.003). There were no significant group-time interactions for other outcome measures.

Conclusion: Use of STARFISH has the potential to improve physical activity and health outcomes in people after stroke and longer term intervention trials are warranted.
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June 2016

Short-term effect of aerobic exercise on symptoms in multiple sclerosis and chronic fatigue syndrome: a pilot study.

Int J MS Care 2014 ;16(2):76-82

College of Medical, Veterinary and Life Sciences, University of Glasgow, Glasgow, Scotland, UK (YCL, LP, RMM, NGM); Department of Kinesiology and Community Health, University of Illinois at Urbana-Champaign, Urbana, IL, USA (YCL); AKM-STATS, Statistical Consultants, Glasgow, Scotland, UK (AKM); Multiple Sclerosis Service, NHS Ayrshire and Arran, Scotland, UK (PM, LM); and School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK (LM).

Background: This pilot study was conducted to determine whether a 15-minute bout of moderate-intensity aerobic cycling exercise would affect symptoms (pain and fatigue) and function (Timed 25-Foot Walk test [T25FW] and Timed Up and Go test [TUG]) in people with multiple sclerosis (MS) or chronic fatigue syndrome (CFS), and to compare these results with those of a healthy control group.

Methods: Eight people with MS (Expanded Disability Status Scale score 5-6; Karnofsky score 50-80), eight people with CFS (Karnofsky score 50-80), and eight healthy volunteers participated in the study. Pain and fatigue levels and results of the T25FW and TUG were established at baseline as well as at 30 minutes, 2 hours, and 24 hours following a 15-minute stationary cycling aerobic exercise test. Repeated-measures analysis of variance (ANOVA) and covariance (ANCOVA) were used to analyze the findings over time.

Results: At baseline there were statistically significant differences between groups in fatigue (P = .039), T25FW (P = .034), and TUG (P = .010). A significant group/time interaction emerged for fatigue levels (P= .005). We found no significant group/time interaction for pain levels or function.

Conclusions: Undertaking 15 minutes of moderate-intensity aerobic cycling exercise had no significant adverse effects on pain or function in people with MS and CFS (with a Karnofsky score of 50-80) within a 24-hour time period. These initial results suggest that people with MS or CFS may undertake 15 minutes of cycling as moderate aerobic exercise with no expected negative impact on pain or function.
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July 2014

Quantifying severe maternal morbidity in Scotland: a continuous audit since 2003.

Curr Opin Anaesthesiol 2014 Jun;27(3):275-81

aReproductive Health Programme, Healthcare Improvement Scotland, Edinburgh, Scotland bAKM-STAT, Glasgow, Scotland, UK.

Since 2003, a continuous audit of severe maternal morbidity in Scotland has been conducted, collecting data on consistently defined events in all the consultant-led maternity units within Scotland. This review summarizes the methodology of the audit and describes some of the main results accumulated in the 10 years audited [2003-2012 (The 2012 Scottish Confidential Audit of Severe Maternal Morbidity report is yet to be published. This article refers to extracts from 2012 data where available, but on other occasions refers to data from 2003 to 2011.)]. Although most causes of severe maternal morbidity have decreased during the audit, major obstetric haemorrhage, the most common cause of severe maternal morbidity, has increased. Some key findings are as follows: admission to an ICU is required for 1 woman in every 700 births; major obstetric haemorrhage is experienced by 1 in 172 women; cases of eclampsia have decreased during the audit; there were deficiencies in antenatal risk identification and action planning; and the direct involvement of consultant obstetricians and anaesthetists in the care of women was below those recommended by the guidelines. The audit has demonstrated changes in clinical practice and in adherence to clinical guidelines over time. The information has been used to inform clinical practice within the Scottish maternity units.
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June 2014

Quantitative analysis of Chiari-like malformation and syringomyelia in the Griffon Bruxellois dog.

PLoS One 2014 12;9(2):e88120. Epub 2014 Feb 12.

Neurology Department, Fitzpatrick Referrals, Godalming, Surrey, United Kingdom ; School of Veterinary Medicine, Faculty of Health & Medical Sciences, University of Surrey, Guildford, United Kingdom.

This study aimed to develop a system of quantitative analysis of canine Chiari-like malformation and syringomyelia on variable quality MRI. We made a series of measurements from magnetic resonance DICOM images from Griffon Bruxellois dogs with and without Chiari-like malformation and syringomyelia and identified several significant variables. We found that in the Griffon Bruxellois dog, Chiari-like malformation is characterized by an apparent shortening of the entire cranial base and possibly by increased proximity of the atlas to the occiput. As a compensatory change, there appears to be an increased height of the rostral cranial cavity with lengthening of the dorsal cranial vault and considerable reorganization of the brain parenchyma including ventral deviation of the olfactory bulbs and rostral invagination of the cerebellum under the occipital lobes.
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January 2015

Obstacle course: users' maneuverability and movement efficiency when using Otto Bock C-Leg, Otto Bock 3R60, and CaTech SNS prosthetic knee joints.

J Rehabil Res Dev 2012 ;49(4):583-96

Department of Occupational Therapy and Prosthetics and Orthotics, Faculty of Health Sciences, Oslo and Akershus University College of Applied Sciences, Norway.

The performance and movement efficiency of prosthesis users while traversing a multisectional obstacle course (OC) were evaluated using a crossover design with random allocation of three prosthetic knee joints: the SNS (CaTech; Dayton, Ohio) the C-Leg (Otto Bock; Duderstadt, Germany), and the 3R60 (Otto Bock). Twelve users completed the OC twice with each joint, once without and once with a mental loading task (MLT). The performance was objectively assessed using time measurement from digital video recordings, and the Total Heart Beat Index was used to estimate movement efficiency. A 1 mo familiarization period was provided for each knee joint before data collection. It took longer to complete the OC with the 3R60 compared with either the SNS or the C-Leg. No significant time differences were found between the C-Leg and the SNS, but differences between the 3R60 and the SNS (slalom and rock sections) and between the 3R60 and the C-Leg (rock section) were observed. Within the simulated sand section, two participants fell with the C-Leg, one with the 3R60, and none with the SNS. Movement efficiency without MLT was similar between all joints, but with an MLT a significant decrease in movement efficiency was observed with the C-Leg. Previous experience using an SNS had no influence on the results.
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October 2012

Reliability and clinical significance of mobility and balance assessments in multiple sclerosis.

Int J Rehabil Res 2012 Mar;35(1):69-74

College of Medical, Veterinary and Life Sciences, University of Glasgow, UK.

The aim of the study was to establish the test-retest reliability, clinical significance and precision of four mobility and balance measures - the Timed 25-Foot Walk, Six-minute Walk, Timed Up and Go and the Berg Balance Scale - in individuals moderately affected by multiple sclerosis. Twenty four participants with multiple sclerosis (Extended Disability Status Score 5-6.5) were assessed on four measures of mobility and balance. The Timed 25-Foot Walk, Six-minute Walk and Timed Up and Go mobility outcome measures and the Berg Balance Scale were assessed by one assessor one week apart. Intraclass correlation coefficient (ICC) analysis was carried out to determine reliability. Minimal detectable change values were calculated to determine clinical significance; the standard error of each measurement was calculated to assess precision. All four outcome measures were found to be reliable: Timed 25-Foot Walk ICC=0.94, Six-minute Walk Test ICC=0.96, Timed Up and Go ICC=0.97 and Berg Balance Scale ICC=0.96. Minimal detectable change values were as follows: Timed 25-Foot Walk=12.6 s, Six-minute Walk Test=76.2 m, Timed Up and Go=10.6 s and Berg Balance Scale=7 points. Standard errors of measurement were as follows: Timed 25-Foot Walk=4.56 s, Six-minute Walk Test=27.48 m, Timed Up and Go=3.81 s and Berg Balance Scale=3 points. The test-retest reliability of these four outcome measures was found to be good. The calculated clinical significance and precision of these measures highlight the problems of assessing a heterogeneous clinical population.
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March 2012

Salicylate inhibition of acanthamoebal attachment to contact lenses.

Optom Vis Sci 2011 Dec;88(12):1422-32

Department of Civil Engineering, University of Strathclyde, John Anderson Building, 107 Rottenrow G4 0NG, United Kingdom.

Purpose: Sodium salicylate has shown potential as a component of contact lens care solutions designed to reduce Acanthamoebal attachment to contact lenses. This study determined the minimum effective concentration required to significantly reduce amoebal attachment.

Methods: Different concentrations of sodium salicylate (10, 15, and 20 mM) were applied during exposure of unworn or bacterial biofilm-coated hydrogel contact lenses to Acanthamoeba castellanii trophozoites. Salicylate was applied at stage 1 intervention during biofilm formation on lenses, at stage 2 intervention during amoebal exposure, or at both stages.

Results: A significant reduction in amoebal attachment was achieved when 10 mM salicylate was included during stage 1 alone; however, 15 mM was required for stage 2 intervention to significantly reduce attachment to clean or biofilm-coated lenses. For stages 1 and 2 combined intervention, 10 mM sodium salicylate produced a significant reduction in amoebal attachment.

Conclusions: In situ, within a contact lens case, biofilm formation and amoebal attachment would occur concurrently; therefore, stages 1 and 2 intervention would be closest to the real-life situation, thus indicating that 10 mM of salicylate would be an effective minimum concentration for reducing amoebal attachment to hydrogel contact lenses. Inclusion of components in contact lens care solution, such as sodium salicylate, which reduce Acanthamoebal attachment, has the potential to enhance effectiveness, particularly where amoebicidal efficacy may be limited, thus reducing the risk of contact lens-associated Acanthamoebal infection.
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December 2011

The trans-femoral fitting predictor: a functional measure to predict prosthetic fitting in transfemoral amputees--validity and reliability.

Arch Phys Med Rehabil 2011 Aug;92(8):1293-7

National Centre for Prosthetics and Orthotics, University of Strathclyde, 131 St James Road, Glasgow, Scotland, UK.

Objective: To assess the psychometric properties of the Trans-femoral Fitting Predictor (TFP).

Design: Prospective observational study.

Setting: Hospital sites (N=9).

Participants: Transfemoral amputees (N=93).

Intervention: The TFP, a 9-item instrument describing graded tasks, aims to assess the prosthetic potential of transfemoral amputees. The instrument was used in its paper form (N=93) and for a video assessment of a subset of these amputees (n=75).

Main Outcome Measure(s): Reliability and validity of the TFP, both paper and video assessments.

Results: The TFP yielded Cronbach α of .92, and all intraclass correlation coefficients between values were greater than 0.8, with narrow 95% confidence intervals. Factor analysis suggested the TFP had 2 constructs representing more advanced and less advanced tasks. Both discriminant analysis and logistic regression suggested that tasks 7 (stand with early walking aid [EWA] for 30s) and 8 (walk to the end of the parallel bars with the EWA and turn around) were more predictive of whether an amputee will go on to receive a prosthesis.

Conclusion: The TFP is a simple, valid, and reliable measure of prosthetic potential for transfemoral amputees. Video assessment with the TFP was very successful and in the future could be used for both training purposes and to provide expert assessment through telehealth.
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August 2011

A mixed-methods evaluation of the effectiveness of tailored smoking cessation training for healthcare practitioners who work with older people.

Worldviews Evid Based Nurs 2011 Sep 7;8(3):177-86. Epub 2011 Jun 7.

Reader, Institute for Applied Health Research/School of Health, Glasgow, United Kingdom.

Background: Older people who smoke derive significant health benefits from stopping smoking in later life. Healthcare practitioners have an important role to play in raising the issue of smoking cessation with this client group; however, they often fail to do so.

Aim: To assess the effectiveness of smoking cessation training for healthcare practitioners who have regular contact with older adults.

Methods: Mixed-methods were used to explore satisfaction with the training, the participants' learning and any resultant changes in behaviour. The effectiveness of the training was assessed using a two-group parallel design randomised controlled trial, followed by semistructured qualitative interviews. Participants (n = 57) were recruited from a cohort of community nurses and allied health professionals (e.g., occupational therapists) working in Scotland. The intervention was 1-day brief intervention smoking cessation training. Validated measures of knowledge, attitudes and practice, were used to assess learning and behaviour at baseline, 1 week and 3 months post training. Data were analysed using two-factor repeated measure analysis of variance, where the factors were "group" and "time." Qualitative data were gathered from members of the intervention group during semistructured interviews (n = 8) and were analysed thematically.

Results/findings: Levels of satisfaction with the training were high. There was a statistically significant improvement in the knowledge and attitudes of the intervention group following the training, with a noticeable, but nonsignificant, improvement in practice. The qualitative findings demonstrate how the training impacted positively on practice.

Conclusions: Smoking cessation interventions in later life are important, as older smokers generally have long-term conditions caused or complicated by smoking. The delivery of brief smoking cessation interventions is known to be highly cost-effective; however, research demonstrates that practitioners often fail to raise the issue of smoking cessation with older adults. This study has demonstrated the effectiveness of a 1-day training course for practitioners. Further research is recommended.
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September 2011

Physical activity and quality of life: A study of a lower-limb amputee population.

Prosthet Orthot Int 2008 Jun;32(2):186-200

University of Strathclyde, Glasgow, UK.

This cross-sectional descriptive study was initiated to investigate the relationship between physical activity and perceived quality of life in a lower-limb amputee population. The objective was to show which aspects of physical activity were most strongly linked to quality-of-life factors in this special patient group. The outcome measurements were two questionnaires: a section of the Trinity Amputation and Prosthetic Experience Scales (TAPES) and the World Health Organization Quality-of-Life Scale (WHOQOL-Bref). The former measures activity restriction and has Athletic, Functional, and Social subscales. The latter includes Physical, Psychological, Social, and Environmental domains, and measures the individual's perception of their quality of life. The two questionnaires were sent by post to 75 male and female participants with either trans-tibial or trans-femoral amputation who were receiving prosthetic care from a Glasgow-based rehabilitation and mobility centre and who met the inclusion criteria. All participants were over 18 years of age (mean age 66 years). In total, 25 participants returned the questionnaires-a response rate of 33%. According to analysis, 8 of the 12 relationships found were statistically significant. There was a very strong correlation between scores on the social elements of each questionnaire. The correlations between scores on the functional and athletic elements of the TAPES questionnaire and scores on the social element of the WHOQOL-Bref questionnaire were less strong. Our findings support the need for greater acknowledgement by healthcare professionals involved in the care of those with amputation about the importance of the patient's social relationships with friends and family. Education about the importance of increasing and maintaining a level of physical activity conducive to health benefits should be implemented within a supportive sociable environment for the patient with lower-limb amputation.
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June 2008

The effect of brief interventions on alcohol consumption among heavy drinkers in a general hospital setting.

Addiction 2007 Nov 3;102(11):1762-70. Epub 2007 Sep 3.

School of Nursing, University of Nottingham, Nottingham, UK.

Aims: (i) To evaluate the effect of receiving one of two brief interventions in reducing alcohol consumption among general hospital patients compared with usual care. (ii) To assess whether a brief intervention of self-efficacy enhancement was superior to a self-help booklet in reducing alcohol consumption.

Design: A three-arm cluster randomized controlled trial.

Setting: Seven general medical, six general surgical, one dermatology and two otolaryngology wards of a large teaching hospital covering a large urban and rural area.

Participants: A total of 215 of 789 in-patients aged 18-75 years, who screened positive for alcohol consumption in excess of national recommended limits according to a 7-day retrospective drinking diary.

Interventions: Participants were allocated to receive one of three interventions: (i) face-to-face self-efficacy enhancement; (ii) a self-help booklet; or (iii) usual care.

Measurements: The primary outcome measure was change in reported alcohol consumption at 6-month follow-up as measured by a 7-day retrospective drinking diary. Secondary outcomes were change in: number of alcohol drinking days in last week; the maximum units of alcohol consumed on any one day in last week; and Drinking Refusal Self-efficacy Expectancy Questionnaire score.

Findings: Compared to the usual care group the self-efficacy enhancement group (-10.1 units 95% CI -16.1 to -4.1) and the self-help booklet group (-10.0 units 95% CI -16.0 to -3.9) had greater reductions in self-reported weekly alcohol consumption. There was no evidence that self-efficacy enhancement was superior to the self-help booklet (P = 0.96).

Conclusions: Brief interventions delivered in hospital offer simple means of helping heavy drinkers to reduce their alcohol consumption.
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November 2007

Attachment of Acanthamoeba to first- and second-generation silicone hydrogel contact lenses.

Ophthalmology 2006 Jan 19;113(1):117-25. Epub 2005 Dec 19.

Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.

Purpose: To investigate the attachment of Acanthamoeba to first- and second-generation silicone hydrogel contact lenses, and to determine if patient wear or the presence of a bacterial biofilm coating affects attachment characteristics.

Design: Experimental study.

Participants And Controls: Attachment to the silicone hydrogel lenses was compared with that to a conventional hydrogel control lens. Sixteen replicates (n = 16) were carried out for unworn, worn, and biofilm-coated lenses of each type.

Methods: Unworn, worn, and Pseudomonas aeruginosa biofilm-coated first-generation (lotrafilcon A) and second-generation (galyfilcon A) silicone hydrogel and conventional hydrogel (etafilcon A) lens quarters were incubated for 90 minutes in suspensions of plate-cultured Acanthamoeba castellanii trophozoites.

Main Outcome Measures: Trophozoites attached to one surface of each lens quarter were counted by direct light microscopy. Logarithmic transformation of data allowed the use of parametric analysis of variance for statistical analysis.

Results: Attachment of Acanthamoeba was affected significantly by lens material type (P<0.001), with higher numbers of trophozoites attaching to the first-generation lotrafilcon A silicone hydrogel lens, compared with the second-generation galyfilcon A lens and the conventional hydrogel lens. Attachments to the latter 2 lenses did not differ significantly from each other (P = 0.126). Patient wear and the presence of a bacterial biofilm had no significant effect on attachment to the lotrafilcon A lens (P = 0.426) but did significantly increase attachment to the galyfilcon A (P<0.001) and the etafilcon A (P = 0.009) lenses; attachment to the latter 2 lenses was still significantly less than that found with the first-generation silicone hydrogel (P<0.001).

Conclusions: Acanthamoeba demonstrated a significantly greater affinity for the first-generation silicone hydrogel lens as compared with the second-generation silicone hydrogel and the conventional hydrogel. If exposed to Acanthamoeba (e.g., when showering or swimming, through noncontinuous wear and ineffective lens care regimes), first-generation silicone hydrogel lenses may promote a greater risk of Acanthamoeba infection due to the enhanced attachment characteristics of this lens material. However, prospective studies in patients are required to determine if these experimental results are clinically significant.
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January 2006

The effects of progressive resistance training for children with cerebral palsy.

Clin Rehabil 2005 May;19(3):283-9

Yorkhill NHS Trust, Glasgow, UK.

Objectives: To investigate the effects of progressive resistance training of quadriceps and hamstrings muscles in children with cerebral palsy (CP).

Design: Pilot study using a repeated measures design with measurements at baseline, immediately after six weeks training then at four-week follow-up.

Setting: The project was undertaken within the physiotherapy department of two special schools in Glasgow.

Subjects: A convenience sample of eight children aged between six and 12 years, with hypertonic CP.

Intervention: The subjects participated three times per week in a six-week, progressive, free-weight, strengthening programme.

Outcome Measures: Maximum isometric muscle strength and resistance to passive stretch were measured with a hand-held myometer. The Gross Motor Function Measure and a 10-metre timed walking test, were used to assess function and gait parameters respectively.

Results: Muscle strength increased, with the quadriceps to hamstrings strength ratio moving towards normal. These changes were retained at follow-up. Muscle tone decreased and continued to decrease to follow-up. The standing (D) and walking, running and jumping (E) goal areas of the Gross Motor Function Measure showed improvement that continued towards follow-up. Walking speed and step rate increased.

Conclusions: A future large-scale randomized controlled study would be of value to substantiate these results as the small convenience sample and lack of control group limit this study. However, the finding that no adverse effect accompanied the positive outcomes in strength and function may encourage clinicians to consider resistance training alongside standard therapeutic interventions.
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May 2005

Determination of amoebicidal activities of multipurpose contact lens solutions by using a most probable number enumeration technique.

J Clin Microbiol 2003 Jul;41(7):2992-3000

Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, United Kingdom.

Six multipurpose contact lens solutions [All-in-One, All-in-One (Light), ReNu MultiPlus, Optifree Express, Complete, and Solo-care soft] were tested for their efficacies against Acanthamoeba castellanii trophozoites and cysts by using a most probable number (MPN) technique for amoebic enumeration. Against trophozoites, All-in-One, ReNu Multiplus, and Optifree Express achieved total kill (log reduction of >3) after the manufacturer's minimum recommended disinfection time (MMRDT), with the remaining solutions failing to reach a log reduction of 1. After 24 h of exposure, all solutions proved trophozoiticidal, achieving, with the exception of Complete (log reduction of 3.13), total kill. Against cysts, All-in-One gave a log reduction of >3 within the MMRDT, with all other solutions failing to achieve a log reduction of 1. After 24 h of exposure, All-in-One achieved total kill of cysts (log reduction of 3.74), ReNu MultiPlus gave a log reduction of 3.15, and the remaining solutions reached log reductions of between 1.09 and 2.27. The MPN technique provides a simple, reliable, and reproducible method of amoebic enumeration that depends on simply establishing the presence or absence of growth on culture plates inoculated with a series of dilutions and determining the MPN of amoebae present from statistical tables. By use of this technique, two of the multipurpose solutions tested, ReNu MultiPlus and Optifree Express, demonstrated effective trophozoiticidal activities within the recommended disinfection times; however, only All-in-One proved effective against both trophozoites and cysts over the same time period. This MPN technique, which uses axenically produced trophozoites and mature, double-walled cysts, has the potential to form the basis of a national standard for amoebicidal efficacy testing of multipurpose contact lens disinfecting solutions.
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July 2003

Enhanced attachment of acanthamoeba to extended-wear silicone hydrogel contact lenses: a new risk factor for infection?

Ophthalmology 2003 Apr;110(4):765-71

Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK.

Purpose: To establish if silicone hydrogel (S-H) contact lenses could be a risk factor for Acanthamoeba infection by facilitating the attachment of trophozoites to their surface and transfer to the cornea and to determine the effect Acanthamoeba culture technique, patient wear, and Pseudomonas biofilm coating have on attachment to the S-H lens.

Design: Experimental material study.

Participants And Controls: Attachment to a S-H lens was compared with that of a conventional hydrogel control lens. Sixteen replicates were carried out for both lens types under each test condition.

Methods: Unworn S-H (PureVision; Bausch & Lomb, Kingston-Upon-Thames UK) and conventional hydrogel (Acuvue; Vistakon, Johnson & Johnson, Jacksonville, FL USA) lens quarters were incubated for 90 minutes in suspensions of liquid or plate-cultured Acanthamoeba castellanii trophozoites. Unworn, worn, and Pseudomonas biofilm coated S-H and hydrogel quarters were incubated for 90 minutes with plate-cultured trophozoites.

Main Outcome Measures: Trophozoites attached to one surface of each lens quarter were counted by direct light microscopy. Logarithmic transformation of data allowed the use of a parametric analysis of variance.

Results: Lens polymer had a significant effect on attachment (P < 0.001), with higher numbers of trophozoites attaching to the S-H lens. Culture technique also had a significant effect on attachment (P = 0.013), with higher numbers of liquid-cultured organisms attaching to both lens types. A significant increase in attachment was demonstrated with worn and Pseudomonas biofilm-coated hydrogel lenses (P < 0.001); however, this difference was not seen with the S-H lens.

Conclusions: Acanthamoebal attachment to the S-H lenses was significantly greater than to the conventional hydrogel. Liquid-cultured trophozoites demonstrated a higher affinity for the lenses tested. Wear and bacterial biofilm coating had no effect on attachment to S-H lenses. The increased attachment found with the S-H lens may be an inherent characteristic of the polymer or a side effect of the surface treatment procedure to which the lenses are exposed. It is possible that S-H lenses are at greater risk of promoting Acanthamoeba infection if exposed to the organism because of the enhanced attachment characteristic of this new material.
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April 2003

Tear production measurement, basal or reflex assessment?

Adv Exp Med Biol 2002 ;506(Pt B):1159-63

Department of Vision Sciences, Glasgow Caledonian University, Glasgow, Scotland.

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May 2003